Cancers Of The Gi Tract Notes

Cancers of the GI tract

Carcinoma of the stomach

Associations

• Blood group A

• H. Pylori – chronic gastritis – atrophic gastritis – intestinal metaplasia

• Smoking

• High salt diet

Pathogenesis

• Most occur in antrum

• P53 and APC affected

• Commonly ‘intestinal’ (intestinal metaplasia seen in surrounding mucosa)

• Adenocarcinoma

Clinical features

• Epigastric pain

• Nausea

• Anorexia

• Weight loss

• Vomiting (severe if near pylorus)

• Dysphagia (if involves fundus)

• Anaemia

• Mets to liver, bone, brain + lung

Investigations

• Bloods

  • FBC (anaemia)

  • Liver biochem

• Imaging

  • CT/MRI staging

  • Gastroscopy and biopsies

Management

• Surgery

• Chemotherapy

• Radiotherapy

• Palliative care

• 5 year survival <10%

Carcinomas of the small intestine

Relatively rare

Adenocarcinoma

• Commonest

• Duodenum and jejenum

Lymphomas

• Commonly in ileum

• Non-hodgkins type

• Most often B-call type arising from MALT

Predisposing factors

• Coeliac disease

• Crohn’s disease (adenocarcinoma)

Clinical features

• Abdominal pain

• Diarrhoea

• Weight loss

• Anorexia

• Palpable mass

Investigations

• USS + CT show small bowel wall thickening and lymph node involvement

• Wireless capsule endoscopy

Management

• Adenocarcinoma – surgery

• Lymphoma – chemo and radiotherapy

Colorectal cancer

Second commonest cause of cancer death

Over 50% of presentations over 70yrs age

Predisposing factors

• Neoplastic polyps

• UC/Crohn’s

• Familial adeonomatous polyposis

  • Mutations in APC gene

• HNPCC

  • Mutation in DNA mismatch repair genes

  • Also causes other cancers – endometrial, ovarian,...

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