GI tract cancers

Question 1

Examples of GI cancers

Answer 1

Oesophageal
Gastric
Colorectal cancer (CRC)

Question 2

Types of oesophageal cancer

Answer 2

Squamous

Adenocarcinoma

Question 3

Clinical presentation of oesophageal cancer

Answer 3

Early = no symptoms
Late = dysphagia, weight loss, heartburn, Haematemesis (vomiting blood), hoarse voice

Question 4

Pathophysiology of oesophageal squamous cancer

Answer 4

Tends to be located in the proximal 2/3rds of the oesophagus

Can locally cause pressure on Recurrent Laryngeal nerve

Question 5

Aetiology of oesophageal squamous cancer

Answer 5

Smoking, alcohol, nitrous amines (BBQ food, tobacco)

Question 6

Pathophysiology of oesophageal adenocarcinoma

Answer 6

Tends to be located in the distal 1/3rd of the oesophagus.

Can locally cause pressure on recurrent laryngeal nerve

Question 7

Aetiology of oesophageal adenocarcinoma

Answer 7

Barrett’s oesophagus, obesity

Question 8

Epidemiology of oesophageal adenocarcinoma

Answer 8

Obese people

Question 9

Diagnosis of oesophageal cancer

Answer 9

Oesophagoscopy with biopsy

CT/MRI to stage cancer

Question 10

Treatment of oesophageal cancer

Answer 10

Oesophagectomy with preoperative chemotherapy

Question 11

Clinical presentation of gastric cancer

Answer 11

Nonspecific: Dyspepsia, weight loss, vomiting, dysphagia and anaemia.
Signs: Epigastric mass, hepatomegaly, jaundice, Troisier’s sign (enlarged left supraclavicular node (Virchow’s node)).

Question 12

What type of cancer are most gastric cancers

Answer 12

90% are Adenocarcinomas

Most involve pylorus

Question 13

Aetiology of gastric cancer

Answer 13

Multifactorial and often unknown
H.pylori can double the risk
Smoking is a risk factor
Gastritis and pernicious anaemia

Question 14

Diagnosis of gastric cancer

Answer 14

Gastroscopy with biopsy

CT/MRI to stage cancer

Question 15

Treatment of gastric cancer

Answer 15

Gastrectomy (partial or total) with preoperative chemo

Question 16

Clinical presentation of Colorectal cancer (CRC) of left side

Answer 16

Most are left side of colon: rectal bleeding, increasing symptoms of intestinal obstruction (bowel habit, coliky pain).

Question 17

Clinical presentation of Colorectal cancer (CRC) of right side or caecum

Answer 17

Right side + ceacum: iron deficiency anaemia, mass in right iliac fossa. Non specific symptoms.

Question 18

Pathophysiology of CRC

Answer 18

Adenomatous polyps develop over time, though begnin they can become malignant through activation of oncogenes and inactivation of tumour suppressor genes. Increased no. of polyps increases chance of malignancy.
5% due to genetic syndromes:
HNPCC: accelerated progression of adenoma to CRC, >50% develop CRC after 40.
FAP: APC gene, >100 polyps develop in teenage years, 100% lifetime risk of CRC. (Both have increased risk of extracolonic malignancy).

Question 19

What are polyps

Answer 19

abnormal tissue growths that most often look like small, flat bumps or tiny mushroomlike stalks. Most polyps are small and less than half an inch wide. Polyps in the colon are the most common

Question 20

CRC risk factors

Answer 20

Smoking
Increased Age
Family hx
Inflammatory Bowel Disease
Streptococcus bovis bacteraemia
(Western diet)
Congenital polyposis syndromes
Genetic predisposition

Question 21

Epidemiology of CRC

mean diagnosis and how common

Answer 21

Mean diagnosis age 60-65
3rd most common malignancy
2nd biggest killer cancer

Question 22

Diagnosis of CRC

Answer 22

DRE (Digital Rectal Exam), colonoscopy with biopsy

Faecal occult blood test for screening only

Question 23

What does treatment of CRC depend on

Answer 23

Extent of the disease

Question 24

Complications of CRC

Answer 24

Local invasion and distant metastases, often liver and lung

Obstruction

Question 25

Give examples of Congenital polyposis syndromes that are risk factors for CRC

Answer 25

Juvenile polyposis syndrome

Peutz-Jeghers syndrome

Question 26

Give examples of genetic predispositions that are risk factors for CRC

Answer 26

Familial adenomatous polyposis (FAP)

Hereditary non-polyposis colorectal cancer

Question 27

What is CRC

Answer 27

Cancer of the colon and rectum

3rd most common cancer and usually an adenocarcinoma on histology

Question 28

Conservative treatment of CRC

Answer 28

Patient education and referral to Macmillan nurses

Question 29

Medical treatment of CRC

Answer 29

Chemotherapy (oxliplatin, folinic acid and 5-fluorouracil is most common regime)
Radiotherapy also used

Question 30

Surgical treatment of CRC

Answer 30

Surgical resection is usually treatment of choice

Question 31

Investigations of CRC

Answer 31

Bowel Cancer Screening Programme - faecal occult blood test in men and women aged 60-69 years
Bloods - FBC for iron deficiency anaemia and carcinoembryonic antigen (CEA) tumour marker
Endoscopy - colonoscopy/sigmoidoscopy
Imaging - double contrast barium enema study ‘apple core’ sign; virtual colonoscopy

Question 32

*Describe the Dukes staging system

Answer 32

Stage A:
Confined to muscularis mucosa (90% 5-year survival)
Stage B:
Extends through muscularis mucosa (65% 5-year survival)
Stage C:
Lymph node involvement (30% 5-year survival)
Stage D:
Distant metastases (<10% 5-year survival)

Question 33

Describe the TNM system

Answer 33

T = Carcinoma in situ:
T1 - Submucosa invaded
T2 - Muscularis mucosa inavded
T3 - Tumour has invaded subserosa but other organs have not been penetrated
T4 - Adjacent organs inavded

N1 = Metastatic spread to 1-3 regional lymph nodes
N2 = Metastatic spread to at least 4 regional lymph nodes

M0 = No distant metastases present
M1 = Distant metastases present