GI: Common GI malignancies Flashcards
How common is oesophageal carcinoma?
What is the prognosis of oesophageal carcinoma?
2% of malignancies in UK - More common in males
Usually presents as advanced disease and can spread directly through the oesophageal wall
Very poor prognosis - 5% 5yr survival
How does oesophageal carcinoma present?
How would you investigate it?
Progressive dysphagia - may start with dry foods, then all foods, then liquids
Weight loss
Investigate using endoscopy and biopsy
What are the 2 types of oesophageal carcinoma?
Squamous cell carcinoma: most common, can occur at any level
Adenocarcinoma: uncommon, occurs in the lower third and associated with barretts oesophagus
How common is gastric cancer and what is the prognosis?
Very common - 15% of cancer deaths world wide
Poor prognosis and more common in men, Associated with gastritis from H Pylori
How does gastric cancer present?
Often presents with vague symptoms - epigastric pain, vomiting (due to obstruction), weight loss
What are the microscopic features of gastric cancer?
Intestinal - variable gland formation
Diffuse - single cells and small groups, get signet ring cells that are full of mucin
How can gastric cancer spread?
- directly through the gastric wall
- via lymph nodes
- trans coelomic eg in peritoneum and ovaries
How is gastric cancer treated?
Surgery, chemotherapy, herceptin (used palliatively, same genetic abnormality seen in breast cancer)
Describe the features of large intestinal adenomas
They are always dysplastic and have definite malignant potential - increased risk of neoplasia even if removed
Increase with age
Some people have genetic syndromes which predispose to adenomas
What genetic condition predisposes to large intestinal adenoma?
Familial adenomatous polyposis - an autosomal dominant condition where there are thousands of adenomas by 20yrs with each having potential to turn cancerous
Need to have prophylactic colectomies
Where is the most common location for colorectal adenocarcinoma?
70% are in the sigmoid colon or rectum
How can colorectal adenocarcinoma spread?
Directly through the bowel wall to adjacent organs eg bladder
Via lymphatics to mesenteric lymph nodes
Via the portal venous system to the liver
How is colorectal adenocarcinoma staged?
Duke’s staging system
A = confined to bowel wall
B = through wall but lymph nodes clear
C = lymph nodes involved
What are the causes of colorectal adenocarcinoma?
Low fibre diet
Slow transit time - more contact time for bad substances
High fat intake
Genetic predisposition
Where is the pancreas in carcinoma most likely?
2/3 of pancreatic cancers are in the head
