16) Common GI Malignancies

Question 1

Which organs are common GI malignancies found in?

Answer 1

Oesophagus 
Stomach
Large intestine 
Pancreas
Liver

Question 2

What percentage of malignancies in UK are oesophageal carcinoma?

Answer 2

2%

Question 3

How does oesophageal carcinoma present?

Answer 3

Dysphagia (worsening as tumour grows)

Weight loss

Question 4

What investigations may be used for suspected oesophageal carcinoma?

Answer 4

Endoscopy, biopsy, barium

Question 5

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

Answer 5

Squamous cell carcinoma

May occur at any level

Question 6

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

Answer 6

Adenocarcinoma

Lower third, associated with Barrett’s oesophagus

Question 7

How does an oesophageal adenocarcinoma progress?

Answer 7

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

Question 8

Why is the prognosis of oesophageal carcinoma so bad?

Answer 8

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

Question 9

What is the five year survival of oesophageal carcinoma?

Answer 9

5%

Question 10

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

Answer 10

Local radiotherapy to shrink tumour

Tube passed through tumour to facilitate swallowing

Question 11

What things is gastric cancer associated with?

Answer 11

Blood group A

Gastritis

Question 12

How does gastric cancer present?

Answer 12

Vague symptoms: epigastric pain, vomiting, weight loss

Question 13

What investigations may be done if gastric cancer is suspected?

Answer 13

Endoscopy, biopsy, barium

Question 14

What are some macroscopic features of gastric cancer?

Answer 14

Fungating
Ulcerating
Infiltrative (linitis plastica)

Question 15

What two types of microscopic gastric cancer can be seen?

Answer 15

Intestinal

Diffuse

Question 16

What are the features of intestinal gastric cancer?

Answer 16

Variable degree of gland formation

Question 17

What are the features of diffuse gastric cancer?

Answer 17

Single cell or small groups

Signet ring cells

Question 18

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

Answer 18

Signet ring cell is full of mucins so pushes nucleus

Question 19

Describe early gastric cancer:

Answer 19

Confined to mucosa/submucosa

Good prognosis

Question 20

Describe advanced gastric cancer:

Answer 20

Further spread, 10% five year survival

Question 21

How can gastric cancer spread?

Answer 21

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

Question 22

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

Answer 22

Duodenum, transverse colon and pancreas

Question 23

What treatment is there for gastric cancer?

Answer 23

Surgery (curative)
Chemotherapy
Herceptin (HER receptor)

Question 24

How is H. pylori associated with gastric cancer?

Answer 24

Chronic inflammation and metaplasia can lead to cancer

Question 25

What other GI cancer is associated with H. pylori?

Answer 25

Gastric lymphoma

Question 26

How can gastric lymphoma be treated?

Answer 26

Eradication of H. pylori may lead to tumour regression | Otherwise, chemotherapy and surgery

Question 27

What cell type are GI stromal tumours derived from?

Answer 27

Interstitial cells of Cajal - pacemaker cells for peristalsis

Question 28

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

Answer 28

Imatinib

Question 29

What unpredictable behaviour may a GI stromal tumour show?

Answer 29

Pleomorphism Mitoses Necrosis

Question 30

Why are large intestinal adenomas dangerous?

Answer 30

Malignant potential | Precursor to adenocarcinoma

Question 31

What is familial adenomatous polyposis?

Answer 31

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

Question 32

What prophylaxis may be used in FAP?

Answer 32

Prophylactic colectomy

Question 33

What is Gardner's syndrome?

Answer 33

Similar to FAP with bone and soft tissue tumours

Question 34

How is the adenoma-carcinoma sequence proved?

Answer 34

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

Question 35

What is the commonest GI malignancy?

Answer 35

Colorectal adenocarcinoma

Question 36

What is the macroscopic appearance of colorectal adenocarcinoma?

Answer 36

60-70% rectosigmoid Fungating Stenotic

Question 37

What is the microscopic appearance of colorectal adenocarcinoma?

Answer 37

Moderately differentiated Mucinous Signet ring cell

Question 38

How can colorectal adenocarcinoma spread?

Answer 38

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

Question 39

What staging is used in colorectal adenocarcinoma?

Answer 39

Dukes' | TNM

Question 40

Describe the Dukes' staging of colorectal adenocarcinoma:

Answer 40

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

Question 41

Give examples of some mutations found in colorectal adenocarcinoma:

Answer 41

FAP, ras, p53 loss/inactivation

Question 42

What are some risk factors for colorectal adenocarcinoma?

Answer 42

Low fibre diet High fat intake Genetics IBD

Question 43

What treatments are there for colorectal adenocarcinoma?

Answer 43

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

Question 44

Where may colorectal adenocarcinoma metastasise to?

Answer 44

Liver

Question 45

Describe the morphology of carcinoma of the pancreas:

Answer 45

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

Question 46

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

Answer 46

Ductal adenocarcinoma

Question 47

What are some symptoms of carcinoma of the pancreas?

Answer 47

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

Question 48

What tumour may block the bile duct causing jaundice?

Answer 48

Carcinoma of the Ampulla of Vater

Question 49

Name some islet cell tumours:

Answer 49

Insulinoma Glucagonoma VIPoma Gastrinoma

Question 50

What is the most common cancer in liver?

Answer 50

Metastasis

Question 51

What benign tumours of the liver are there?

Answer 51

Hepatic adenoma | Bile duct adenoma

Question 52

What malignant tumours of the liver are there?

Answer 52

Hepatocellular carcinoma | Cholangiocarcinoma