Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Jess GI > 10: Malignancies > Flashcards

10: Malignancies Flashcards

1
Q

What is the histological change seen in Barrett’s esophagus and why does it occur?

A

Metaplastic change seen in the mucosal cells lining the lower portion of the esophagus due to gastric-esophageal reflux disease (GORD)

Stratified squamous epithelia (non-keratinised) -> simple columnar with goblet cells interspersed normally only seen in the SI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the name of the carcinoma that develops following the dysplastic change in Barrett’s esophagus?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How is Barrett’s esophagus prevented? How is it treated?

A

Surveillance programs to see if dysplasia is developing and pick early adenocarcinomas

Treatment is done by treating the reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Where geographically are squamous cell carcinomas and adenocarcinomas of the esophagus highest?

A

Squamous cell carcinomas: Asian esophagus cancer belt

Adenocarcinomas: USA, UK, Europe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is associated with causing squamous cell carcinomas? Name four other risk factors for developing this disease

A
  • *Alcohol and tobacco use
    1. Genetic
    2. Diet-hot drinks, less intake of fruits and veggies
    3. HPV
    4. Associated with other head and neck malignancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name four risk factors associated with developing an adenocarcinoma of the esophagus

A
  1. Obesity
  2. Smoking
  3. Genetics
  4. Predisposing to reflux-zollinger Ellison syndrome, achalasia, scleroderma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which part of the esophagus do squamous cell carcinomas and adenocarcinomas usually occur?

A

Squamous cell: middle third

Adenocarcinomas: distal third

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the gross appearance of squamous cell carcinomas and adenocarcinomas of the esophagus

A

Squamous cell: Exophytic (tends to grow outwards beyond surface epithelium), Ulcerative infiltrating, Stricture

Adenocarcinoma: Mostly ulcerative and stricturing, less likely to be exophytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Name two clinical features of any esophageal cancer

A

Dysphagia, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What clinical features are associated specifically with adenocarcinomas of the esophagus?

A

Long history of dyspepsia (indigestion), vomiting, anemia and bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name four investigative methods that can be used for an esophageal malignancy
*Including how the tumour can be staged

A
  1. Barium swallow
  2. Endoscopy
  3. Endoscopic ultrasound (EUS)
  4. Staging purposes: CT, PET CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What’s beneficial about using an EUS (endoscopic ultrasound) to investigate an esophageal malignancy?

A

Can identify early (small) tumours and how far they’ve spread into the esophageal wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the 5yr survival for early mucosa confined squamous cell carcinomas and adenocarcinomas of the esophagus?

A

Squamous cell: 70%

Adenocarcinoma: 80-100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are survival rates for squamous cell carcinomas and adenocarcinomas of the esophagus once they’ve invaded the muscularis propria?

A

SCC: 50%
Adenocarcinoma: 10-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name treatment options available for esophageal malignancies, how would you choose the right one?

*Not including any treatment that is primarily symptomatic

A

Depends on the stage of the disease

  1. Mucosa confined tumours: Endoscopic mucosal resection (EMR; nonsurgical removal of tumour) and radioablation
  2. Advanced:
    A) esophagectomy (removal of part or all of esophagus)
    B) Neoadjuvant chemo to achieve complete surgical excision (shrinks tumour)
    C) Metastatic disease: adjuvant chemotherapy
  3. HER2 guiding treatment in adenocarcinomas (herceptin)
  4. Radiotherapy: pre and post operatively (can be therapeutic or to treat the disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name two major treatment options primarily available for symptomatic relief of esophageal malignancies

A
  1. Stenting to enable swelling

2. Palliative brachytherapy (insertion of radioactive implants into tissue) and radiotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which gender and geographical region is most affected by gastric cancer?

A

Men, highest incidence in Eastern Asia/Europe and Latin America

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the genetic predisposition associated with gastric cancer? Which age group does it normally present in?

A

Germaine mutation of e-cadherin

90% occur >45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Other than genetic predispositions, name six other things that are commonly associated with gastric cancer?

A
  1. Infection: H. Pylori mostly but also EBV
  2. Autoimmune gastritis may lead to lack of intrinsic factor and the patient develops pernicious anemia
  3. Previous gastric surgery; if part of stomach was removed the patient can develop bile reflux which causes persistent injury
  4. Gastric ulcers
  5. Diet: low in fruit and vegetables and high in salt-preserved foods or smoked foods
  6. Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Which part of the stomach is most commonly affected by gastric tumours?

