16) Common GI Malignancies Flashcards
Which organs are common GI malignancies found in?
Oesophagus Stomach Large intestine Pancreas Liver
What percentage of malignancies in UK are oesophageal carcinoma?
2%
How does oesophageal carcinoma present?
Dysphagia (worsening as tumour grows)
Weight loss
What investigations may be used for suspected oesophageal carcinoma?
Endoscopy, biopsy, barium
What is the most common type of oesophageal carcinoma and where does it occur?
Squamous cell carcinoma
May occur at any level
What is the second most common type of oesophageal carcinoma and where does it occur?
Adenocarcinoma
Lower third, associated with Barrett’s oesophagus
How does an oesophageal adenocarcinoma progress?
Arises in metaplastic epithelium of Barrett’s oesophagus and progresses through dysplasia
Why is the prognosis of oesophageal carcinoma so bad?
Advanced disease at presentation, as usually spread through oesophageal wall
Only 40% resectable
What is the five year survival of oesophageal carcinoma?
5%
What treatment can be given in oesophageal cancer to relieve symptoms?
Local radiotherapy to shrink tumour
Tube passed through tumour to facilitate swallowing
What things is gastric cancer associated with?
Blood group A
Gastritis
How does gastric cancer present?
Vague symptoms: epigastric pain, vomiting, weight loss
What investigations may be done if gastric cancer is suspected?
Endoscopy, biopsy, barium
What are some macroscopic features of gastric cancer?
Fungating
Ulcerating
Infiltrative (linitis plastica)
What two types of microscopic gastric cancer can be seen?
Intestinal
Diffuse
What are the features of intestinal gastric cancer?
Variable degree of gland formation
What are the features of diffuse gastric cancer?
Single cell or small groups
Signet ring cells
Why are the nuclei of signet ring cells at the peripheries?
Signet ring cell is full of mucins so pushes nucleus
Describe early gastric cancer:
Confined to mucosa/submucosa
Good prognosis
Describe advanced gastric cancer:
Further spread, 10% five year survival
How can gastric cancer spread?
Direct - through gastric wall
Lymph nodes
Liver
Trans-coelomic - into peritoneal cavity, can deposit here and spread to ovaries
What structures may be affected by the direct spread of gastric cancer?
Duodenum, transverse colon and pancreas
What treatment is there for gastric cancer?
Surgery (curative)
Chemotherapy
Herceptin (HER receptor)
How is H. pylori associated with gastric cancer?
Chronic inflammation and metaplasia can lead to cancer
What other GI cancer is associated with H. pylori?
Gastric lymphoma
How can gastric lymphoma be treated?
Eradication of H. pylori may lead to tumour regression
Otherwise, chemotherapy and surgery
What cell type are GI stromal tumours derived from?
Interstitial cells of Cajal - pacemaker cells for peristalsis
What specific targeted treatment may be used to treat GI stromal tumours?
Imatinib
What unpredictable behaviour may a GI stromal tumour show?
Pleomorphism
Mitoses
Necrosis
Why are large intestinal adenomas dangerous?
Malignant potential
Precursor to adenocarcinoma
What is familial adenomatous polyposis?
Autosomal dominant condition leading to thousands of adenomas and a high risk of cancer
What prophylaxis may be used in FAP?
Prophylactic colectomy
What is Gardner’s syndrome?
Similar to FAP with bone and soft tissue tumours
How is the adenoma-carcinoma sequence proved?
Synchronous lesions
Metachronous lesions - after one more likely to get other
Anatomical distribution is similar
What is the commonest GI malignancy?
Colorectal adenocarcinoma
What is the macroscopic appearance of colorectal adenocarcinoma?
60-70% rectosigmoid
Fungating
Stenotic
What is the microscopic appearance of colorectal adenocarcinoma?
Moderately differentiated
Mucinous
Signet ring cell
How can colorectal adenocarcinoma spread?
Through bowel wall to adjacent organs e.g. bladder
Lymphatics to mesenteric lymph nodes
Portal venous system to liver
What staging is used in colorectal adenocarcinoma?
Dukes’
TNM
Describe the Dukes’ staging of colorectal adenocarcinoma:
A - confined to bowel wall
B - through wall (outer layer of muscle)
C - lymph nodes involved
(C1/C2 highest node clear/involved)
Give examples of some mutations found in colorectal adenocarcinoma:
FAP, ras, p53 loss/inactivation
What are some risk factors for colorectal adenocarcinoma?
Low fibre diet
High fat intake
Genetics
IBD
What treatments are there for colorectal adenocarcinoma?
Surgery with local radiotherapy
Resection of liver deposits
Chemotherapy (palliative)
Where may colorectal adenocarcinoma metastasise to?
Liver
Describe the morphology of carcinoma of the pancreas:
2/3 in head
Firm pale mass with necrotic, haemorrhagic and cystic surface
May infiltrate adjacent structures e.g. spleen
What is the most common type of carcinoma of the pancreas?
Ductal adenocarcinoma
What are some symptoms of carcinoma of the pancreas?
Weight loss
Jaundice
Trousseau’s sign - blood clots on skin
What tumour may block the bile duct causing jaundice?
Carcinoma of the Ampulla of Vater
Name some islet cell tumours:
Insulinoma
Glucagonoma
VIPoma
Gastrinoma
What is the most common cancer in liver?
Metastasis
What benign tumours of the liver are there?
Hepatic adenoma
Bile duct adenoma
What malignant tumours of the liver are there?
Hepatocellular carcinoma
Cholangiocarcinoma
