GI tumours (upper tract) Flashcards
What percentage of oesophageal tumours are benign?
5%
What are some benign tumours of the oesophagus?
- Leiomyomas
- Fibromas
- Lipomas
- Haemangiomas
- Neurofibromas
- Lymphangiomas
- Mucosal polyps
- Squamous papillomas
What percentage of malignant tumours of the oesophagus are squamous cell carcinomas?
90%
What are the different malignant tumours of the oesophagus?
- Squamous cell carcinoma
- Adenocarcinoma
Rare: - Carcinoid tumour
- Malignant melanoma
- Lymphoma
- Sarcoma
Who is affected by squamous cell carcinoma?
- > age 50
- 5 per 100,000 population in males and 1 per 100,000 in females (average in europe)
- male to female ration 2:1 to 20:1
- High incidence in countries where individuals drink very hot drinks
What are some factors associated with SCC?
Dietary - Deficiency of vitamins (A, C, riboflavin, thiamine, pyridoxine) - Fngal contamination of foodstuffs - High content of nitites/nitrosamines Lifestyle - Burning hot beverages or food - Alcohol, tobacco Oesophageal disorders - Long-standing oesophagitis and achalasia Genetic predisposition
Where are SCCs located on the oesophagus?
- 20% in upper 1/3
- 50% in middle 1/3
- 30% in lower 1/3
What do SCCs of the oesophagus look like?
Small, grey-white, plaque-like thickenings that become tumourous masses
What are the 3 patterns of SCC in the oesophagus?
- Protruded polypod exophytic (60%)
- Flat, diffuse, infiltative (15%)
- Excavated, ulcerated (25%)
Describe the Histological features of SCC of the oesophagus
- Squamous epithelium
- Pleomorphism (different size and shape of nucleus and cells)
- Hyperchromatism (darker - multiplying faster)
- Mitotic figures
- Degree of atypia:
low grade vs high grade
What are the clinical geatures of SCC of the oesophagus?
- Dysphagia
- Extreme weight loss (cachexia)
- Haemorrhage and sepsis
- Cancerous tracheoesophageal fistula
- Metastases (lymph nodes)
Cervical
Mediastinal
Paratracheal
Tracheobronchial
Gastric and celiac
What is the overall five-year survival rate of GI tumours?
5%
Where does adenocarcinoma take place?
Lower 1/3 of the oesophagus
When does adenocarcinoma take place?
40 with a median age 60
What percentage of adenocarcinomas are caused by gastric reflux?
10%
What social factors are associated with adenocarcinoma?
Tobacco + obesity
What are the stages that lead to adenocarcinoma?
- Squamous epithelium
- Oesophagitis
- Barrett oesophagus
- Dysplasia
- Carcinoma
What does adenocarcinoma look like?
- Flat or raised patches or nodular masses
- May be infiltritive or deeply ulcerative
- Mucin-producing glandular tumours
What do the different stages of TNM staging mean?
Tis - carcinoma in situ T1 - invasion of submucosa T2 - invasion of muscularis propria T3 - invasion of adventitia T4 - invasion of adjacent structures N0 - no node spread N1 - regional node metastases M0 - no distant spread M1 - distant metastases
What are the clinical features of adenocarcinoma?
- Dysphagia
- Progressive weight loss
- Bleeding
- Chest pain
- Vomitting
- Heartburn
- Regurgitation
What is the 5 year overall survival rate for adenocarcinoma?
20%
What is a polyp?
Nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum
What percentage of benign tumours of the stomach are non neoplastic and neoplastic?
- Non neoplastic = 90%
- Neoplastic = 5 - 10%
Biopsy needed to differentiate
What are the two types of benign tumours of the stomach that are not polyps?
Leiomyomas and Schwannomas (rare)
Desribe non neoplastic benign tumors of the stomach
- Most are small and sessile (without a stalk)
- Hyperplastic surface epithelium
- Cystically dilated glandular tissue
Describe neoplastic adenomas of the stomach
- Contains proliferative dysplastic epithlium
- Malignant potential
- Sessile (without a stalk) or pedunculated (stalked)
What percentage of tumours of the stomach are malignant?
