GI Cancers

Question 1

define cancer

Answer 1

term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems

Question 2

define primary cancer

Answer 2

Arising directly from the cells in an organ

Question 3

define secondary/metastatic cancer

Answer 3

Spread from another organ, directly or by other means (blood or lymph)

Question 4

hallmarks of cancer

Answer 4

resisting cell death
inducing angiogenesis
enabling replicative immortality
activating invasion and metastasis
evading growth suppressors
sustaining proliferative signalling

Question 5

what four things underlie the hallmarks of cancer?

Answer 5

enabling characteristics: genome instability and mutation, tumor-promoting inflammation
emerging hallmarks: deregulating cellular energetics, avoiding immune destruction

Question 6

cancer of squamous epithelium is called?

Answer 6

squamous cell carcinoma

Question 7

cancer of glandular epithelium is called?

Answer 7

adenocarcinoma

Question 8

cancer of enteroendocrine cells is called?

Answer 8

neuroendocrine tumours

Question 9

cancer of interstitial cells of Cajal is called?

Answer 9

gastrointestinal stromal tumours

Question 10

cancer of smooth muscle is called?

Answer 10

leiomyoma/leiomyosarcomas

Question 11

cancer of adipose tissue is called?

Answer 11

liposarcomas

Question 12

what diseases are suitable for screening? Wilson & Jungner criteria

Answer 12

important health problem
should be accepted treatment
available facilities for diagnosis and treatment
recognizable latent / early symptomatic stage
suitable test/exam
test should be acceptable to population
development of disease should be adequately understood

Question 13

list GI cancers that are screened for

Answer 13

colorectal
oesophageal
pancreatic + gastric
hepatocellular

Question 14

screening for colorectal cancer

Answer 14

Offered to healthy individuals:
Faecal immunochemical test (FIT) - detects haemoglobin in faeces, every 2 years for everyone aged 60-74
One-off sigmoidoscopy for everyone aged >55 to remove polyps (reducing future risk of cancer)

Question 15

screening for oesophageal cancer

Answer 15

Regular endoscopy to patients with:
Barrett’s oesophagus
Low- or high-grade dysplasia

Question 16

screening for hepatocellular cancer

Answer 16

Regular ultrasound & AFP for high-risk individuals with cirrhosis
Viral hepatitis
Alcoholic hepatitis

Question 17

patient’s cancer journey

Answer 17

signs and symptoms > diagnosis > staging > surgically removed?/systemic therapy (chemo)/radiotherapy

Question 18

GI cancer MDT is made up of?

Answer 18

pathologist
cancer nurse specialist
surgeon
radiologist
palliative care
gastroenterologist
oncologist

Question 19

role of pathologist in GI cancer MDT

Answer 19

confirms cancer diagnosis using biopsy samples
provides histologic typing
provides molecular typing
provides tumour grade

Question 20

role of radiologist in GI cancer MDT

Answer 20

reviews scans
provides radiological tumour stage
provides restaging after treatment
interventional radiology

Question 21

role of surgeon in GI cancer MDT

Answer 21

decides whether surgery is appropriate

performs operation & cares for patient in perioperative period

Question 22

role of gastroenterologist in GI cancer MDT

Answer 22

endoscopy - diagnostic and therapeutic

stents and biopsies

Question 23

role of oncologist in GI cancer MDT

Answer 23

Decides on whether chemotherapy, radiotherapy or other systemic therapy is appropriate
Coordinates the overall treatment plan
Should chemotherapy come before surgery (neoadjuvant) or after (adjuvant)?

Question 24

purpose of MDT in cancer care

Answer 24

MDT decides whether plan should be for radical (curative) or palliative therapy or palliative care

Question 25

what is the major driver of gastric adenocarcinoma?

Answer 25

chronic gastritis

Question 26

causes of gastric adenocarcinoma

Answer 26

``` H.pylori infection pernicious anaemia partial gastrectomy epstein-barr virus infection heritable diffuse type gastric cancer ```

Question 27

how does H.pylori infection lead to gastric cancer?

Answer 27

chronic acid overproduction

Question 28

how does pernicious anaemia lead to gastric cancer?

Answer 28

autoantibodies against parts & products of parietal cells

Question 29

how does partial gastrectomy lead to gastric cancer?

Answer 29

leading to bile reflux

Question 30

what mutations in heritable diffuse type gastric cancer?

Answer 30

E-cadherin mutations

Question 31

pathogenesis of gastric cancer

Answer 31

chronic gastritis > intestinal metaplasia > dysplasia > malignancy

Question 32

what is the commonest symptom of GI cancer?

Answer 32

dyspepsia

Question 33

red flag symptoms for GI cancers

Answer 33

``` anaemia loss of weight/appetite abdominal mass on examination recent onset of progressive symptoms melaena or haematemesis swallowing difficulty 55 years of age or above ```

Question 34

diagnosis of GI cancer

Answer 34

similar to oesophageal cancer: endoscopy + biopsy

Question 35

staging of GI cancer

Answer 35

CT of the chest, abdomen & pelvis will provide information on distant lesions PET-CT Diagnostic laparoscopy - peritoneal & liver metastases disease prior to full operation Endoscopic ultrasound - will give most detail about local invasion & node involvement

Question 36

treatment options for gastric cancer

Answer 36

oesophago-gastrectomy total gastrectomy subtotal gastrectomy neoadjuvant/adjuvant chemotherapy

Question 37

neuroendocrine tumours arise from?

Answer 37

Arise from the gastroenteropancreatic (GEP) tract (or bronchopulmonary system)

Question 38

neuroendocrine tumours are associated with _________ in 25% and are __________ in 75%

Answer 38

genetic syndrome | sporadic

Question 39

presentation of neuroendocrine tumours

Answer 39

most are asymptomatic and incidental abnormal hormonal secretion carcinoid syndrome

Question 40

carcinoid syndrome

Answer 40

``` Vasodilatation Bronchoconstriction ^ intestinal motility Endocardial fibrosis (PR & TR) ```

Question 41

clinical features of insulinoma

Answer 41

hypoglycaemia | Whipple's triad

Question 42

clinical features of glucagonoma

Answer 42

diabetes mellitus | necrolytic migratory erythema

Question 43

clinical features of gastrinoma

Answer 43

Zollingere-Ellison

Question 44

clinical features of VIPoma

Answer 44

Verner-Morrison syndrome | watery diarrhoea

Question 45

clinical features of somatostatinoma

Answer 45

gallstones diabetes mellitus steatorrhoea

Question 46

diagnosis of neuroendocrine tumours - biochemical assessment

Answer 46

Chromogranin A is a secretory product of NETs Other gut hormones: insulin, gastrin, somatostatin, PPY Measured in fasting state Other screening: Calcium, PTH, prolactin, GH 24 hr urinary 5-HIAA (serotonin metabolite)

Question 47

diagnosis of neuroendocrine tumours - imaging

Answer 47

``` Cross-sectional imaging (CT and/or MRI) Bowel imaging (endoscopy, barium follow through, capsule endoscopy) Endoscopic ultrasound Somatostatin receptor scintigraphy 68Ga-DOTATATE PET/CT most sensitive ```

Question 48

why is tumour grade useful?

Answer 48

provides valuable prognostic information | influences management

Question 49

treatment modalities for NETs

Answer 49

curative resection cytoreductive resection liver transplantation