8 Cancer of the alimentary tract

Question 1

Describe Barret’s esophagus

Answer 1

It occurs due to gastric reflux
- Squamous epithelium turns into the columnar lined epithelium
- This can develop into dysplasia
> low-grade dysplasia has a 0.5% chance of having an adenocarcinoma
> high-grade dysplasia has a 7% chance of having an adenocarcinoma

Question 2

Describe the management available for Barret’s esophagus

Answer 2

• Adenocarcinoma - therefore not responsive to radiotherapy
• Is it surgically resectable? - curative intent only
• Palliative insertion of a tube?

Question 3

List the clinical features of carcinoma of the esophagus

Answer 3

• Dysphasia
• Weight loss
• Chest pain/pressure
• Worsening indigestion/heartburn
• Coughing or hoarseness

Normal epithelium of the esophagus is squamous - most tumors are squamous carcinomas

Spread is by local extension, nodal spread, and vascular spread

Question 4

List some oesophageal cancer risk factors

Answer 4

• Reflux (GORD)
• Smoking
• Barret’s esophagus (Adeno)
• Obesity
• Alcohol
• Bile reflux
• Hot liquid
• Male
• Older age

Question 5

List some clinical features of carcinoma of the stomach

Answer 5

• Adenocarcinoma
• Poorly differentiated adenocarcinoma can have a ‘signet ring cell’ pattern
• Metastasis is common (blood-borne)

Question 6

List some risk factors for carcinoma of the stomach

Answer 6

• Helicobacter infection
• Family history of gastric cancer
• Pernicious anemia
• Age
• Alcohol
  The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM), and dysplasia

Question 7

Discuss the survival rates of carcinoma of the stomach

Answer 7

• Majority of gastric cancers worldwide are diagnosed at a late stage, resulting in a poor prognosis, with a 29% average 5-year survival
• The UK all-stage average 5-year survival rate is 18%, compared with an 80% average 5-year survival for stage 1A

Question 8

Describe some clinical features of carcinomas of the colon

Answer 8

Always almost an adenocarcinoma

• Carcinomas on the right site (caecum) commonly present because of bleeding with anemia
• Spread is to lymph nodes, and by blood to the liver
• Histologically, poorly differentiated colonic adenocarcinoma can be seen
• Survival is better than other colo-rectal cancers (almost 60% survive their cancer for 10 years or more)

Question 9

List some risk factors for carcinomas of the colon

Answer 9

• Family history: 35% CRC are due to heritable factors
• Inherited syndromes: familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC).
• Racial/ethnicity: African Americans have the highest incidence in the UK; Ashkenazi Jews
• Lifestyle: Diet; red and processed meats, very high-temperature cooking.
  > Diet rich in fruits, veg and high fibre grains may reduce risk
  > Inactive lifestyle/Obesity/Type II diabetes mellitus
  > Smoking
  > Alcohol use
• Age
• History of colorectal cancer or polyps
• History of IBS (Irritable bowel syndrome)

Question 10

Describe carcinoma of the rectum

Answer 10

• Nearly always an adenocarcinoma
• Clinical features: bleeding or obstruction
• Resection at an early stage can be curative