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Semester 3 > GI 10 malignancy > Flashcards

GI 10 malignancy Flashcards

1
Q

What are the common GI malignancies?

A 
Oesophagus
Stomach
Large intestine
Pancreas
liver
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2
Q

What % of malignancies in the UK are oesophageal carcinoma?

A

2%

Male>female

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3
Q

What are the clinical features of oesophageal carcinoma?

A

Dysphagia - progressively worsening

Weight loss

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4
Q

What investigations are done to confirm a diagnosis of GI malignancy?

A

Endoscopy
Biopsy
Barium

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5
Q

What are the pathological features of oesophageal carcinoma?

A

Squamous:
Most common
May occur at any level

Adenocarcinoma:
Uncommon
Lower 1/3
Association with Barrett’s oesophagus

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6
Q

What is the presumed pathogenesis of squamous cell oesophageal carcinoma?

A

Progression through dysplasia

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7
Q

Describe the pathogenesis of adenocarcinoma of the oesophagus.

A

Arises metaplastic epithelium of Barrett’s oesophagus
Progresses through dysplasia
Controversy over follow-up

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8
Q

What is the prognosis of oesophageal carcinoma?

A

Advanced disease at presentation in most cases
Direct spread through oesophageal wall
Only 40% resectable
Many patients have a tube passed through tumour to facilitate swallowing
5% five year survival

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9
Q

How common is gastric cancer and what is the prognosis?

A

15% of cancer deaths worldwide
Poor prognosis
5 year survival <20%

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10
Q

Who is gastric cancer most common in?

A

Men > women
Japan
Associated with gastritis
Commoner in blood group A

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11
Q

What are the clinical features of gastric cancer?

A

Symptoms often vague
Epigastric pain
Vomiting
Weight loss

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12
Q

What are the macroscopic features of gastric cancer?

A

Fungating
Ulcerating
Infiltrative (linitis plastica)
Early

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13
Q

What are the microscopic features of gastric cancer?

A

Intestinal - variable degree of gland formation

Diffuse - single cell and small groups, signet ring cells

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14
Q

What are the differences in early and advanced gastric cancer?

A

Early - confined to mucosa/sub-mucosa, described in Japan, good prognosis
Advanced - Further spread, common in UK, <10% five year survival

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15
Q

How does gastric cancer spread?

A

Direct
Lymph nodes
Trans-coelomic - peritoneum/ovaries
Liver

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16
Q

What bacteria is associated with gastric cancer?

A

H. pylori - general association of chronic inflammation with cancer

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17
Q

What is the most common GI lymphoma? Give some details.

A

Gastric lymphoma
Starts as low-grade lesion
Strong association with Hp
Eradication of Hp may lead to regression of tumour
Prognosis much better than gastric cancer

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18
Q

Describe GI stromal tumours.

A 
Uncommon
Derived from interstitial cells of Cajal
C-kit (CD117)
Specific targeted treatment
Unpredictable behaviour - pleomorphism, mitoses, necrosis
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19
Q

What are the different types of tumours of the large intestine?

A

Adenomas
Ademocarcinomas
Polyps
Anal carcinoma

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20
Q

What are the macroscopic and microscopic features of large intestinal adenomas?

A

Macro - sessile or pedunculated

Micro - variable degree of dysplasia

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21
Q

What is the incidence of large intestinal adenomas?

A

Increase with age in western population
Genetic syndromes associated
Definite malignant potential

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22
Q

What genetic conditions are associated with large intestinal adenomas?

A

Familial adenomatous polyposis - autosomal dominant, chromosome 5. Thousands of adenomas by 20ys. High risk of cancer
Gardner’s syndrome - similar to FAP. Bone and soft tissue tumours

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23
Q

How are adenomas and carcinomas similar?

A

Geographical and anatomical distribution
Synchronous and metachronous lesions
Adenomas with invasion

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24
Q

What are the macroscopic features of colorectal adenocarcinoma?

A

60-70% rectosigmoid
Fungating (esp right)
Stenotic (esp left)

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25
Q

What are the microscopic features of colorectal adenocarcinoma?

A

Moderately differentiated

Occasionally mutinous and signet ring cell types present

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26
Q

How does colorectal adenocarcinoma spread?

A

Direct through bowel wall to adjacent organs e.g. bladder
Via lymphatics to mesenteric lymph nodes
Via portal venous system to liver

27
Q

How is colorectal adenocarcinoma staged?

A

Duke’s staging:
A - confined to bowel wall
B - through wall, lymph nodes clear
C - Lymph nodes involved

TNM

28
Q

What genetic conditions are associated with colorectal adenocarcinoma?

A

FAP - chromosome 5
RAS mutations
18q (DCC) deletion
17p (p53) loss/inactivation

29
Q

What is the incidence of colorectal adenocarcinoma?

A

peak 60-70
High UK/USA, low Japan
Polyposis syndromes
UC (and crohn’s) associated

30
Q

What is the aetiology of colorectal adenocarcinoma?

A

Low residue diet
Slow transit time
High fat intake
Genetic predisposition

31
Q

What are the likely outcomes for colorectal adenocarcinoma?

