2. Tumours of the Upper GIT Flashcards
What is the classification for benign and malignant tumours of the oesophagus
Benign:
- Mesenchymal e.g. Leiomyomas (Smooth muscle)
- Squamous papillomas
Malignant:
- Squamous cell carcinoma
- Adenocarcinoma
What is the classification of benign and malignant tumours of the stomach
Benign:
- Polyps: Non-neoplastic, adenomas
- Mesenchymal
Malignant:
- Carcinoma (epithelial cells)
- Lymphoma
- Carcinoid
- Mesenchymal
Sqaumous cell carcinoma: Incidence? Associated factors? Morphology? (Location, structure and patterns) Clinical features? Prognosis
SSC
Incidence:
->50
-More males
Associated factors:
- Diet: Vitamin deficiency, fungal contamination of foods, high content of nitrites/nitrosamines
- Lifestyle: Hot food/drinks, alcohol, tobacco
- Oesophageal disorders: Long standing oesophagitis and achalasia
- Genetic predisposition
Morphology:
- Location: Mainly in middle 1/3 of oesophagus
- Small, gray/white, plaque-like thickenings that become tumours masses
- Three patterns:
1. Protruded polypoid exophytic
2. Flat, diffuse, infiltrative,
3. Exacavated, ulcerated
Clinical features:
- Dysphagia
- Extreme weight loss
- Haemorrhage and sepsis
- Metastases to lymph nodes
- Cancerous TEF
Prognosis: 5% overall five-year survival
Adenocarcinoma: Where does it occur? Incidence? Associations? Morphology? Histology? Clinical features? Prognosis?
In lower 1/3 of oesophagus
Incidence: Age 40
Associations:
- Arise from Barrett Mucosa (intestinal metaplasia caused by gastric reflux)
- Tobacco and obesity
Morphology:
- Flat/ raised patches or nodular masses
- May be infiltrative or deeply ulcerative
Histology:
Mucin producing glandular tumours
Clinical features: • Dysphagia • Progressiveweightloss • Bleeding • Chestpain • Vomiting • Heartburn • Regurgitation
Prognosis: 20% overall five year survival
How is TNM staging of tumours broken down?
Tis carcinoma in situ
T1 invasion of submucosa
T2 invasion of muscularis propria T3 invasion of adventitia
T4 invasion of adjacent structures
N0 no node spread
N1 regional node metastases
M0 no distant spread
M1 distant metastases
What is a polyp?
Module or mass that projects above the level of the surrounding mucosa, usually at the Antrum
What is the most common malignant tumour of the stomach?
Gastric carcinoma
What are the environmental, host and genetic factors of gastric carcinomas?
Environmental:
- Infection ny H pylori
- Diet
- Low socioeconomic status
- Cigarette smoking
Host:
- Chronic gastritis
- Gastric adenomas
- Barrett oesophagus
Genetic:
- Increased risk with blood group A
- Family history
- Hereditary non-polyposis
- Familial gastric carcinoma syndrome
Gastric carcinoma: Location? Classification? Macroscopic growth factors? Morphology? Clinical features? Prognosis?
Location:
-Pylorus and Antrum **
Classification on the basis of:
- Depth of invasion
- Macroscopic growth pattern
- Histological subtype
Macroscopic growth patterns:
- Exophytic
- Flat or depressed –> Linitis plastica
- Excavated
Morphology:
- All carcinomas eventually spread to regional and more distant lymph nodes.
- ->Supraclavicular node
- ->Local invasion to duodenum, pancreas and retroperitoneum
- Metastases to the liver and lungs are common
- Metastases to the liver and lungs
- Metastases to the ovaries called Krukenberg tumour
Clinical features: • Asymptomatic until late • Weight loss • Abdominal pain • Anorexia • Vomiting • Altered bowel habits • Dysphagia • Anaemic symptoms • Haemorrhage
Prognosis: 90-95% for early gastric cancer. Less than 15% for advanced
What is the histopathology of intestinal, diffuse and mixed type gastric adenocarcinomas?
[LAUREN CLASSIFICATION]
Intestinal type:
- Composed of neoplastic intestinal glands resembling those of colonic adenocarcinoma
- Cells often contain apical mucin vacuoles
Diffuse type:
- Composed of gastric-type mucous cells which permeate the mucosa and wall as scattered individual cells or small clusters in a n “infiltrative” growth pattern
- Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring”
Mixed type
Gastric lymphoma: What are they? Associations? Prognosis? Morphology?
What are they?
B cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas)
Associations: Chronic gastritis and H. pylori infection
Prognosis: 50% five year survival
Morphology:
- Occurs in mucosa and superficial submucosa
- Lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction
