GI Malginancy

Question 1

what pre-malignant change predisposes to oesophageal cancer

Answer 1

Barrets oesophagus

Question 2

what is Barrets oesophagus

Answer 2

constant reflux causes change of squamous epithelium to columnar epithelium
- premalignant

Question 3

Types of oesophageal cancer

Answer 3

squamous cell (upper 2/3rds)
adenocarcinoma (lower 1/3rd)

Question 4

Barrets oesophagus predisposes to which type of cancer

Answer 4

adenocarcinoma

Question 5

risk factors for oesophageal cancer

Answer 5

smoking
GORD
Barrets oesophagus
alcohol 
achalasia

Question 6

most common presenting symptom of oesophageal cancer

Answer 6

dysphagia

Question 7

investigation of oesophageal cancer

Answer 7

upper GI endoscopy

Question 8

management of oesophageal cancer

Answer 8

Ivor-Lewis oesophagectomy if appropriate

chemotherapy

Question 9

signet ring cells are associated with what cancer

Answer 9

gastric cancer

Question 10

virchows node indicates what type of cancer

Answer 10

gastric cancer

Question 11

presentation of gastric cancer

Answer 11

dyspepsia
nausea, vomiting
anorexia, weight loss
dysphagia

Question 12

investigation of gastric cancer

Answer 12

endoscopy + biopsy

Question 13

treatment of gastric cancer

Answer 13

sub total gastrectomy if 5-10cm from OG junction

total gastrectomy if <5cm from OG junction

Question 14

symptoms of colorectal cancer

Answer 14

change in bowel habit -- more frequent + loose
weight loss
PR bleeding
tenesmus
iron deficiency anaemia

Question 15

genetic conditions that increase risk of colorectal cancer

Answer 15

familial adenomatous polyposis syndrome (FAP)

hereditary non-polyposis colon cancer (HNPCC)

Question 16

How are FAP and HNPCC inherited

Answer 16

autosomal dominant

Question 17

gene affected in FAP

Answer 17

APC gene chromosome 5

Question 18

gene affected HNPCC

Answer 18

MSH2

Question 19

Screening offered for colorectal cancer

Answer 19

faecal immunochemical testing (FIT)
- sent through post and sample tested for blood
given every 2 years to adults 50-74 years old

Question 20

investigation for colorectal cancer

Answer 20

colonoscopy

Question 21

tumour marker in colorectal cancer

Answer 21

CEA

Question 22

staging system for colorectal cancer

Answer 22

Dukes Classification 
A - confined to bowel wall
B - extending through muscle of bowel wall
C - lymph node involvement 
D- metastatic disease

Question 23

right hemicolectomy

Answer 23

removal of tumours in caecum, ascending colon and proximal transverse colon

Question 24

left hemicolectomy

Answer 24

removal of tumours of distal transverse colon and descending colon

Question 25

sigmoid colectomy

Answer 25

removal of tumours of sigmoid colon

Question 26

anterior resection

Answer 26

removal of tumours of high rectum

Question 27

abdominoperitoneal resection

Answer 27

removal of rectum + anus | - permanent colostomy

Question 28

types of liver cancer

Answer 28

``` hepatocellular carcinoma (80%) cholangiocarcinoma (20%) ```

Question 29

main risk factor for hepatocellular carcinoma

Answer 29

liver cirrhosis

Question 30

causes of liver cirrhosis that predispose to hepatocellular carcinoma

Answer 30

hep B + C alcohol non-alcoholic fatty liver disease

Question 31

what condition is linked to cholangiocarcinoma

Answer 31

primary sclerosing cholangitis | - RUQ pain, jaundice, fatigue

Question 32

tumour marker for hepatocellular carcinoma

Answer 32

alpha feto protein (AFP)

Question 33

presentation of hepatocellular carcinoma

Answer 33

``` RUQ pain jaundice ascites pruritis hepatomegaly weight loss ```

Question 34

presentation of cholangiocarcinoma

Answer 34

painless jaundice (same as pancreatic cancer)

Question 35

investigation of hepatocellular carcinoma

Answer 35

USS + AFP blood test

Question 36

treatment of hepatocellular carcinoma

Answer 36

resection of area of liver in early disease transplant if confined to liver kinase inhibitors to extend life e.g. sorafenib

Question 37

what virus are oropharyngeal cancers linked to

Answer 37

HPV