Malignancy And Imaging Flashcards
1
Q
What percentage of all cancers in the UK does oesophageal make up?
A
2%
2
Q
Is oesophageal cancer more common in males or females?
A
Males
3
Q
Name some symptoms/features of oesophageal cancer
A
Dysphagia
Progressively worsening
Weight loss
4
Q
What investigations are necessary with oesophageal cancer?
A
Endoscopy
Biopsy
5
Q
What is the most common type of oesophageal cancer?
A
Squamous cell carcinoma
6
Q
Where in the oesophagus can squamous cell carcinoma occur?
A
Anywhere
7
Q
Where are adenocarcinomas in the oesophagus occur?
A
Lower third
8
Q
Give some causes of squamous cell carcinoma of the oesophagus
A
HPV Tannin Vit A deficiency Riboflavin deficiency (Presumed progression through dysplasia)
9
Q
What is the prognosis of oesophageal cancer?
A
Poor
At presentation most are advanced
Direct spread though wall
10
Q
What percentage of oesophageal carcinomas are resectable on presentation?
A
40%
11
Q
What is the 5 year survival rate for oesophageal carcinoma?
A
5%
12
Q
What is the 5 year survival of gastric cancer?
A
< 20%
13
Q
Is gastric cancer more common in men or women?
A
Men
14
Q
What can gastric cancer be associated with?
A
Gastritis
15
Q
Which blood group seems to get more gastric cancer?
A
A
16
Q
What are the clinical features of gastric cancer?
A
Often vague
Epigastric pain
Vomiting
Weight loss
17
Q
What investigations are needed for gastric cancer?
A
Endoscopy
Biopsy
18
Q
What are the different macroscopic types of gastric cancer?
A
Fungating
Ulceration
Infiltrative
Early
19
Q
Describe intestinal gastric cancer
A
Microscopic features
Variable degree of gland formation
20
Q
Describe diffuse gastric cancer
A
Microscopic features
Single cell and small groups
Signet ring cells and full of mucin
21
Q
Describe early gastric cancer
A
Confined to mucosa/sub-mucosa
Good prognosis
22
Q
What is the 5 year survival of advanced gastric cancer?
A
10%
23
Q
How can gastric cancer spread?
A
Direct (through gastric wall)
Lymph nodes
Liver
Transcoelomic - to peritoneum or ovaries
24
Q
Describe Virchow’s nodes
A
Enlarged supraclavicular lymph nodes on same side as gastric cancer
25
What are the treatment options for gastric cancer?
Surgery
Chemotherapy (sometimes radiotherapy)
Herceptin - palliative
26
How come we can use Herceptin for some gastric cancers?
The same genetic abnormality is present in 10% of gastric cancers as is present in breast cancer
Amplification of HER-2 oncogene
27
What is the most common GI lymphoma?
Gastric lymphoma
28
What is gastric lymphoma strongly associated with?
H pylori infection
29
Is the prognosis for gastric lymphoma better or worse than gastric carcinoma?
Much better
30
Where do GI stromal tumour come from?
Derived from interstitial cells of Cajal
(Pacemakers cells for peristalsis)
Uncommon
31
What is the targeted treatment for GI stromal tumours and which other cancer do we use this treatment for?
Imatinib
| Chronic myeloid leukaemia
32
Why are GI stromal tumours difficult to treat?
Unpredictable behaviour
33
What are the most common tumours of the large intestine?
Adenomas
| Adenocarcinomas
34
Name the 4 different types of tumours of the large intestine
Adenoma
Adenocarcinomas
Polyps
Anal carcinoma
35
What is the difference between sessile or pedunculated adenomas?
Sessile - stalk
| Pendunculated - no stalk
36
As age increases, incidence of adenomas ...
Increases
37
Is the patient still at higher risk of cancer, even when adenomas are removed?
Yes
| Large intestine will have a higher risk of cancer
38
Describe familial adenomatous polyposis
Autosomal dominant
Each mutation in families is slightly different
Will have thousands of adenomas by 20 years old
High risk of cancer
39
What is the common treatment for FAP?
Prophylactic colectomy
40
What is Gardner's syndrome?
Similar to FAP
| But also get bone and soft tissue tumours
41
What are synchronous lesions?
Lesions that develop at the same time in different places
42
What are metachronous lesions?
Lesions appearing at different times
43
What metabolic abnormality might people with adenomas present with?
Hypokalaemia
| Adenomas can secrete lots of liquid rich in K+
44
What percentage of colorectal adenocarcinomas are rectosigmoid?
60-70%
45
What are the 2 types of adenocarcinoma and where do they commonly occur?
Fungating - right side
| Stenotic - left side
46
How can colorectal adenocarcinomas spread?
Direct through bowel wall
Via lymphatics
Via portal venous system
47
Describe Dukes' staging
Of colorectal adenocarcinomas
A = confined to bowel wall
B = through wall, lymph nodes clear
C = lymph nodes involved
48
What is the different between C1 and C2 in Dukes' staging?
```
C1 = highest lymph node biopsied is clear
C2 = highest lymph node biopsied is involved
```
49
What genetic abnormalities increase the risk of colorectal adenocarcinoma?
FAP
Ras mutations
DCC deletion
P53 loss/inactivation
50
How does cetuximab work for bowel cancer?
Molecular therapy
Targets to RAS signalling pathway
Cannot use if they have a RAS mutation
51
What is the most common age for bowel cancer?
60-70s
52
What diseases is bowel cancer linked to?