A

Survival reduces with increasing Duke’s staging
Liver metastases common in advanced disease
Chemotherapy - palliative
Resection of liver deposits gaining support
Local radiotherapy for incompletely excised lesions

32
Q

What are some other large intestinal tumours?

A

Carcinoid tumour - rare neuro-endocrine tumour, difficult to predict behavious
Lymphoma - rare, may be primary or spread from elsewhere
Smooth muscle/stromal tumours - rare and unpredictable

33
Q

How is pancreatic carcinomaa diagnosed?

A

Imaging. Usually delayed, early symptoms vague -> weight loss, jaundice, Trousseau’s sign

34
Q

Describe the morphology of carcinoma of the pancreas

A

2/3 in head
Firm, pale mass
Cut surface - necrotic, haemorrhagic, cystic
May infiltrate adjacent structures e.g. spleen

35
Q

What is the histology of carcinoma of the pancreas?

A

80% ductal adenocarcinomas
Well-formed glands +/- mucin
Some acinar tumours containing zymogen granules
All types have a poor prognosis

36
Q

Describe the different islet cell tumours

A 
Rare
Insulinoma - hypoglycaemia
Glucagonoma -> characteristic skin rash
VIPoma -> Werner Morrison syndrome
Gastrinoma -> Zollinger-Ellison syndrome
37
Q

What are the different types of benign liver tumours?

A

Hepatic adenoma
Bile duct adenoma/hamartoma
Haemangioma

38
Q

What are the different primary malignant liver tumours?

A

Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma
etc

39
Q

What are the options for imaging the GIT?

A 
Plain x-ray
Contrast studies
Ultrasound
Cross-sectional imaging
Angiography
40
Q

What are the risks of using radiation?

A

Carcinogenesis
Genetic
Development risk of foetus

41
Q

When would you request an abdominal x-ray?

A

Acute abdominal pain
Small or large bowel obstruction
acute exacerbation of IBD
Renal colic

42
Q

What are the features of an AXR?

A

Bowel pattern
Soft tissue structures
Bones

43
Q

When is a part of a hollow tube visible in and AXR?

A

When gas filled - low density gas acts as a contrast

Fully fluid filled not visible

44
Q

How are abnormal gas patterns viewed?

A 
Small bowel obstruction >3cm
Large bowel obstruction >6cm - competent ileocaecal valve (caecum >9cm), incompetent ileocaecal valve
May be seen:
in the ileum, 
volvulus 
toxic megacolon
(rule of 3s - 3/6/9)
45
Q

What is the presentation of a small bowel obstruction?

A

Vomiting (early)
Distension (mild)
Absolute constipation (late)
Colicky pain

46
Q

What are the causes of small bowel obstruction?

A

Adhesion
Hernias
Tumours
Inflammation

47
Q

What is the presentation of a large bowel obstruction?

A

Vomiting (late, faeculant)
Distension (significant)
Pain
Absolute constipation

48
Q

Wat are the causes of large bowel obstruction?

A 
Colorectal carcinoma
Diverticular stricture
Hernia
Volvulus
Pseudo-obstruction
49
Q

What is a volvulus?

A

Twisting around mesentery
Enclosed bowel loop - dilates - perforation, ischaemia

Sigmoid volvulus common, caecal uncommon

50
Q

What are the classic signs of sigmoid volvulus on an AXR?

A

Coffee bean sign towards RUQ, dilation of proximal bowel

51
Q

What are the classic signs of a caecal volvulus?

A

‘mobile’ caecum (20%) with mesentery

52
Q

Can AXR be used to see inflammation and infection?

A

Yes but not god standard - will see:
Mucosal thickening
Featureless colon
Bowel wall oedema

53
Q

What is toxic megacolon?

A

Acute deterioration with UC or colitis
Colon dilatation
Oedema
Pseudopolyps

54
Q

What are the features of lead pipe colon?

A

featureless colon
loss of hausfrau
Chronic UC

55
Q

What other abnormalities can be seen in AXR?

A 
Stones
Organs/masses
Calcification - pancreatitis, vascular, nodes
Bones
Artefact
Foreign body
56
Q

What might cause perforation in the GIT?

A 
Peptic ulcer
Diverticular
Tumour
Obstruction
Trauma
Iatrogenic
57
Q

What contrast studies are used to define hollow viscera?

A

Barium

Water soluble

58
Q

What are the common GI contrast studies?

A

Swallowing
Meal
Follow through
Enema

59
Q

What is used for an abdominal CT scan?

A

High dose radiation
IV or oral/rectal contrast
Good spatial resolution

60
Q

What does CT stand for?

A

computerized axial tomography

61
Q

What does MRI stand for?

A

Magnetic resonance imaging

62
Q

What are the pros and cons of MRI?

A

No radiation
Good spatial and contrast resolution
Time consuming

63
Q

How does an ultrasound work?

A

Use of sound waves to generate image - frequency above audible range of human hearing
Cheap, portable but highly dependent on user

Semester 3 (19 decks)

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