A

The cardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the ingested chemical compounds in food associated with gastric cancer?

A

N-nitroso compounds and benzopyrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does H.pylori lead to the development of a carcinoma?

A

Indirect as it causes regeneration which lead to the development of and/or replicate genetic mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe the macropsopic features of gastric cancer

A

Fungating, ulcerative, Infiltrative, early

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What does linitis plastica mean? What type of tumour and histological feature is associated with this?

A

Tumour infiltrates and you don’t see much mucosal lesion, the stomach becomes thickened (looks like a leather bottle). Associated with signet ring cells found in adenocarcinomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What type of tumour most commonly arises in gastric cancer? Describe two microscopic features of this tumour

A

Adenocarcinoma (as the epithelia lining the stomach is glandular)

  • Variable degree of ‘intestinal-type of epithelium’/gland formation
  • Diffuse single cells/small groups signet ring looking cells with a lot of mucin in the centre that pushes the nuclei to the periphery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When is the appearance of diffuse signet cells in gastric adenocarcinoma common?

A

Younger age groups and EBV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Describe the onset of symptoms in gastric cancer and name four clinical features of the disease

A

Symptoms are often vague and present late in the disease process

  1. Epigastric pain
  2. Vomiting (more advanced, may be due to obstruction)
  3. Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Name three investigative techniques for gastric cancer

A
  1. Endoscopy
  2. Biopsy
  3. Barium studies
  4. CT identifies the staging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Define an ‘early’ and ‘late’ gastric cancer and the prognosis of each

A

Early: confined to mucosa/sub-mucosa, good prognosis

Late: further spread, overall 5 year survival is 10% but with curative surgery 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Where can gastric cancer spread?

A
  1. Directly to adjacent organs, i.e pancreas, liver, spleen, transverse colon, greater omentum
  2. Lymphatic - regional lymph nodes (but can go supraclavicular - Virchow’s node)
  3. Hematogenous spread to liver (most commonly), then lung peritoneum, adrenals and ovary
  4. Transcoelomic (spread through peritoneal cavity) to peritoneum and ovaries (Krukenberg tumour)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is a Krukenberg tumour and how does it commonly present?

A

Bilateral enlarged ovaries. It’s a malignancy in the ovary that metastasized from a primary site (classically the GI tract with gastric adenocarcinomas being the most common but it can also come from the breast)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

How is gastric cancer treated?

A

Surgery, chemotherapy and herceptin if patient expresses HER2 receptor

33
Q

What gastric malignancy has a strong association with H.pylori?

A

Gastric lymphoma

34
Q

Describe the onset of a gastric lymphoma, how is it treated and how is the prognosis in comparison to other gastric cancer?

A

Starts as a low-grade lesion and rarely progresses to a high grade lesion. Treatment may require eradication of H.pylori which causes regression of the tumour. Deeply infiltrating low/high grade lymphomas require treatment with chemo and radiotherapy

Prognosis much better than gastric cancer

35
Q

Where are gastrointestinal stromal tumours (GIS) most commonly found? What are they derived from?

A

Commonest site is in the stomach, derived from interstitial cells of Cajal

36
Q

How can GIS tumours be detected and how are they treated? How do they appear on a biopsy?

A

Histologically: the express C-kit which can be detected, they are specifically targeted with imatinib

On a biopsy they have a smooth muscle shape

37
Q

Describe the behaviour of GIS tumours

A

Can be benign, borderline or malignant (45% of gastric lesions) - an ‘unpredictable tumour’. It’s behaviour depends on the tumour site, size, degree of mitosis and presence of other necrosis.

38
Q

What is the common presentation for GIS tumours and why?

A

Bleeding: It is a stromal neoplasm that usually presents as a submucosal lesion, it protrudes through the mucosa and can ulcerated causing bleeding

39
Q

What is a trichobezoar?

A

Presents as a tumour BUT is actually a ball of hair (usually psychiatric causes)

40
Q

How common are SI malignancies and what are the two most prevalent types of tumours?

A

Rare, commonest types are lymphomas and neuroendocrine tumours

41
Q

List the sites that a neuroendocrine tumours arise from most-least common

A

70% come from the GI tract:
-SI, rectum, colon, stomach, rare in esophagus and anus

Some come from the lung

42
Q

What three factors determine how are neuroendocrine tumours classified?

A

Tumour size, site and proliferation rate

43
Q

How can neuroendocrine tumours detected histologically?

A

Specifically stain with neuroendocrine markers

44
Q

Where is the commonest incidental finding of neuroendocrine tumours, what causes symptoms?

