Lecture 16-GI Malignancy Flashcards by Vibha Shaji

What are the differentials for dysphagia?

extraluminal: compression of another structure on the oesophagus
luminal: wall integrity problems
intraluminal: foreign body
malignancy: SSC, adenocarcinomas

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What are the red flags of dysphagia? HINT: alarm

Anaemia
Loss of weight
Anorexia
Recent onset of progressive symptoms
Masses/Melaena

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What type of carcinoma can develop in the:

1) oesophagus
2) rest of GI tract

1) squamous cell carcinoma (SCC)

2) adenocarcinoma

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Why can the lower 1/3 of the oesophagus develop adenocarcinoma?

If Barrett’s oesophagus has occured

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What are the risk factors for oesophageal carcinomas?

Smoking, obesity, Barrett’s

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What are the red flags for epigastric pain?

melaena

- haematemesis

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What are the commonest causes of epigastric pain?

oesophageal varices
gastric or duodenal ulcers
acute gastritis

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Where does gastric cancer commonly present?

Cardia or antrum

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What are the risk factors for gastric cancer?

Smoking, high salt diet, family history, chronic inflammation

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What is gastric lymphoma?

Affects MALT tissue, presents like gastric cancer

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How can gastric cancer be treated?

Commonly associated with H. Pylori so treat this condition and the cancer should regress

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What are GI stromal tumours?

Sarcomas (not epithelium)

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What are the differentials for jaundice?

pre-hepatic
hepatic
post-hepatic

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What are the red flags for jaundice?

hepatomegaly
ascites
painless (painful more likely to be inflammation or infection)
unintentional weight loss

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How does pancreatic cancer present?

if in head: painless jaundice

- if in body/tail: vaguer symptoms of abdo pain

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What are the risk factors for pancreatic cancer?

Family history, smoking, men > women, chronic pancreatitis

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True or false: primary malignancy in the liver is common

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FALSE - rare

Why are metastases common in the liver?

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Portal system drains all of the GI tract so any malignant cells in the GI organs will go to the liver

Which other cancers metastasise to the liver?

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Breast, prostate

What are the symptoms of obstruction?

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Abdo distension, pain, constipation, nausea and vomiting

What are the red flags for obstruction?

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unexplained abdo pain

- unintentional weight loss

What are the differentials of obstruction?

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benign: diverticular disease, volvulus, hernias

- malignant: adenocarcinoma of LI, SI cancer

What are the symptoms of per rectum bleeding?

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Fresh bright red bleeding, melaena, anal pain, tenesmus

What is tenesmus?

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Feeling of incomplete emptying of the bowel

What are the red flags for per rectum bleeding?

- iron deficient anaemia - unexplained weight loss - age dependent - change in bowel habit

What are the differentials of per rectum bleeding?

- benign: haemorrhoids, anal fissures, infective gastroenteritis, IBD, diverticular disease - malignant: adenocarcinoma of LI, SI cancer

What are the symptoms of change in bowel habit?

- change in frequency - change in consistency - bloating - abdo discomfort

What are the red flags for change in bowel habit?

- iron deficient anaemia - unexplained weight loss - age dependent - PR blood loss

What are the differentials of change in bowel habit?

- benign: thyroid disorder (underactive -> constipation and vice versa), IBD, medication related (metformin -> runny, opiods -> constipation), IBS, coeliac disease - malignant: adenocarcinoma of LI, SI cancer

Which cancer is the 3rd commonest in the UK?

Large bowel adenocarcinoma

What are the risk factors of large bowel cancer?

Family history, IBD, FAP, diet

At what age are people screened for large bowel cancer and how often?

60-74 y/o | Every 2 years

How can polyps cause adenocarcinoma?

-benign growth from genetic changes -> abnormal differentiation -> dysplastic cells -> carcinoma

True or false: left sided colon cancer is more common than right side

TRUE

What are the symptoms of left sided colon cancer?

Overflow diarrhoea, weight loss, abdo pain, rectal bleeding, bowel obstruction, tenesmus

What are the symptoms of right sided colon cancer?

Weight loss, anaemia, RIF mass

What are the five types of small bowel cancer?

- stromal - lymphoma - adenocarcinoma - sarcoma - carcinoid tumours

What are the risk factors for small bowel cancer?

IBD, coeliac disease, FAP, diet, any chronic inflammatory process

What are the symptoms of small bowel cancer?

Weight loss, abdo pain, blood in stools

Which tumour marker can indicate GI malignancy (adenocarcinoma)?

CEA = carcinoembryonic antigen

What are the treatment options for GI malignancy?

Chemo, radiotherapy, surgical resections

Lecture 16-GI Malignancy Flashcards

(41 cards)