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3 - GI > deck_1666075 > Flashcards

deck_1666075 Flashcards

1
Q

What are the common GI malignancies?

A

OesophagusStomachLiverPancreas Large Intestine

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2
Q

Give some epidemiological features of oesophageal cancer

A

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

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3
Q

WHat are the clinical features of oesophageal carcinoma?

A

Dyspepsia as tumour occludes lumenWeight loss

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4
Q

What are the types of oesophageal carcinoma that you will see?

A

Squamous cell carcinomaAdenocarcinoma

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5
Q

Describe squamous cell carcinoma

A

Most common typeCan occur at any level

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6
Q

Give some suggested causes for squamous cell carcinoma

A

HPVTanninVitamin A and/or riboflavin deficiencyPossible progression through dysplasia

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7
Q

Describe Adenocarcinoma

A

Uncommon but are increasing in numbers Lower thirdAssociation with Barrett’s oesophagus- Change from squamous to columnar/glandular mucosa (metaplasia) then dysplasia

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8
Q

What is the prognosis for oesophageal carcinoma?

A

Tends to be at advanced stages at presentation - spread directly through oesophageal wallOnly 40% are resectableHave a 5% five year survival rate

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9
Q

Give some epidemiology for gastric cancer

A

– 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

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10
Q

Give some clinical features for gastric cancer

A

Vague symtoms- epigastric pain- vomiting- weight loss- anaemia due to bleeding

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11
Q

What are the main investigations for suspected gastric cancer?

A

EndoscopyBariumBiopsy

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12
Q

Give some of the macroscopic features of gastric cancer

A

FungatingUlceratingEarly — how far through the stomach the caancer has progressedInfiltrative– Linitis plastica - leather bottle stomach

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13
Q

Give some microscopic features of gastric cancer

A

Intestinal cancers –tubules have formedDiffuse cancers – single cells or small groups are present. Known as signet rings

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14
Q

Give the characteristics of early gastric cancer

A

Confined to the mucosa or submucosaHas a good prognosisOften foudn in Japan

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15
Q

Give the characteristics of advanced gastric cancer

A

Further spread is presentIs common in the UKHave about a 10% survival rate.

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16
Q

What are the ways in which gastric cancer can spread?

A
  1. Directly through gastric wall (affects duodenum, transverse colon and pancreas2. Lymph nodes3. Trans-coelomic- to peritoneum- or ovaries
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17
Q

What are the main treatments for gastric cancer?

A

Herceptin (amplifies HER1 gene, which help to limit spreadSurgery Chemotherapy

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18
Q

Describe how H pylori can lead to gastric cancer

A

H pylori infection to Acute Gastritisto Chronic Gastritisto Atrophic Gastritisto Intestinal Metaplasiato Dysplasia to Advanced Gastric Cancer

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19
Q

What does H pylori have a strong association with?

A

Gastric lymphoma- can cause regression with eradication of H pylori

20
Q

Describe gastric lymphoma

A

Is the commonest GI lymphomaStarts as a low-grade lesionPrognosis much better than gastric cancer

21
Q

What are gastrointestinal stromal tumour derived from?

A

Interstitial cells of Cajal- C-kit mutation

22
Q

What treatments are there for gastrointestinal stromal tumours and why is this the case?

A

Mutation makes it vulnerable to treatment- imanitib is a tyrosine kinase inhibitor

23
Q

Give some characteristics of gastrointestinal stromal tumours

A

Have unpredictable behaviour and show:pleomorphismMitosesNecrosis which leads to gastrointestinal haemmorhage

24
Q

What are the main tumours of the large intestine?

A

AdenomasAdenocarcinomaPolypsAnal Carcinoma

25
Q

What is a polyp?

A

Anything that sticks out into the lumen

26
Q

What are the main types of adenomas?

A
  1. Benign neoplastic lesions inthe large bowel dut to dysplasia2. Familial Adenomatous Polyposis3. Gardner’s Syndrome
27
Q

Describe the benign neoplastic lesions in the large bowel

A

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

28
Q

Describe Familial Adenomatous Poloposis

A

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.

29
Q

Describe Gardner’s Syndrome

A

Similar to FAP but also has extra-colonic tumours as well, such as osteomas, thyroid cancers, adenomas in spleen, stomach and duodenum

30
Q

Give some epidemiology for colorectal adenocarcinomas

A

Commonest GI malignancyabout 25,000 new cases in england and wales per year

31
Q

Give some macroscopic and microscopic features of colorectal cancers

A

Macroscopic– 60-70% rectosigmoid fungating/stenotic MicroscopicHave moderately different adenocarcinomas– Mucinous– Signet ring cell type

32
Q

How can colorectal cencers spread?

A

Directly through bowel wallThrough lymphatic system to mesenteric lymph nodesVia portal venous system to the liver

33
Q

What are the two types of staging for colorectal cancer?

A

TNMDukes

34
Q

What are some mutations that can lead to colorectal cancer?

A

FAP – Chromosome 5Ras mutations (N-ras and K-ras) p53 loss/inactivationDCC (deleted in colorectal cancer) gene Braf

35
Q

Describe the incidence of colorectal cancer

A

Peak at 60-70 yearsHigh in UK/USA, low in JapanPolyposis syndromesUC and Crohn’s sufferers can go on to develop cancers

36
Q

Give some possible causes of colorectal cancer

A

Low residue dietSlow transit timeHigh fat intakeGenetic predisposition

37
Q

Give some common treatments for colorectal cancers

A

Palliative chemotherapyResection of liver deposits if accessible. Helps to prolong disease-free survival Also have local radiotherapy

38
Q

Where do colorectal cancers commonly spread to?

A

Liver

39
Q

Give three other large intestine tumours

A

Carcinoid Tumour– Rare and unpredictable neuro-endocrine tumourLymphoma– Rare, may be primary or spread from elsewhereSmooth muscle/stromal tumours– Rare and unpredictable

40
Q

Descrive the morphology of carcinomas that appear in the pancreas

A

2/3 aare found in the headAre a firm pale mass with a necrotic centreCommonly infiltrate adjacent structures

41
Q

Describe the histology of carcinomas of hte pancreas

A

80% are ductal adenocarcinomasWell formed glands. may be mutinousSome acinar tumours contain zymogen granules - differentiation towards acinar cells rather than ductal cells

42
Q

Describe what happens in a carcinoma of the ampulla of vater

A

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.

43
Q

Describe some islet cell tumours

A

Are rare tumoursInsulinoma– Leading to hypoglycaemiaGlucagonoma–Causes a characteristic skin rash (thrombophlybitis)Vasoactive Intestinal Peptideoma (VIPoma)– Werner Morrison syndromeGastrinoma– Zollinger-Ellison syndrome

44
Q

What are the two types of tumour in the liver?

A

BenignMalignant

45
Q

Describe benign tumours of the liver

A

Are fairly rare- hepatic adenomas (occur more in women due to bis oestrogen and contraceptives)- bile duct adenoma- haemangioma

46
Q

Describe malignant tumours of the liver

A

Have both primary and metastatic malignant tumours of the liver- Hepatocellular carcinoma- Cholangiocarcinoma- Hepatoblastoma (occur in newborns)

3 - GI (36 decks)

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