cancer of the alimentary tract Flashcards
common GI tract cancers
oesophagus
stomach
colorectal
what is carcinoma
cancer derived from epithelial cells
squamous cell carcinoma:
squamous epithelium in oesophagus
adenocarcinoma- glandular
columnar epithelium
TNM staging
Primary tumour (T)
TX: Primary tumour cannot be assessed
T0: No evidence of primary tumour
Tis: Carcinoma in situ: intraepithelial or invasion of the lamina propria*
T1: Tumour invades submucosa
T2: Tumour invades muscularis propria
T3: Tumour invades through the muscularis propria into the subserosa
T4: Tumour directly invades other organs or structures and/or perforates visceral peritoneum
Nodal disease Histology Grade
0 –None G1: Well differentiated
1 - 1-2 +ve regional lymph nodes G2 Moderately differentiated
2 - 3-6 +ve regional lymph nodes G3 Poorly differentiated
3 - =>7 +ve regional lymph nodes G4 Undifferentiated
Metastatic disease
M0 – None
M1 - Distant metastases
survival
> 40% survive 1 year or more after diagnosis
15% survive 5 years
10% survive 10 years
Stage 1: 55% survive 5 years
Stage 2: 30% survive 5 years
Stage 3 15% survive 5 years
Stage 4: No data – very poor outlook
clinical features of carcinoma in the oesophagus
Dysphagia, wt loss, chest pain/ pressure, worsening indigestion/heartburn, coughing or hoarseness
biological features of carcinoma in the oesophagus
Normal epithelium of oesophagus is SQUAMOUS – most tumours worldwide are squamous carcinomas.
Adenocarcinoma arising in metaplastic epithelium- lower oesophagus – increasing incidence – in US overtakes squamous cancer
Spread is by local extension, nodal spread and vascular spread
oesophageal cancer risk factors
GORD Male Smoking Older age Barrett’s Oesophagus (Adeno) Obesity Alcohol Bile Reflux Hot liquids
clinical features of carcinoma of the stomach
- carcinoma of stomach is adenocarcinoma
- poorly differentiated adenocarcinoma can have a ‘signet ring cell’ pattern
- metastasis to the liver is common (blood-borne)
risk factors of stomach cancer
Helicobacter Infection Family history of gastric cancer Pernicious anaemia Age Alcohol
The stages in the progression to cancer include chronic gastritis, gastric atrophy (GA), gastric intestinal metaplasia (GIM) and dysplasia
survival of stomach cancers
Majority of gastric cancers worldwide are diagnosed at a late stage, resulting in 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.
carcinoma of the colon
- nearly always adenocarcinoma
Carcinomas on the right side (caecum) commonly present because of bleeding with anaemia.
Spread is to lymph nodes and, by blood, to liver.
colorectal cancer survival
Approx 75% survive their cancer for 1 year or more
Approx 60% survive their cancer for 5 years or more
Almost 60% survive their cancer for 10 years or more
Rectal cancer
Approx 80% survive their cancer for 1 year or more
5 and 10 year survival similar to colorectal
risk factors for colorectal cancer
Family history: 35% CRC due to heritable factors
Inherited syndromes: Familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). Lynch, Turcot, Peutz-Jeghers, Juvenile Polyposis Syndrome.
Racial/ethnicity: African Americans highest incidence in US. Ashkenazi Jews .
Lifestyle
Diet: Red and processed meats. Very high temperatures cooking. Diet rich in fruits, vegetables and high-fibre grains may reduce risk.
Inactive lifestyle /Obesity/ Type II DM (rectal)
Smoking
Alcohol use
Age
Hx of CRC or polyps
Hx of IBD
carcinoma of the rectum
- nearly always adenocarcinoma
Clinical features: bleeding or obstruction
Resection at an early stage can be curative
