Upper GI Cancer Flashcards
- Gastric cancer - Liver cancer - Pancreas cancer - Cholangiocarcinoma (51 cards)
1
Q
Epidemiology of Gastric cancer
A
- 5th most common cancer
- 2nd most common cause of death
2
Q
Type of gastric cancer
A
- Adenocarcinoma (90%)
- lymphoid
- connective tissue
- neuroendocrine
3
Q
RF of gastric cancer
A
- Non modifiable
- Male
- Age
- FHx
- pernicious anaemia
- Japan, china
- Modifiable
- H.Pylori
- Smoking
- Alcohol
- Salty diet
*
4
Q
A
5
Q
Where would gastric cancers normally appear?
A
- antrum
6
Q
What are the Sx of gastric cancer?
A
* majority present at advanced stage
- dyspepsia
- dysphagia
- wt loss
- anaemia
7
Q
What signs will you find on cinical examination?
A
- epigastric mass
- Troisier sign - palpable Virchow’s node(left supraclavicular node)
- Other signs of metastasis
- hepatomegaly
- ascites
- jaundice
- acanthosis nigricans
8
Q
Differentials for Gastric cancer
A
- PUD
- GORD
- Pancreatic cancer
9
Q
What Ix would you order for gastric cancer?
A
Bedside
- FBC
- LFT
- Clotting
Imaging
- CXR - check for mets
- CT chest abdo pelvis - staging
Special test
- Urgent OGD - primary investigation
10
Q
What are the NICE guidelines for urgent OGD referral
A
- new onset dysphagia
- >55 c weight loss
- upper abdominal pain, reflux, dyspepsia
11
Q
What is the Mx plan for Gastric cancer
A
Curative tx
- Early Gastric Cancer (EGC) resection
- partial gastrectomy - if distal
- total gastrectomy - if proximal
- Roux-en-Y for both
- Endoscopic Mucosal Resection (EMR)
Palliative
- Chemo
- pyloric stenting
- gasro-jejunostomy
12
Q
What are the Cx for Gastric cancer
A
- gastric outlet obstrction
- iron deficiency anaemia
- perforation
- haematemesis, melaena
13
Q
In liver cancer, which is more common, metastatic or primary?
A
- Metastatic 90%
- Primary 10%
14
Q
What is the type of cancer in primary liver cancer?
A
- Hepatocellular Carcinoma (HCC)
15
Q
What is the epidemiology of HCC?
A
- 6th most common cancer
- 3rd cause of cancer death
16
Q
What are the risk fctors for HCC?
A
Non modifiable
- Age
- FHx
- Male
Modifiable
- Hepatitis B & C
- Chronic alcohol
- Smoking
- Aflatoxin exposure (toxic fungal metabolite found in cereal and nuts)
17
Q
What are the ligaments of the liver?
A
- Right coronary
- Right triangular
- Left coronary
- Left triangular
- Falciform
18
Q
What are the clinical features of HCC?
A
* similar to liver cirrhosis
- Fatigue, fever, weight loss
- Ascites, jaundice
- Dull RUQ pain - specific to HCC
On examintaion
- irregular, craggy and tender liver
19
Q
What are the differentials of HCC?
A
- Hepatitis
- Cardiac failure
- Benign hepatocellular adenoma
20
Q
What Ix would you order for HCC?
A
Bedside
- FBC - low hb
- LFT
- Clotting test - pronlonged
- alpha fetoprotein AFP - raised
Imaging
- USS
- CT - for staging
- MRI
Special test
- Liver biopsy - risk of tumour seeding
21
Q
How would you diagnose HCC?
A
- USS >2cm mass
- AFP raised
22
Q
What staging syste would you use for HCC
A
Barcelona CLinic Liver Cancer (BCLC)
23
Q
WHat risk assessment tool you can use for liver cirrhosis and what does it measure?
A
MELD score
- Creatinine
- bilirubin
- INR
- sodium
- use of dialysis
24
Q
What does the MELD score predict?
A
- mortality from cirrhosis
- likelihood of patient tolerating liver transplant
25
What is the Mx for HCC?
Non surgical
* image guided ablation - for early HCC (BCLC 0)
* transarterial embolisation - for BCLC stage B
Surgical
* Resection
* Transplantation - must satisfy Milan criteria
26
What is the Milan Criteria?
* 1 lesion smaller than 5cm or 3 lesions smaller than 3cm
* No extrahepatic manifestation
* No vascular infiltration
27
What cancers commonly metastasise to liver?
* bowel
* breast
* pancreas
* stomach lung
28
What is cholangiocarcinoma
cancer of biliary system
29
What is the biliary tree made of?
