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GI > Session 8 > Flashcards

Session 8 Flashcards

1
Q

What is a carcinoma

A

Malignancy of cells that make up the epithelial lining of skin or tissue lining organs

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2
Q

What is an adenocarcinoma

A

Malignancy of glandular cells in epithelial tissue

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3
Q

What is an adenoma

A

Benign tumour formed from glandular structures in epithelial tissue

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4
Q

Incidence of GI cancers most common to least

A

Bowel
Pancreas
Oesophagus
Stomach
Liver

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5
Q

Features of oesophageal cancer histology

A

Usually squamous cell carcinoma
generally upper 2/3rds

Adenocarcinomas from columnar epithelium can occur in lower 1/3rd
Barrett’s oesophagus

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6
Q

Common clinical presentation of oesophageal cancer

A

Progressive dysphagia - Initially solids more difficult to swallow than fluids, this progresses until its hard to swallow liquids too

Odynophagia (pain on swallowing)

Unexplained weight loss

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7
Q

Oesophageal cancer red flags

A

ALARM

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

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8
Q

Risk factors for oesophageal cancers

A

Squamous cell carcinomas- smoking, alcohol use, dietary intake e.g. hot beverages

Adenocarcinomas- obesity, reflux disease, most arise in background of Barrett’s oesophagus

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9
Q

Prognosis of oesophageal cancer

A

Prognosis is poor with 5% survival at 5 years

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10
Q

Investigations for oesophageal cancer

A

Blood tests- FBC (anaemia)

Oesophagogastroduodenoscopy (OGD) with biopsy (can help determine whether benign or cancerous cause)

CT thorax and abdomen (size of primary, local invasion, metastatic spread)

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11
Q

Treatment for oesophageal cancer

A

Dependent on stage

Endoscopic therapies (for limited disease)

Oesophagectomy (removal of oesophagus)

Chemoradiotherapy

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12
Q

histology of gastric cancer

A

Most commonly adenocarcinomas

Can get lymphomas, leimyosarcoma, neuroendocrine tumours

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13
Q

Where are gastric adenocarcinomas commonly found

A

Gastric cancer

gastric cardia most common, then antrum, then body of stomach

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14
Q

Classification of gastric cancer

A

Cardia gastric cancer- similar presentation to oesophageal cancer

Non cardia- arises in other parts of stomach

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15
Q

Types of gastric cancer

A

Lauren classification

Diffuse- younger patients, worse prognosis than intestinal type

Intestinal

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16
Q

Risk factors for gastric cancer

A
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17
Q

Most common clinical presentation of gastric cancer

A
  • Unexplained weight loss
  • Epigastric abdominal pain
  • Lymphadenopathy (Virchow’s node in left supraclavicular)
  • Dysphagia if cancer is located around cardia
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18
Q

Prognosis of gastric cancer

A

70% 5 year survival for local disease
5% if distant metastasis

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19
Q

Gastric cancer investigations

A

Bloods- looking for iron deficiency anaemia

Upper GI endoscopy and biopsy- for tissue diagnosis

CT CAP (chest, abdomen and pelvis, for staging)

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20
Q

Management of gastric cancer

A

Superficial- endoscopic mucosal resection

Localised- surgery to remove all or part of the stomach (gastrectomy) BUT if not suitable for surgery then chemo radiation

Advanced/metastatic- chemotherapy/immunotherapy and supportive care

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21
Q

Pancreatic cancer stats

A

8th leading cause of cancer death worldwide

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22
Q

Histology of pancreatic cancer

A

Pancreatic ductal adenocarcinoma is the main type

Pancreatic neuroendocrine tumours are rare and originate from the endocrine cells in the pancreas

They may be non-functional, or they may secrete hormones e.g. insulinoma = insulin

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23
Q

Risk factors for pancreatic cancer

A

Smoking
Chronic pancreatitis
Inherited mutations with BRCA 1/2, and PALB2 and with familial syndromes
Men > women plus increasing age

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24
Q

Classic clinical presentation

A

Painless jaundice, unexplained weight loss, can present with abdominal/back pain

New-onset type 2 diabetes mellitus in an adult over 50 years of age without any obesity-related risk factors

Changes to poo

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25
Q

pancreatic cancer investigations

A

Bloods- LFTs if jaundiced, CA 19-9

CT- focused on pancreas can give very high diagnostic accuracy and can assess respectability in 80-90%

USS- can detect cancer arising in the head with reasonable accuracy but not in the body or tail

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26
Q

management of pancreatic cancer

A

10-15% are suitable for surgical resection following by pancreatic enzyme replacement (only possible cure, 20% 5 year survival)

Biliary stenting for jaundice

Chemotherapy and symptom management if not resectable

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27
Q

Histology of hepatocellular carcinoma

A

Primary cancer arising from hepatocytes (usually with background of cirrhosis)

28
Q

Risk factors for Hepatocellular carcinoma

A

Most HCCs occur in patients with underlying cirrhosis

Many causes of cirrhosis including alcohol, Hep B and C

29
Q

Hepatocellular carcinoma clinical presentation

A

Symptoms of liver disease can often mask the malignancy e.g. ascites, fatigue

Acute hepatic decompensation or RUQ pain can be signs of development of HCC

30
Q

Prognosis of hepatocellular carcinoma

A

5 year survival rate = approx 50% with complete surgical resection or liver transplantation