A

Benign tumours found incidentally in the appendix

Symptoms can arise…

  1. Obstructive symptoms: if the tumour grows and obstructs nearby structures like the SI and/or as a result of tumour fibrosis
  2. by substances the tumour secretes
45
Q

How do neuroendocrine tumours present, what does this tell you about the tumour?

A

Non specific symptoms, can include alternating abdominal pain, diarrhea and hot flushes. Primary tumours are usually silent and symptoms generally only present when there is metastasis (carcinoid syndrome)

46
Q

What often happens to the substances secreted by neuroendocrine tumours?

A

They are metabolized in the liver into an ‘inactive’ form and thus many don’t cause symptoms.. BUT if the patient develops metastasis in the liver the secreted substances then move directly into the systemic circulation

47
Q

Name four ways neuroendocrine tumours are treated

A
  1. Surveillance
  2. Endoscopic removal (EMR): if tumours are smaller
  3. Surgical removal if they involve a larger segment
  4. Hepatic metastasis: resection, radiofrequency ablation
48
Q

Why is cytotoxic chemotherapy not effective in treated neuroendocrine tumours?

A

Most have a low proliferation rate so chemotherapy won’t be very effective

49
Q

What is meant by the ‘adenoma-carcinoma sequence’?

How many mutations is it estimated that one needs to develop a fully evolved malignant neoplasm?

A

Tumours in the gut progress through multiple mutations, and over a period of time you attain many mutations so that the adenoma becomes an invasive carcinoma

Thought to be ~10 or less

50
Q

What are the two major types of large intestine tumours?

A

Adenomas and adenocarcinomas

51
Q

What are two genetic donations that predispose someone to a large intestine tumour? What % of colon cancers is thought to be hereditary?

A
  1. Familial adenomatous polyposis (FAP); thousands of adenomas by 20 yrs
  2. Gardner’s syndrome: similar to FAP but for bone and soft tissue
    ~5-10% thought to be hereditary
52
Q

What is the inheritance pattern and chromosome associated with familial adenomatous polyposis?

A

Autosomal dominant (chromosome 5)

53
Q

How are adenomas classified histologically?

A

Based on how much of the tumour expresses ‘finger-like’ processes/villi morphology

54
Q

What determines how likely an adenomas is to develop into an adenocarcinoma on colorectal screening?

A
  1. The more villus morphology the higher the risk of developing a carcinoma
  2. Dysplasia (malignancy rate increases to 27% if high grade dysplasia)
  3. Polyp size (>20mm increases risk of invasive carcinoma by 35-53%)
  4. Number of polyps
  5. Type
55
Q

Describe the two major screening programmes available for

A
  1. Bowel cancer screening to 70-75 yr olds, patient sends in a faecal sample and fecal immunochemical testing (FIT) is performed
  2. Branch of bowel cancer screening for 55 year olds for a flexible sigmoidoscopy to examine the left side of the colon
56
Q

How common are colorectal adenocarcinomas and which age group is most commonly affected?

A

3rd most common (and 3rd commonest cause of cancer death), peaks in the 70s

57
Q

Which gender is more commonly affected by rectal cancer?

A

Men

58
Q

At which stage of the disease colorectal adenocarcinomas commonly present at?

A

Most aren’t diagnosed until there’s been lymphatic or systemic spread, and 20% present at A&E

59
Q

Other than genetic, name three other risk factors for colorectal adenocarcinoma

A
  1. IBD: UC and Crohn’s
  2. Diet: high fat and low fibre
  3. Slow transit time; so colonic mucosa more exposed to carcinogens
60
Q

Name three major investigations that can be done for colorectal adenocarcinomas
*specify which investigation is key for the staging of rectal tumours

A
  1. Blood tests: FBC (look for anemia), LFT, CEA
  2. Colonic examination: colonoscopy with biopsy, CT colonography, barium enema
  3. Radiology: CT chest/abdo/pelvis, PET evaluation of suspicious lesions on CT. MRI is key for staging rectal cancer
61
Q

What would carcinoembryonic antigen (CEA) be used for on a blood test?

A

Follow up rather than primary diagnosis

62
Q

How can most colon tumours be identified and why?

A
  1. 50% occur in the rectum and can therefore be examined with a finger
  2. 30% occur in the Sigmoid colon

Therefore, 80% can be examined by flexible sigmoidoscopy (Looks at left side of colon)

63
Q

Is there a difference in the site of colorectal carcinoma and the clinical presentation?

