GI Malignancies Flashcards
What are the most common GI malignancies?
Oesophageal, gastric, large intestine, pancreas and liver
Most common is colorectal carcinoma
How does oesophageal carcinoma present clinically?
dysphagia - progressively worsening as tumour grows and occludes lumen
weight loss as it affects the ability to eat and swallow
How do you investigate oesophageal carcinoma?
endoscopy, biopsy and barium swallow
What two types of carcinomas occur in the oesophagus?
Squamous cell carcinoma or adenocarcinoma
squamous cell is most common and can occur at any level
adenocarcinoma is associated with the lower third of the oesophagus and barrett’s oesophagus
What is the prognosis of oesophageal carcinoma?
Poor due to clinical presentation usually occurs at advanced stages of disease. The tumour can directly spread through the oesophageal wall and only 40% can be resected (cut out)
How common is gastric cancer?
Common - 15% worldwide
Is gastric cancer more common in men or women?
Men
Where worldwide is gastric cancer most common?
Japan, Columbia (high prevalence of H. pylori infectons), Finland
With which blood group is gastric cancer most commonly associated?
A
With what disease is gastric cancer associated?
Gastritis and H. pylori infections
How does gastric cancer present clinically?
Vague symptoms
Epigastric pain, vomiting, weight loss
How would you investigate gastric cancer?
Endoscopy, biopsy, barium swallow
What are the macroscopic features of gastric cancer?
Fungating (a fungating lesion is marked by ulcerations and areas of necrosis)
Ulcerating
Infiltrative -> linitis plastica
What are the microscopic features of gastric cancer?
Gastric tissue resembles intestinal with variable degree of gland formation, and is diffuse with single cells and small groups, as well as signet ring cells
What is the difference between early and advanced gastric cancer?
Early gastric cancer is confined to the mucosa/sub-mucosa and has a good prognosis
Advanced gastric cancer has spread and has a poor prognosis
How can gastric cancer spread?
Directing through gastric wall -> duodenum, transverse colon or pancreas
via lymph nodes
to the liver
trans-coelomic - around the peritoneum, or to the ovaries
Where can gastric cancer spread to in females that it cant in males
Ovaries
What types of tumours can you get in the large intestine? (remember that the large bowel extends from cecum -> anus)
Adenomas - benign neoplastic lesions in the large bowel, FAP, Gardner’s syndrome
Adenocarcinomas
Polyps
Anal carcinoma
What are benign neoplastic lesions in the large bowel?
Dysplastic changes
Macroscopic appearance - sessile (direct attachement at base without stalk like if it were pedunculated) or pedunculated
microscopic changes - variable degree of dysplasia
Can become malignant
Can come about due to genetic syndromes - and incidence increases with age
What is FAP?
Familial adenomatous polyposis
Autosomal dominant condition on chromosome 5 -> formation of thousands of adenomas in the large intestine
Increase risk of malignancy - especially colorectal carcinoma
What is Gardner’s syndrome?
Similar to FAP, autosomal dominant condition that causes bone and soft tissues (large colon) tumours
What are the macroscopic features of colorectal carcinoma?
fungating or stenosis of the sigmoid colon and rectum
What are the microscopic features of colorectal adenocarcinoma?
there are different types of colorectal adenocarcinomas - they can be mucinous or signet ring cell types - histology varies depending on the type
How does colorectal adenocarcinoma spread?
through bowel wall to adjacent organs such as the bladder
via lymphatics -> mesenteric lymph nodes
via portal venous system -> liver
What is the staging for colorectal adenocarcinoma?
Duke’s
A - confined to wall B - through wall, no lymph involvement C - lymph node involved C1 - highest lymph node clear C2 - high lymph node involved
What mutations give rise to colorectal adenocarinoma?
Ras mutations, p53 mutations, FAP - mutation on chromosome 5 -> lots of adenomas -> can lead to colorectal adenocarcinoma
What IBD conditions can give rise to colorectal adenocarcinoma?
UC and Crohn’s
Apart from mutations, what else can cause colorectal adenocarcinoma?
Low residue diet - one that reduces frequency and volume of stool production and prolongs gut transit time
slow gut transit time
high fat intake
What is the prognosis of colorectal carcinoma?
Prognosis worsens with increasing Duke’s staging.
Metastases to liver are common in advance stages
Apart from colorectal adenocarcinoma, what other malignant tumours can you get in the large intestine?
Carcinoid tumour - unpredictable neuro-endocrine tumour that is rare
Lymphoma - primary and secondary but rate
Smooth muscle/stromal tumours - rare and unpredictable
Where in the pancreas is pancreatic carcinoma most common?
in the head of the pancreas
What are the macroscopic features of pancreatic cancer?
Firm pale mass - necrotic core that may infiltrate other structures that are adjacent e.g. the spleen
What is the most common type of pancreatic cancer?
Ductal adenocarcinoma
What are the microscopic features of ductal adenocarcinoma
well formed glands
What are the microscopic features of acinar adenocarcinoma?
zymogen granules
What is the prognosis of pancreatic carcinoma?
Poor
What can carcinoma of the ampulla of vater present as clinically?
Jaundice due to obstruction of the bile duct - early presentation = good prognosis
What are the types of islet cell tumours?
Insulinoma -> hypoglycaemia
Glycagonoma -> characteristic skin rash
Vasoactive intestinal peptideoma
Gastrinoma
What are the types of benign tumours of the liver?
- Hepatic adenoma
- Bile duct adenoma
- Hemangioma (benign tumour of blood vessels -> red birth mark)
what are the types of malignant tumours of the liver?
Hepatocellular carcinoma
Cholangiocarcinoma
Hepatoblastoma (rare, in children, tissue resembles fetal liver cells, mature liver cells or bile duct cells)