Vs advanced HCC = median overall survival time with treatment approx 1 year

31
Q

Investigations for hepatocellular carcinoma

A

Blood tests- LFTs, Prothrombin time/INR, viral hepatitis panel

USS- non invasive and a good way to screen high risk individuals

CT or MRI of abdomen

Liver biopsy

32
Q

Treatment of hepatocellular carcinoma

A

If suitable then ablation, resection or transplantation

if not suitable, then chemotherapy/immunotherapy aims to slow tumour growth

33
Q

Liver is a common site for metastases from

A
34
Q

Routes for liver metastasis

A

Haematological e.g. portal spread from other GI viscera

Lymphatic

Spread via other routes e.g. ovarian = transcoelomic

35
Q

Histology of cholangiocarcinoma

A

Bile duct cancers

Majority are adenocarcinomas
Can be intrahepatic or extrahepatic

36
Q

Risk factors for Cholangiocarcinoma

A

Liver and bile duct diseases- cirrhosis, alcohol liver disease, non-specific bile duct diseases (bile duct adenoma), gallstones, PSC

Infections

High alcohol consumption

Exposure to certain toxins/medications

37
Q

Common clinical presentation of cholangiocarcinoma

A

Painless jaundice, pruritis, dark urine, light colour stool in extrahepatic due to biliary obstruction

38
Q

Prognosis of cholangiocarcinoma

A

Poor prognosis

5 year overall survival rate in patients with metastatic disease is 2%

39
Q

Colorectal cancer histology

A

Adenocarcinomas which progress from normal epithelium in a classical pattern

40
Q

Risk factors for colorectal cancer

A

Dietary factors- high dietary fat, high red meat consumption, low dietary fibre, alcohol intake

History of IBD

genetic conditions: FAP familial adenomatous polyposis, and hereditary non polyposis colorectal cancer (HNPCC)

41
Q

Colorectal cancer clinical presentation

A

Blood in stool and altered bowel habits

Advanced = bowel obstruction or perforation or symptoms due to hepatic or peritoneal metastasis e.g. abdominal pain and ascites

42
Q

Prognosis of colorectal cancer

A

Among gastrointestinal cancers, colorectal has the best overall prognosis

For non-metastatic disease, the 5 year survival rate ranges from 50% to 95%

43
Q

Colorectal cancer red flags

A

Blood in stool/rectal bleeding (not usually fresh or painful)

Change in bowel habit (age, frequency, consistency)

  • Iron deficiency anaemia
  • Unexplained weight loss
  • Tenesmus (incomplete evacuation)
  • Mass on rectal exam
44
Q

Features of right and left sided colon cancer

A
45
Q

Adenocarcinoma sequence relating to colorectal cancer

A
46
Q

Colorectal cancer investigations

A

Stool tests e.g. FIT
Blood tests e.g. FBC for anaemia, CEA
Colonoscopy and biopsy
Imaging- CT, MRI

47
Q

Management of colorectal cancer

A

Dependent on stage

Surgery with pre or post operative chemotherapy/immunotherapy

Chemotherapy/immunotherapy if not for surgical intervention

48
Q

Bowel cancer screening

A

FIT test

49
Q

Anal cancer histology

A

Typically squamous cell carcinomas

50
Q

Risk factors for anal cancer

A

HPV infection
HIV infection
Engaging in anal-receptive sexual intercourse
Chronic local inflammation due to IBD or recurrent anal fissures

51
Q

Anal cancer clinical presentation

A

Local symptoms- parianal puritis or pain, bleeding, discharge and a mass like sensation

52
Q

Prognosis of anal cancer

A

More than 70% of cases can be cured with chemo radiation

Pap smear in high risk populations, and better prevention and treatment of HIV infection should lower the incidence

53
Q

GI cancer staging

A

TNM

T = size of primary tumour
N = extent of regional lymph node involvement
M = metastatic spread

Stages 1-4

54
Q

How can we stage colorectal cancer

A

Dukes’

55
Q

Most stomach cancers are adenocarcinomas that arise from a

A

Chronic gastritis or metaplasia. Stomach ulcers are potentially malignant

56
Q

What is the most common site for a primary gastrointestinal lymphoma

A

Stomach

57
Q

What is the most important environmental factor in stomach cancer

A

H pylori

58
Q

Why are most stomach cancers advanced

A

Present late

59
Q

Pancreatic cancer generally affects those

A

Over 60 years old with no specific cause identified

60
Q

What is the most affected portion of the pancreas

A

Pancreatic head

61
Q

Why is it surprising that the small intestine is an uncommon site for adenomas and carcinomas

A

It’s large surface area and rapid cell turnover

62
Q

Features of familial adenomatous polyposis

A

Inherited condition where invariably the numerous adenomas present will undergo malignant change

63
Q

Colorectal cancers are related to several genetic events such as the

A

Activation of oncogenes

Ineffective DNA repair

Loss of tumour suppressor genes

64
Q

Most colorectal cancers can be viewed with a

A

Sigmoidoscope

65
Q

Rectal cancers are usually ulcerating and therefore give

A

PR bleeding

66
Q

Why do rectal cancers produce tenesmus

A

Distension of the rectum

67
Q

Staging of colorectal cancers relates to

A

How far the cancer has advanced through the abdominal wall, whether the lymph nodes are involved and the presence or absence of metastasis

GI (22 decks)

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