deck_1666075 Flashcards
What are the common GI malignancies?
OesophagusStomachLiverPancreas Large Intestine
Give some epidemiological features of oesophageal cancer
Make up 2% of malignancies in the UKIs more common in males than in femalesHas a wide geographical variation- high around Caspian Sea and Parts of China
WHat are the clinical features of oesophageal carcinoma?
Dyspepsia as tumour occludes lumenWeight loss
What are the types of oesophageal carcinoma that you will see?
Squamous cell carcinomaAdenocarcinoma
Describe squamous cell carcinoma
Most common typeCan occur at any level
Give some suggested causes for squamous cell carcinoma
HPVTanninVitamin A and/or riboflavin deficiencyPossible progression through dysplasia
Describe Adenocarcinoma
Uncommon but are increasing in numbers Lower thirdAssociation with Barrett’s oesophagus- Change from squamous to columnar/glandular mucosa (metaplasia) then dysplasia
What is the prognosis for oesophageal carcinoma?
Tends to be at advanced stages at presentation - spread directly through oesophageal wallOnly 40% are resectableHave a 5% five year survival rate
Give some epidemiology for gastric cancer
– second most common GI malignancy– approximately 11,000 new cases in England and Wales each year.– is common– men are more affected than women– Associated with gastrisis from H pylori– commoner in blood group A
Give some clinical features for gastric cancer
Vague symtoms- epigastric pain- vomiting- weight loss- anaemia due to bleeding
What are the main investigations for suspected gastric cancer?
EndoscopyBariumBiopsy
Give some of the macroscopic features of gastric cancer
FungatingUlceratingEarly — how far through the stomach the caancer has progressedInfiltrative– Linitis plastica - leather bottle stomach
Give some microscopic features of gastric cancer
Intestinal cancers –tubules have formedDiffuse cancers – single cells or small groups are present. Known as signet rings
Give the characteristics of early gastric cancer
Confined to the mucosa or submucosaHas a good prognosisOften foudn in Japan
Give the characteristics of advanced gastric cancer
Further spread is presentIs common in the UKHave about a 10% survival rate.
What are the ways in which gastric cancer can spread?
- Directly through gastric wall (affects duodenum, transverse colon and pancreas2. Lymph nodes3. Trans-coelomic- to peritoneum- or ovaries
What are the main treatments for gastric cancer?
Herceptin (amplifies HER1 gene, which help to limit spreadSurgery Chemotherapy
Describe how H pylori can lead to gastric cancer
H pylori infection to Acute Gastritisto Chronic Gastritisto Atrophic Gastritisto Intestinal Metaplasiato Dysplasia to Advanced Gastric Cancer
What does H pylori have a strong association with?
Gastric lymphoma- can cause regression with eradication of H pylori
Describe gastric lymphoma
Is the commonest GI lymphomaStarts as a low-grade lesionPrognosis much better than gastric cancer
What are gastrointestinal stromal tumour derived from?
Interstitial cells of Cajal- C-kit mutation
What treatments are there for gastrointestinal stromal tumours and why is this the case?
Mutation makes it vulnerable to treatment- imanitib is a tyrosine kinase inhibitor
Give some characteristics of gastrointestinal stromal tumours
Have unpredictable behaviour and show:pleomorphismMitosesNecrosis which leads to gastrointestinal haemmorhage
What are the main tumours of the large intestine?
AdenomasAdenocarcinomaPolypsAnal Carcinoma
What is a polyp?
Anything that sticks out into the lumen
What are the main types of adenomas?
- Benign neoplastic lesions inthe large bowel dut to dysplasia2. Familial Adenomatous Polyposis3. Gardner’s Syndrome
Describe the benign neoplastic lesions in the large bowel
Macroscopic Features – Sessile or pedunculatedMicroscopic Features – Variable degree of dysplasia but all are dsyplastic, either low grade or high gradeMalignant PotentialIncidence increases with age in western population
Describe Familial Adenomatous Poloposis
An autosomal dominant condition on Chromosome 5 (APC gene). By the time the patient is 20 there are thousands of adenomas in the large intestine, giving a high risk of cancer. Treatment is removal of large bowel to prevents cancer development.
Describe Gardner’s Syndrome
Similar to FAP but also has extra-colonic tumours as well, such as osteomas, thyroid cancers, adenomas in spleen, stomach and duodenum
Give some epidemiology for colorectal adenocarcinomas
Commonest GI malignancyabout 25,000 new cases in england and wales per year
Give some macroscopic and microscopic features of colorectal cancers
Macroscopic– 60-70% rectosigmoid fungating/stenotic MicroscopicHave moderately different adenocarcinomas– Mucinous– Signet ring cell type
How can colorectal cencers spread?
Directly through bowel wallThrough lymphatic system to mesenteric lymph nodesVia portal venous system to the liver
What are the two types of staging for colorectal cancer?
TNMDukes
What are some mutations that can lead to colorectal cancer?
FAP – Chromosome 5Ras mutations (N-ras and K-ras) p53 loss/inactivationDCC (deleted in colorectal cancer) gene Braf
Describe the incidence of colorectal cancer
Peak at 60-70 yearsHigh in UK/USA, low in JapanPolyposis syndromesUC and Crohn’s sufferers can go on to develop cancers
Give some possible causes of colorectal cancer
Low residue dietSlow transit timeHigh fat intakeGenetic predisposition
Give some common treatments for colorectal cancers
Palliative chemotherapyResection of liver deposits if accessible. Helps to prolong disease-free survival Also have local radiotherapy
Where do colorectal cancers commonly spread to?
Liver
Give three other large intestine tumours
Carcinoid Tumour– Rare and unpredictable neuro-endocrine tumourLymphoma– Rare, may be primary or spread from elsewhereSmooth muscle/stromal tumours– Rare and unpredictable
Descrive the morphology of carcinomas that appear in the pancreas
2/3 aare found in the headAre a firm pale mass with a necrotic centreCommonly infiltrate adjacent structures
Describe the histology of carcinomas of hte pancreas
80% are ductal adenocarcinomasWell formed glands. may be mutinousSome acinar tumours contain zymogen granules - differentiation towards acinar cells rather than ductal cells
Describe what happens in a carcinoma of the ampulla of vater
Bile duct is blocked with a small tumour, which leads to obstructive jaundice. This leads to an early presentation whilst the tumour is still treatable.
Describe some islet cell tumours
Are rare tumoursInsulinoma– Leading to hypoglycaemiaGlucagonoma–Causes a characteristic skin rash (thrombophlybitis)Vasoactive Intestinal Peptideoma (VIPoma)– Werner Morrison syndromeGastrinoma– Zollinger-Ellison syndrome
What are the two types of tumour in the liver?
BenignMalignant
Describe benign tumours of the liver
Are fairly rare- hepatic adenomas (occur more in women due to bis oestrogen and contraceptives)- bile duct adenoma- haemangioma
Describe malignant tumours of the liver
Have both primary and metastatic malignant tumours of the liver- Hepatocellular carcinoma- Cholangiocarcinoma- Hepatoblastoma (occur in newborns)