A
  1. Rectal lesions: if ulcerated present as fresh rectal bleeding
  2. Left sided lesions are usually stricturing lesions and present with obstruction: altered bowel habit and colicky abdominal pain
    as
  3. In right sided tumours the patient will often be anemic due to recurrent ‘occult’ bleeding, they also often present late as the right side of the colon is more distensible and the feces are more fluid and rarely cause obstruction
64
Q

What tends to be the macroscopic appearance of colorectal adenocarcinomas on the right and left side, where do they most commonly occur?

A

60-70% rectosigmoid. Fungating lesions (esp right side. Stenotic lesions (esp left side)

65
Q

What are the prognostic indicators for colorectal cancer?

A

Grading: how well tumour resembles parent tissue

Staging (TNM and Duke’s)

66
Q

Name three microscopic descriptions of colorectal cancer

*include a common variant, where in the colon they commonly occur, which population group they tend to affect and what they are often associated with

A
  • Adenocarcinomas (arising from glandular structures)
  • Mucinous adenocarcinomas (a specific variant) which are often right sided tumours, tend to affect younger patients and are usually associated with microsatellite instability
  • signet ring cell type
67
Q

What is meant by the term ‘microsatellite instability’

A

Predisposition to a genetic mutation due to impaired DNA mismatch repair

68
Q

What are the routes of spread for colorectal adenocarcinomas?

A
  1. Directly through bowel wall to adjacent organs, i.e bladder, prostate
  2. Lymphatics to mesenteric lymph nodes (often does this before reaching the bloodstream)
  3. Blood stream
69
Q

Which two organs are commonly affected by hematogenous spread of colorectal adenocarcinomas?

A

Liver and lung

70
Q

Describe the T status of colorectal cancer staging, how does it influence prognosis?

A

T1 - goes into submucosa
T2 - goes into muscle
T3 - goes beyond muscle layer (12% increase of metastasis)
T4 - breached the serosal layer of the colon

71
Q

What must be removed during surgical treatment of rectal adenocarcinomas?

A

The fat around the rectum (only area that doesn’t have a peritoneal covering) to prevent tumour spread

72
Q

Name five ways colorectal cancers are managed and three specific to a palliative setting

A
  1. Surgical resection with a curative intent
  2. May have neoadjuvant therapy in rectal tumours (to shrink tumour)
  3. Resection if there has been metastasis to the liver and/or lung
  4. Post-operative chemoradiotherapy if lymph node involvement
  5. Targeted/personalized therapy

In a palliative setting…

  1. Stenting for obstructive tumours
  2. Chemotherapy
  3. Surgery
73
Q

What are the two important genes to be aware of in targeted/personalized therapy for colorectal cancer and why?

A
  1. Mismatch repair genes; four mismatch proteins which can be detected using immunohistochemistry to determine if the patient has a microsatellite instability
  2. Kras: if patient has metastatic disease and mutated Kras the patient will not respond to EGFR inhibitors (unless patient has “wild type Kras”), and other forms of treatment are required
74
Q

Why is it important to be aware of whether the patient has a mismatch repair protein and thus a microsatellite instability? List 3 reasons

A
  1. Prognostic: those with a microsatellite instability have better prognosis if there is no lymph involvement
  2. Predictive: if patient has it they don’t respond to 5FU based chemotherapy
  3. MMR protein detection in tumours is useful to identify lynch syndrome (high risk of secondary cancers, should screen family if found positive)
75
Q

Other than adenomas and adenocarcinomas, name three other large intestinal tumours

A
  1. Neuroendocrine tumour
  2. Lymphoma
  3. Sm muscle/stromal tumours
76
Q

What are the five most common cancers in males and females?

A

Males: prostate, lung, colorectal, bladder and non-Hodgkin’s lymphoma

Females: breast, lung, colorectal, uterus and ovarian

77
Q

What is the difference in symptom presentation in tumours high up in the colon vs sigmoid tumours?

A

Sigmoid tumours present with more obvious symptoms, there may be visible blood and symptoms such as tenesmus: continual/recurrent inclination to evacuate bowels

Higher up tumours have few symptoms, blood is usually altered and not visible

78
Q

What areas that can be affected by cancerous growths are encompassed in the term Colorectal carcinoma?

A

Colon, rectum and appendix

79
Q

What is the most common and second most GI malignancy and the commonest type?

A
  1. Colorectal cancer
  2. Stomach carcinoma
    Adenocarcinomas

Jess GI (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions