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BRS Y1 > Week 11- GI Cancers > Flashcards

Week 11- GI Cancers Flashcards

1
Q

Define a cancer

A

A disease caused by uncontrolled cell division of abnormal cells in a part of the body

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2
Q

What is the difference between a primary and secondary cancer?

A

Primary: arises directly from the cells in the organ
Secondary: spread from another organ (eg via lmyph or blood)

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3
Q

What are the 2 types of epithelial cells in the GI tract?

A

Squamous

Glandular epithelium

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4
Q

What are the 2 types of neuroendocrine cells in the GI tract?

A

Enterocendocrine cells

Interstitial cells of Cajal

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5
Q

What are the 2 types of connective tissue cells in the GI tract?

A

Smooth muscle

Adipose tissue

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6
Q

What GI cancer arises from squamous cells?

A

Squamous Cell Carcinoma (SCC)

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7
Q

What GI cancer arises from glandular epithelium?

A

Adenocarcinoma

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8
Q

What GI cancer arises from enteroendocrine cells?

A

Neuroendocrine Tumours (NETs)

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9
Q

What GI cancer arises from interstitial cells of Cajal?

A

Gastrointestinal Stromal Tumours (GISTs)

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10
Q

What GI cancer arises from smooth muscle cells?

A

Leiomyoma/leiomyosarcomas

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11
Q

What GI cancer arises from adipose tissue cells?

A

Liposarcomas

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12
Q

What are the 3 parts of the oesophagus?

A

Cervical
Middle
Lower

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13
Q

What are the 2 main oesophageal cancers?

A

Squamous cell carcinoma

Adenocarcinoma

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14
Q

Describe oesophageal squamous cell carcinoma

A

From normal oesophageal squamous epithelium
Upper 2/3 of oesophagus
Acetaldehyde pathway
More common in the less developed parts of the world

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15
Q

Describe oesophageal adenocarinoma

A

From metaplastic columnar epithelium
Lower 1/3 of oesophagus
Associated with acid reflux
More common in developed parts of the world

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16
Q

How much does acid reflux increase the risk of oesophageal cancer?

A

30-100 times

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17
Q

What are the 3 stages of getting oesophageal cancer? What are the risks at each stage

A

Oesophagitis (inflammation)- 30% of UK pop
Barrett’s (metaplasia)- 5% of oesophagitis
Adenocarcinoma (neoplasia)- 0.5/1% lifetime risk per year

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18
Q

If a patient has Barrett’s how often should they have check ups?

A

No dysplasia evident= every 2/3 years
Low grade dysplasia= every 6 months
High grade dysplasia= intervention

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19
Q

How common is oesophageal adenocarcinoma?

A

9th most common cancer

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20
Q

Who does adenocarcinoma mainly affect?

A

The elderly

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21
Q

What is the male/female ratio for adenocarcinoma?

A

10:1

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22
Q

Describe survival rates for oesophageal cancer

A

Late presentation, mainly palliative care which is difficult to carry out, high morbidity and complex surgery

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23
Q

What is the 5 year survival for oesophageal cancer?

A

Less than 20%

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24
Q

How is oesophageal cancer diagnosed?