* R&L hepatic ducts
* Common hepatic duct
* cystic duct
* common bile duct
* pancreatic duct
* hepatopancreatic duct (ampulla of vater)
30
Where is the most common location of cholangiocarcinoma?
* birufication of R&L hepatic duct (Klatskin tumours)
31
What cells bring rise to cholangiocarcinoma?
* Cholangiocytes (95%)
* squamous cell carcinoma
* sarcoma (coonective tissue)
* lymphoma
* small cell carcinoma
32
What are the RF for cholangiocarcinoma?
* Intramural gallbladder wall calcification (porcelain gall bladder)
* Primary sclerosing cholangitis
* UC
* Liver fluke, hepatitis
* CHemicals in rubber and aircraft
* Caroli's disease
* choledocal cyst
* excess alcohol
* DM
33
What are the clinical features of cholangiocarcinoma?
\*present at late stage
* post hepatic jaundice
* pruritis
* pale stools, dark urine
* other cancer related sx
34
What will you find on examinatin for cholangiocarcinoma
* jaundice
* cachexia
* Courvoisier's law
35
What is corvoisier's law?
* palpable enlarged gallbladder + jaundice = suspect malignancy of biliary tree as gall stone is unlikely
36
What are the differentials for cholangiocarcinoma
\*think things that cause post hepatic jaundice
* primary sclerosing cholangitis
* biliary cirrhosis
* pancreatic tumours
* beningn biliary tumours
* bile duct strictures
* gall stones
37
What Ix would you order for cholangiocarcinoma
Bedside
* Bloods
* LFT - elevated bilirubin, ALP, yGT
* CEA & CA19-9 - tumour markers
Imaging
* USS
* MRCP
* ERCP
* CT - staging
38
What are the Mx options for cholangiocarcinoma?
Surgical
* Comlete resection
* partial hepatetctomy + reconstruction of biliary tree - Klatskin tumour
* Whipple's procedure - pancreaticoduodenectomy - for distal common duct tumours
Palliative
* ERCP stenting
* Bypass
* raidotherapy
39
What is Whipple's procedure?
* Removal of
* head of pancrease
* duodenum
* gall bladder
* bile duct
40
What are the Cx of cholangiocarcinoma
* Biliary tract sepsis
* Secondary biliary cirrhosis
41
What are the types of pancreatic cancer?
Where do they typically appear?
* ductal adenocarcinoma (90%)
* exocrine tumours - pancreatic cystic carcinoma
* endocrine tumours - islet cells
* Head (60%)
* body (25%)
* tail (15%)
42
What is the epidemiology of pancreatic cancer?
* 4th most common cause of cancer death
43
Whar are the RF for pancreatic cancer?
* Non modifiable
* FHx
* Modifiable
* Chronc pancreatitis
* Smoking
* late onset DM \>50
44
How would pancreatic cancer present?
* Obstructive jaundice (90%)
* painless
* Weight loss - due to exocrine dysfunction
* Abdominal pain - invasion of celiac plexus
* Acute pancreatitis
* Thrombophlebitis sign
* Red, swollen skin around effected site
*
45
What will you find on Ex on pt with pancreatic cancer?
* Cachexia
* Malnourished
* Jaundice
* Abdominal mass @ epigastric region
* Enlarged gall bladder
* Courvorsier's law
46
What is Courvoisier's law?
* In the presence of jaundice and palpable gallbladder, cholangiocarcinoma or pancreatic cancer should be suspected
47
What are the differential diagnosis for pancreatic cancer?
* Think about causes of obstructive jaundice
* gall stones
* cholangiocarcinoma
* gall bladder stricture
* Think about causes of epigastric pain
* gallstones
* PUD
* gastric carcinoma
* ACS
48
What Ix would you order for pancreatic cancer?
Bedside
* Bloods
* Tumour marker: CA 19-9 - high sensitivity and specificity for pancreatic cancer
* LFT: raised bilirubin, ALP, y-GT
* FBC: anaemia
Imaging
* USS: pancreatic mass, dilated biliary tree
* CT abdo
* CT chest-abdo-pelvis: staging
* PET CT-scan
Special test
* Endoscopic ultrasound (EUS)
* ERCP
49
How would you Mx pancreatic cancer?
Surgical
* Whipple's procedure - if head of pancreas
* Distal pancreatectomy - if tail of pancreas
Chemotherapy
* Adjuvant with 5 fluorouracil
Palliative care (most patients)
* ERCP biliary stent
* Enzyme replcament
50
What is the prognosis of pancreatic cancer
* 5 year survical rate \<5%
51