Polyposis
UC
Crohn's
53
Give some causes of bowel cancer
Low fibre diet
Slow transit time
High fat intake
Genetic predisposition
54
Describe carcinoid tumours
Rare endocrine tumour
| Difficult to predict behaviour
55
Why are pancreatic carcinomas difficult to diagnose?
Early symptoms are vague
| Malaise, epigastric pain
56
What symptoms/signs occur for pancreatic cancer?
```
Epigastric pain
Malaise
Weight loss
Jaundice
Trousseau's sign - thrombophlebitis
```
57
How do we diagnose pancreatic cancers?
Via imaging
| Biopsies are very difficult to do for the pancreas
58
What proportion of pancreatic cancers occur in the head?
2/3
59
Describe the morphology of pancreatic cancers
Firm, pale mass
Necrotic, haemorrhagic, cystic
May infiltrate adjacent structures eg. Spleen
60
What type of cancer is most common in the pancreas?
Ductal adenocarcinomas
| 80%
61
What is the histology of ductal adenocarcinomas?
Well formed glands
| Mucin
62
How might an insulinoma present?
Hypoglycaemia from too much insulin
63
What is the classic sign of a glucagonoma?
Characteristic skin rash
64
What are the commonest tumours of the liver?
Metastases
65
Name some benign tumours of the liver
Hepatic adenoma
Bile duct adenoma
Haemangioma
66
Name some malignant tumours of the liver
Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
67
What 2 conditions is hepatocellular carcinoma associated with?
Cirrhosis
| Viral hepatitis
68
What is the radiation dose of USS and MRI?
None
69
What is the radiation dose of any abdominal xray?
1 mSv
70
What is the radiation dose of an abdo CT?
15 mSv
71
What is the background radiation of the UK per year?
1 - 3 mSv
72
What are the risks of radiation exposure?
Carcinogenesis
Genetic changes
Development problems in foetus
73
Why would you request an abdominal x-ray?
Acute abdominal pain
Small/large bowel obstruction suspected
Acute exacerbation of IBD
74
When is a hollow tube visible and not visible on an xray?
Visible = gas or gas and fluid filled
| Not visible = fully fluid filled
75
Why is the small intestine difficult to see?
Fast transit time therefore more fluid filled
76
What are valvulae conniventes?
Bands that cross the entire wall of the small intestine
| Thin
77
How can we tell if the intestine you are looking at on xray is large bowel?
Peripheral position
Haustra
Faeces and gas (slower transit)
78
Where can the transverse colon hang down to?
Pelvis
79
A small bowel obstruction has to be wider than ...
> 3 cm
80
A large bowel obstruction has to be wider than ...
> 6 cm
81
Why can a competent ileocaecal valve become a problem?
Large bowel obstruction can cause increased pressure
Keeps building up against valve
Causes perforation
82
What is the height of a vertebral body in a full grown adult?
3 cm
83
What is the most common cause of small bowel obstruction?
Adhesions
| Esp post operative
84
Describe the presentation of small bowel obstruction
Vomiting (early)
Mild distension
Absolute constipation (late)
Colicky pain
85
Give some causes of small bowel obstruction
Adhesions
Hernias (esp inguinal)
Tumours
Inflammation
86
Large bowel obstruction is caused by what until proven otherwise?
Cancer
87
Describe the presentation of large bowel obstruction
Vomiting (late)
Significant distension
Pain (not colicky)
Absolute constipation (early)
88
Give some causes of large bowel obstruction
```
Colorectal carcinoma
Diverticula stricture
Hernia
Volvulus
Pseudo-obstruction
```
89
What imaging must we do for a large bowel obstruction?
CT of abdomen and pelvis with contrast
90
What is a volvulus?
Twisting around mesentery cutting off blood supply
91
What are some consequences of volvulus?
Perforation
| Ischaemia
92
Where is a volvulus most common?
Sigmoid colon
93
How can we treat a volvulus?
Endoscopic untwisting
| Surgery
94
What is the gold standard imaging for infection or inflammation of abdomen?
Ultrasound
| MRI
95
What might you see on a AXR to do with inflammation/infection?
Mucosal thickening
Featureless colon (common in UC)
Bowel wall oedema
96
What is toxic megacolon?
Acute deterioration of UC or colitis
Chronic dilation with oedema and pseudopolyps
Emergency
Requires a colectomy
97
What is a lead pipe colon and what condition is it common in?
Featureless colon
Loss of haustra
UC
98
What is thumb printing of colon?
Oedematous thickened haustra
Active inflammation
Often UC
99
What type of xray are we most likely to see a pneumoperitoneum in?
Erect chest x-ray
| Gas under the diaphragm
100
Why do we use contrast studies for the GI tract?
Defines the hollow viscera
101
What are the common GI contrast studies?
Swallow
Meal
Small bowel enema
102
In whom is incomplete evacuation common?
Women after childbirth
103
What do the levels of the CT correspond to?
Vertebral levels
| NOT dermatomes
104
What is a CT scan at L1 called?
Transpyloric plane
105
What structures does the transpyloric plane pass through?
```
Stomach pylorus
Gall bladder
End of spinal cord
Neck of pancreas
Origin of SMA
Left and right colic flexures
Hilum of kidneys
Root of transverse mesocolon
Duodenojejunal flexure
1st part duodenum
Spleen
```
106
At what level does the aorta divide into the iliac vessels?
L4
107
What are MRIs very good at?
Differentiating between different tissues
108
Why are abdo USS good?
Cheap
| Portable
109
Why are abdo USS bad?
Highly user dependent
110
How do we do a GI angiography?
Catheters into arteries to insert contrast then do 3 X-rays
1 plain
1 with contrast
1 delayed
To work out which vessels have the problem
