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Gastrointestinal Tract > 16) Common GI Malignancies > Flashcards

16) Common GI Malignancies Flashcards

1
Q

Which organs are common GI malignancies found in?

A 
Oesophagus 
Stomach
Large intestine 
Pancreas
Liver
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2
Q

What percentage of malignancies in UK are oesophageal carcinoma?

A

2%

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3
Q

How does oesophageal carcinoma present?

A

Dysphagia (worsening as tumour grows)

Weight loss

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4
Q

What investigations may be used for suspected oesophageal carcinoma?

A

Endoscopy, biopsy, barium

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5
Q

What is the most common type of oesophageal carcinoma and where does it occur?

A

Squamous cell carcinoma

May occur at any level

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6
Q

What is the second most common type of oesophageal carcinoma and where does it occur?

A

Adenocarcinoma

Lower third, associated with Barrett’s oesophagus

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7
Q

How does an oesophageal adenocarcinoma progress?

A

Arises in metaplastic epithelium of Barrett’s oesophagus and progresses through dysplasia

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8
Q

Why is the prognosis of oesophageal carcinoma so bad?

A

Advanced disease at presentation, as usually spread through oesophageal wall
Only 40% resectable

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9
Q

What is the five year survival of oesophageal carcinoma?

A

5%

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10
Q

What treatment can be given in oesophageal cancer to relieve symptoms?

A

Local radiotherapy to shrink tumour

Tube passed through tumour to facilitate swallowing

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11
Q

What things is gastric cancer associated with?

A

Blood group A

Gastritis

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12
Q

How does gastric cancer present?

A

Vague symptoms: epigastric pain, vomiting, weight loss

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13
Q

What investigations may be done if gastric cancer is suspected?

A

Endoscopy, biopsy, barium

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14
Q

What are some macroscopic features of gastric cancer?

A

Fungating
Ulcerating
Infiltrative (linitis plastica)

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15
Q

What two types of microscopic gastric cancer can be seen?

A

Intestinal

Diffuse

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16
Q

What are the features of intestinal gastric cancer?

A

Variable degree of gland formation

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17
Q

What are the features of diffuse gastric cancer?

A

Single cell or small groups

Signet ring cells

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18
Q

Why are the nuclei of signet ring cells at the peripheries?

A

Signet ring cell is full of mucins so pushes nucleus

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19
Q

Describe early gastric cancer:

A

Confined to mucosa/submucosa

Good prognosis

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20
Q

Describe advanced gastric cancer:

A

Further spread, 10% five year survival

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21
Q

How can gastric cancer spread?

A

Direct - through gastric wall
Lymph nodes
Liver
Trans-coelomic - into peritoneal cavity, can deposit here and spread to ovaries

22
Q

What structures may be affected by the direct spread of gastric cancer?

A

Duodenum, transverse colon and pancreas

23
Q

What treatment is there for gastric cancer?

A

Surgery (curative)
Chemotherapy
Herceptin (HER receptor)

24
Q

How is H. pylori associated with gastric cancer?

A

Chronic inflammation and metaplasia can lead to cancer

25
Q

What other GI cancer is associated with H. pylori?

A

Gastric lymphoma

26
Q

How can gastric lymphoma be treated?

A

Eradication of H. pylori may lead to tumour regression

Otherwise, chemotherapy and surgery

27
Q

What cell type are GI stromal tumours derived from?

A

Interstitial cells of Cajal - pacemaker cells for peristalsis

28
Q

What specific targeted treatment may be used to treat GI stromal tumours?

29
Q

What unpredictable behaviour may a GI stromal tumour show?

A

Pleomorphism
Mitoses
Necrosis

30
Q

Why are large intestinal adenomas dangerous?

A

Malignant potential

Precursor to adenocarcinoma

31
Q

What is familial adenomatous polyposis?

A

Autosomal dominant condition leading to thousands of adenomas and a high risk of cancer

32
Q

What prophylaxis may be used in FAP?

A

Prophylactic colectomy

33
Q

What is Gardner’s syndrome?

A

Similar to FAP with bone and soft tissue tumours

34
Q

How is the adenoma-carcinoma sequence proved?

A

Synchronous lesions
Metachronous lesions - after one more likely to get other
Anatomical distribution is similar

35
Q

What is the commonest GI malignancy?

A

Colorectal adenocarcinoma

36
Q

What is the macroscopic appearance of colorectal adenocarcinoma?

A

60-70% rectosigmoid
Fungating
Stenotic

37
Q

What is the microscopic appearance of colorectal adenocarcinoma?

A

Moderately differentiated
Mucinous
Signet ring cell

38
Q

How can colorectal adenocarcinoma spread?

A

Through bowel wall to adjacent organs e.g. bladder
Lymphatics to mesenteric lymph nodes
Portal venous system to liver

39
Q

What staging is used in colorectal adenocarcinoma?

A

Dukes’

TNM

40
Q

Describe the Dukes’ staging of colorectal adenocarcinoma:

A

A - confined to bowel wall
B - through wall (outer layer of muscle)
C - lymph nodes involved
(C1/C2 highest node clear/involved)

41
Q

Give examples of some mutations found in colorectal adenocarcinoma:

A

FAP, ras, p53 loss/inactivation

42
Q

What are some risk factors for colorectal adenocarcinoma?

A

Low fibre diet
High fat intake
Genetics
IBD

43
Q

What treatments are there for colorectal adenocarcinoma?

A

Surgery with local radiotherapy
Resection of liver deposits
Chemotherapy (palliative)

44
Q

Where may colorectal adenocarcinoma metastasise to?

45
Q

Describe the morphology of carcinoma of the pancreas:

A

2/3 in head
Firm pale mass with necrotic, haemorrhagic and cystic surface
May infiltrate adjacent structures e.g. spleen

46
Q

What is the most common type of carcinoma of the pancreas?

A

Ductal adenocarcinoma

47
Q

What are some symptoms of carcinoma of the pancreas?

A

Weight loss
Jaundice
Trousseau’s sign - blood clots on skin

48
Q

What tumour may block the bile duct causing jaundice?

A

Carcinoma of the Ampulla of Vater

49
Q

Name some islet cell tumours:

A

Insulinoma
Glucagonoma
VIPoma
Gastrinoma

50
Q

What is the most common cancer in liver?

A

Metastasis

51
Q

What benign tumours of the liver are there?

A

Hepatic adenoma

Bile duct adenoma

52
Q

What malignant tumours of the liver are there?

A

Hepatocellular carcinoma

Cholangiocarcinoma

Gastrointestinal Tract (11 decks)

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