90 - 95%
What is the second most common tumour of the GI tract?
Gastric carcinoma (first is colon)
What food possibly leads to high levels of gastric carcinoma?
Smoked fish
What enviromental factors are associated with gastric carcinoma?
- Infection by H pylori
- Diet
- Low socioeconomic status
- Cigarette smoking
What genetic factors are associarted with gastric carcinoma?
- Slightly increased risk with blood group A
- FH
- Hereditary nonpolyposis colon cancer syndrome
- Familial gastric carcinoma syndrome
What conditions can lead to an increased risk of gastric carcinoma?
- Chronic gastritis
- Gastric adenomas
- Barrett oesophagus
What part of the stomach are gastric carcinomas more likely and ledd likely to take place?
- Pylorus and antrum 50 - 60%
- Cardia - 25%
- Remainder in body and fundus
- Lesser curvature is involved in about 40% and the greater curvature in 12%
What are gastric carcinomas classified on the basis of?
- Depth of invasion
early and advanced - Macroscopic growth pattern
- Histological subtype
What are the macroscopic growth patterns associated with gastric carcinomas?
- Exophytic
- Flat or depressed -> linitis plastica
- Excavated
Ill-defined, central ulcer surrounded by irregular, heaped-up borders
What does lintis plastica look like?
- Leather bottle
- Diffuse infiltrative gastric carcinoma
- Mucosal erosion
- Markedly thickened gastric wall
What are intestinal type adenocarcinomas (lauren classification)?
- Composed of neoplastic intestinal GLANDS resembling those of colonic adenocarcinoma
- Cells often contain apical mucin vacuoles, and abundant mucin may be present in glan lumens
What are diffuse type adenocarcinomas (lauren classification)?
- Composed of gastric-type mucous cells, which generally do not form glands, but rather permeate the mucosa and wall as scattered individual cells or small clusters in an “infiltrative” growth pattern
- Mucin formation expands the malignant cells and oushes the nucleus to the periphery, creating a “SIGNET RING”
How do gastric carcinomas spread and where do they spread to?
- Supraclavicular (Virchow) node
- Local invasion of gastric carcinoma into duodenum, pancreas, and retroperitoneum
- Metastases to the liver and lungs are common
- Metastases to the ovaries called Krukenberg tumour
WHat is a Krukenberg tumour?
Gastric tumour which has spread to the ovaries
How are gastric carcinomas classified (in terms of tumours)?
T0 - no evidence of primary tumour
Tis - carcinoma in situ
T1 - invades lamina propria or submucosa
T2 - Invades muscularis propria or subserosa (not visceral peritoneum)
T3 - Penetrates visceral peritoneum but not adjacent structures
T4 - Invades adjacent structures (spleen colon etc)
How are gastric carcinomas classified in terms of lymph node involvement?
N0 - no LN involvement
N1 - 1-6 lymph nodes
N2 - 7-15
N3 - more than 15
How are gastric carcinomas classified in terms of metastasis?
M0 - no distant metastasis
M1 - Distant metastasis, in portal LN, mesenteric, retroperitoneal or more distant
What are the clinical features of gastric carcinomas?
- Aymptomatic until late
- Weight loss
- Abdo pain
- Anorexia
- Vomitting
- Altered bowel habits
- Dysphagia
- Anaemic symptoms
- Haemorrhage
What is the prognosis like for gastric carcinoma?
5 year survival
- CAught early - 90 - 95%
- Advanced gastric cancer < 15%
What is gastric lymphoma?
- B-cell lymphomas of mucosa-associated lymphoid tissue (MALT)
- 5% of all gastric malignancies
- > 80%are associated with chronic gastritis and H pylori infection
- 50% 5 year survival
What is the morphology of gastric lymphomas?
- Commonly occurs in the mucosa or superficial submucosa
- Lymphocytic infiltrate of the lamina propria surrounds gastric glands massic=vely infiltrated with atypical lymphcytes and undergoing destruction
The lymphoid epithloid legion
What does gastric lymphomas look like under the microscope?
- Mucosa looks normal
- Underneath the lymphocytes accumuate with epitheloid groups of cekls
