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13. Gastrointestinal > 10. GI Malignancies and Investigation of the GI Tract > Flashcards

10. GI Malignancies and Investigation of the GI Tract Flashcards

1
Q

What is the epidemiology of oesophageal carcinoma considering geographical and gender variation?

A

Wide variation geographically - low in USA, high in China. 2% of UK malignancies. More common in males than females.

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2
Q

What are the clinical features of oesophageal carcinoma?

A

Dysphagia getting progressively worse as tumour grows. Weight loss.

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3
Q

What are the investigations for oesophageal carcinoma?

A

Endoscopy, biopsy, and barium.

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4
Q

What are the pathological features of oesophageal carcinoma?

A

Squamous cell carcinoma is the commonest type and can occurs at any level. Adenocarcinoma occurs in the lower third and is associated with Barrett’s oesophagus.

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5
Q

Which type of oesophageal carcinoma is linked with Barrett’s oesophagus?

A

Adenocarcinoma.

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6
Q

What is the prognosis for oesophageal carcinoma?

A

Presents at advanced stage in more cases with direct spread through oesophageal wall so only 40% resectable. 5% five year survival.

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7
Q

What is the second most common GI malignancy?

A

Gastric cancer.

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8
Q

How many new cases of gastric cancer are there in England and Wales per year?

A

11000.

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9
Q

What percentage of cancer deaths worldwide does gastric cancer account for?

A

15%.

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10
Q

In which gender is gastric cancer more common?

A

Men.

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11
Q

How does gastric cancer prevalence differ geographically?

A

Common in Japan, Columbia, Finland.

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12
Q

What is gastric cancer associated with?

A

Gastritis and helicobacter pylori and commoner in blood group A.

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13
Q

What are the clinical features of gastric cancer?

A

Vague symptoms - epigastric pain, vomiting, weight loss.

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14
Q

What are the investigations for gastric cancer?

A

Endoscopy, biopsy, barium.

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15
Q

What are the macroscopic features of gastric cancer?

A

Fungating, ulcerating, infiltrative (linitis plastica).

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16
Q

What are the microscopic features of gastric cancer?

A

Intestinal - variable degree of gland formation.

Diffuse - single cells and small groups, signet ring cells.

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17
Q

What are the features and prognosis of early gastric cancer?

A

Confined to mucosa/sub-mucosa. Good prognosis.

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18
Q

What are the features and prognosis of advanced gastric cancer?

A

Further spread, common in UK and only 10% five year survival.

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19
Q

How can gastric cancer spread?

A

Directly through gastric wall into duodenum, transverse colon, pancreas. Lymph nodes, liver, or transcoelomically to peritoneum or ovaries.

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20
Q

How is gastric cancer association with H pylori supported?

A

By serological and epidemiological evidence.

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21
Q

What is the commonest GI lymphoma?

A

Gastric lymphoma.

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22
Q

How does gastric lymphoma start?

A

As a low-grade lesion.

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23
Q

How is the strong association with H pylori of gastric lymphoma important clinically?

A

Eradication of H pylori can lead to regression of the tumour.

24
Q

From what cells are gastrointestinal stromal tumours derived?

A

Interstitial cells of Cajal.

25
Q

What is the causative mutation of gastrointestinal stromal tumours and the clinical significance of knowing this?

A

C-kit (CD117), means it targeted treatment can be used.

26
Q

What are the unpredictable behavioural features of gastrointestinal stromal tumours?

A

Pleomorphism, mitoses, necrosis.

27
Q

What are the four tumours of the large intestine?

A

Adenomas, adenocarcinomas, polyps, and anal carcinoma.

28
Q

What are large intestinal adenomas?

A

Benign, neoplastic lesions in the large bowel.

29
Q

What are the macroscopic features of large intestinal adenomas?

A

Sessile or pedunculated.

30
Q

What are the microscopic features of large intestinal adenomas?

A

Variable degree of dysplasia.

31
Q

What is familial adenomatous polyposis?

A

An autosomal dominant condition on chromosome 5 that means by the time a patient is 20, there are thousands of adenomas in the large intestine - all with the potential to be malignant.

32
Q

What is Gardner’s syndrome?

A

An autosomal dominant form of polyposis characterized by the presence of multiple polyps in the colon together with tumors outside the colon, e.g. in bone and soft tissue.

33
Q

What is the commonest GI malignancy?

A

Colorectal cancer.

34
Q

How many new cases of colorectal cancer are reported per year in England and Wales?

A

25000.

35
Q

What is the macroscopic feature in 60-70% of colorectal adenocarcinomas?

A

Rectosigmoid fungating/ stenotic.

36
Q

What are the two microscopic types of colorectal adenocarcinoma?

A

Mucinous or signet ring type.

37
Q

How can colorectal adenocarcinoma spread?

A

Directly through the bowel wall to adjacent organs, or via lymphatic to mesenteric lymph nodes, or via portal system to liver.

38
Q

What are the Duke’s stages of colorectal adenocarcinoma?

A

A - confined to bowel wall.
B - through wall, lymph nodes clear.
C - lymph node involvement.
C1/C2 - highest node clear/involved.

39
Q

What staging can be used to assess colorectal adenocarcinoma?

A

Duke’s staging of TMN staging.

40
Q

What are the mutations linked with colorectal adenocarcinomas?

A

FAP on chromosome 5 (familial adenomatous polyposis), Ras mutations, and p53 loss or inactivation.

41
Q

When does incidence of colorectal adenocarcinoma peak age wise?

A

At 60-70 years.

42
Q

What is the aetiology of colorectal adenocarcinoma?

A

Low residue diet, slow transit time, high fat intake, genetic predisposition.

43
Q

What is the prognosis for colorectal adenocarcinoma?

A

It depends on the staging, it decreases with increasing Duke’s staging and metastases to the liver.

44
Q

What are the large intestine tumours?

A

Carcinoid tumour (neuro-endocrine), lymphoma (primary or secondary from elsewhere), smooth muscle/stromal tumours.

45
Q

Where do most carcinomas of the pancreas occur?

A

2/3 are in the head.

46
Q

What is the macroscopic appearance of pancreas carcinomas?

A

Firm pale mass with a necrotic core.

47
Q

Where can pancreas carcinomas spread?

A

To adjacent structures like the spleen.

48
Q

What is the most common histological cause of pancreas carcinomas?

A

Ductal adenocarcinoma.

49
Q

What is the prognosis for pancreatic carcinoma?

A

Poor.

50
Q

What is the clinical presentation of a carcinoma of the Ampulla of Vater?

A

It blocks the bile duct when only small so causes jaundice and early presentation, so the tumour presents when still treatable.

51
Q

What are the types of islet cell tumours?

A

Insulinoma, glycagonoma, vasoactive intestinal peptideoma, and gastrinoma.

52
Q

What does insulinoma present with?

A

Hypoglycaemia.

53
Q

What does glycagonoma present with?

A

Characterisitc skin rash.

54
Q

What is vasoactive intestinal peptideoma linked with?

A

Werner Morrison syndrome.

55
Q

What is gastrinoma linked with?

A

Zollinger-Ellison syndrome.

56
Q

What are the benign tumours of the liver?

A

Fairly rare: hepatic adenoma, bile duct adenoma/hamartoma, haemangioma.

57
Q

What are the malignant tumours of the liver?

A

Hepatocellular carcinoma, cholangiocarcinoma, and hepatoblastoma.

13. Gastrointestinal (17 decks)

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