A

Endoscopy to get a biopsy

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25
How is staging of oesophgeal cancer carried out?
CT scan and laparoscopy
26
Describe curative treatment for oesophageal cancer
Neo adjuvant chemo then radical surgery
27
Describe palliative care for oesophageal cancer
Chemotherpy, DXT, Stent
28
How is a oesophagectomy carried out?
Two stage Ivor Lewis approach
29
How common is colorectal cancer?
Most common GI cancer is western world | 3rd most common cancer deaths in men and women
30
What is the lifetime risk of colorectal cancer for men and women
1/10 men | 1/14 women
31
Who does colorectal cancer mainly effect?
Over 50 years old
32
What are the 4 forms of colorectal cancer? Explain them
Sporadic- no family history Familial- family history, higher risk if family member was under 50 yrs and first degree relative Hereditary syndrome- family history, FAP, HNPCC or Lynch syndrome Histopathology- adenocarcinoma
33
What are risk factors of colorectal cancer?
Past history Family history Diet/ environmental- smoking, obesity etc
34
Where are colorectal cancers found?
2/3 in descending colon and rectum | 1/2 in sigmoid colon and rectum
35
How do caecal and right sided cancers present?
Iron deficiency anaemia (most common) Change in bowel habit (diarrhoea) Late presentations: distal ileum obstruction, palpable mass
36
How do left sided and sigmoid cancers present?
``` PR bleeding, mucus Thin stool (late presentation) ```
37
How do rectal carcinomas present?
PR bleeding, mucus Tenesmus Anal, perianal and sacral pain
38
What are late presentations of colorectal cancer?
Bowel obstruction Local invasion: bladder symptoms, female genital tract symptoms Metastasis: lung=cough, liver= hepatic pain/jaundice, regional lymph nodes
39
What are signs of primary colorectal cancer?
Abdominal mass Digital rectal mass Rigid sigmoidoscopy Abdominal tenderness and distension (large bowel obstruction)
40
What are signs of metastasis and complications of colorectal cancer?
Hepatomegaly (mets) Monophonic wheeze Bone pain
41
What are the 3 main investigative tests for colorectal cancer?
Faecal occult blood Blood test Double contrast barium enema
42
Describe a faecal occult blood investigation
Based on pseudoperoxidase activity of haematin | Avoid red meat, horseradish, vit C and NSAIDs 3 days before test
43
Describe blood tests as an investigation for colorectal cancer
FBC: anaemia, haematinics, low ferritin Tumor markers: CEA NOTE- not a diagnostic diagnostic
44
Describe a double contrast barium enema investigation for colorectal cancer
Doesnt require sedation More limited in detecting small lesion All lesions still need to be confirmed by a colonoscopy and biopsy
45
Describe a colonoscopy as an investigation
Can visualise lesions less than 5 mm Small polyps can be removed to reduce cancer incidence Performed under sedation
46
Describe a CT colonoscopy as an investigation
Can visualise lesions greater than 5 mm No need for sedation Less invasive and better tolerated Colonoscopy needed for diagnosis
47
Describe an MRI of the pelvis for rectal cancer
Depth of invasion can be identified No bowel prep or sedation needed Helps choose between preoperative chemo or straight to surgery
48
How is colon cancer mainly managed?
By surgery
49
How is surgery on the right and transverse colon carried out?
Resection and primary anastamosis
50
How is surgery on the right side carried out?
Hartmann's procedure (proximal end colonoscopy) Primary anastomosis (intraoperative bowel lavage and defunctioning ileostomy) Palliative stent
51
What is the most common form of pancreatic cancer?
Pancreatic ductal adenocarcinoma
52
How is does pancreatic cancer often present?
80-85% late presentation
53
What are survival rates of pancreatic cancer?
Median survival 6 months | 5 year survival 0.4- 5%
54
What age does pancreatic cancer mainly occour
Mostly 60-80%
55
What are some risk factors for pancreatic cancer?
``` Chronic pancreatitis T2DM Cholelithasis Diet Cigarette smoking Family history ```
56
What are some inherited syndromes accociated with pancreatic cancer risk?
``` Hereditary pancreatitis Familial atypical multiple mole melanoma Peutz Jeghers syndrome HNPCC FAP ```
57
Describe the pathogenesis of pancreatic cancer
Presence of pancreatic intraepithelial neoplasias | PDAs evolve through non invasive precursor lesions, they are microscopic (<5mm) and not visible via imaging
58
What are clinical presentations of pancreatic cancer?
Jaundice Weight loss Pain (70 % at time of diagnosis) GI bleeding
59
What part of the pancreas do most pancreatic cancers arise in?
Head of the pancreas
60
How are carcinomas in the body and tail of the pancreas different to the head?
``` More advanced than lesions in the head at diagnosis Marked weight loss 60% patients have back pain Jaundice is uncommon Most unresectable at time of diagnosis ```
61
How is the tumor marker CA19-9 relevant in pancreatic cancer?
Falsely elevated in pancreatitis | Conc > 200 confer high specificity
62
How is ultrasonography useful for pancreatic cancer?
Can identify pancreatic tumors Can identify dilated bile ducts Can identify liver metastases
63
How is dual phase CT useful for pancreatic cancer?
Predicts respectability accurately in 80-90% of cases Shows continguous invasion Shows distant metasteses
64
What imaging types are used for pancreatic cancer?
MRI- detects and predicts resectabilty accurately MRCP- provides ductal images without ERCP complication ERCP- confirms double duct sign, shows aspiration of the bile duct system, can be used therapeutically to biliary stent to relive jaundice
65
What is EUS and how is it used in pancreatic cancer?
Detects small tumors, assesses vascular invasion
66
How is laparoscopy used in pancreatic cancer?
Detects metastatic lesions of liver and peritoneal cavity
67
What is a common feature of most patients with liver cancer?
Most of them have underlying cirrhosis
68
What is the 5 year survival rate of liver cancer?
Less than 5%
69
What are resection options for liver cancer?
OLTx TACE RFA
70
How many people with liver cancer can have surgery?
5-15%
71
What can increase risk of gallbladder cancer?
Gallstones Porcelain gallbladder Chronic typhoid infection
72
What is the 5 year survival rate of gallbladder cancer?
Less than 5 %
73
How many people with gallbladder cancer can have surgery?
Less than 15%
74
What can increase risk of cholangiocarcinoma?
Liver fluke | Choledochal cyst
75
What is the 5 year survival rate of cholangiocarcinoma?
Less than 5%
76
How many people with cholangiocarcinoma can have surgery?
20-30%
77
What is the 5 year survival rate of secondary liver metasteses?
0%
78
What is 5 year survival with optimal surgical resection of primary liver cancer?
Over 30%
79
What is 5 year survival with optimal surgical resection of gallbladder cancer?
Less than 15%
80
What is 5 year survival with optimal surgical resection of cholangiocarcinoma?
20-40%
81
What is 5 year survival with optimal surgical resection of secondary liver metastases?
25-50%

BRS Y1 (52 decks)

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