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MD3002 Pathology > GI tumours (upper tract) > Flashcards

GI tumours (upper tract) Flashcards

1
Q

What percentage of oesophageal tumours are benign?

A

5%

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2
Q

What are some benign tumours of the oesophagus?

A
  • Leiomyomas
  • Fibromas
  • Lipomas
  • Haemangiomas
  • Neurofibromas
  • Lymphangiomas
  • Mucosal polyps
  • Squamous papillomas
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3
Q

What percentage of malignant tumours of the oesophagus are squamous cell carcinomas?

A

90%

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4
Q

What are the different malignant tumours of the oesophagus?

A
  • Squamous cell carcinoma
  • Adenocarcinoma
    Rare:
  • Carcinoid tumour
  • Malignant melanoma
  • Lymphoma
  • Sarcoma
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5
Q

Who is affected by squamous cell carcinoma?

A
  • > 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
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6
Q

What are some factors associated with SCC?

A 
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
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7
Q

Where are SCCs located on the oesophagus?

A
  • 20% in upper 1/3
  • 50% in middle 1/3
  • 30% in lower 1/3
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8
Q

What do SCCs of the oesophagus look like?

A

Small, grey-white, plaque-like thickenings that become tumourous masses

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9
Q

What are the 3 patterns of SCC in the oesophagus?

A
  • Protruded polypod exophytic (60%)
  • Flat, diffuse, infiltative (15%)
  • Excavated, ulcerated (25%)
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10
Q

Describe the Histological features of SCC of the oesophagus

A
  • 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
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11
Q

What are the clinical geatures of SCC of the oesophagus?

A
  • Dysphagia
  • Extreme weight loss (cachexia)
  • Haemorrhage and sepsis
  • Cancerous tracheoesophageal fistula
  • Metastases (lymph nodes)
    Cervical
    Mediastinal
    Paratracheal
    Tracheobronchial
    Gastric and celiac
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12
Q

What is the overall five-year survival rate of GI tumours?

A

5%

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13
Q

Where does adenocarcinoma take place?

A

Lower 1/3 of the oesophagus

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14
Q

When does adenocarcinoma take place?

A

40 with a median age 60

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15
Q

What percentage of adenocarcinomas are caused by gastric reflux?

A

10%

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16
Q

What social factors are associated with adenocarcinoma?

A

Tobacco + obesity

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17
Q

What are the stages that lead to adenocarcinoma?

A
  • Squamous epithelium
  • Oesophagitis
  • Barrett oesophagus
  • Dysplasia
  • Carcinoma
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18
Q

What does adenocarcinoma look like?

A
  • Flat or raised patches or nodular masses
  • May be infiltritive or deeply ulcerative
  • Mucin-producing glandular tumours
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19
Q

What do the different stages of TNM staging mean?

A 
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
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20
Q

What are the clinical features of adenocarcinoma?

A
  • Dysphagia
  • Progressive weight loss
  • Bleeding
  • Chest pain
  • Vomitting
  • Heartburn
  • Regurgitation
21
Q

What is the 5 year overall survival rate for adenocarcinoma?

A

20%

22
Q

What is a polyp?

A

Nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum

23
Q

What percentage of benign tumours of the stomach are non neoplastic and neoplastic?

A
  • Non neoplastic = 90%
  • Neoplastic = 5 - 10%
    Biopsy needed to differentiate
24
Q

What are the two types of benign tumours of the stomach that are not polyps?

A

Leiomyomas and Schwannomas (rare)

25
Q

Desribe non neoplastic benign tumors of the stomach

A
  • Most are small and sessile (without a stalk)
  • Hyperplastic surface epithelium
  • Cystically dilated glandular tissue
26
Q

Describe neoplastic adenomas of the stomach

A
  • Contains proliferative dysplastic epithlium
  • Malignant potential
  • Sessile (without a stalk) or pedunculated (stalked)
27
Q

What percentage of tumours of the stomach are malignant?

A

90 - 95%

28
Q

What is the second most common tumour of the GI tract?

A

Gastric carcinoma (first is colon)

29
Q

What food possibly leads to high levels of gastric carcinoma?

A

Smoked fish

30
Q

What enviromental factors are associated with gastric carcinoma?

A
  • Infection by H pylori
  • Diet
  • Low socioeconomic status
  • Cigarette smoking
31
Q

What genetic factors are associarted with gastric carcinoma?

A
  • Slightly increased risk with blood group A
  • FH
  • Hereditary nonpolyposis colon cancer syndrome
  • Familial gastric carcinoma syndrome
32
Q

What conditions can lead to an increased risk of gastric carcinoma?

A
  • Chronic gastritis
  • Gastric adenomas
  • Barrett oesophagus
33
Q

What part of the stomach are gastric carcinomas more likely and ledd likely to take place?

A
  • 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%
34
Q

What are gastric carcinomas classified on the basis of?

A
  1. Depth of invasion
    early and advanced
  2. Macroscopic growth pattern
  3. Histological subtype
35
Q

What are the macroscopic growth patterns associated with gastric carcinomas?

A
  • Exophytic
  • Flat or depressed -> linitis plastica
  • Excavated
    Ill-defined, central ulcer surrounded by irregular, heaped-up borders
36
Q

What does lintis plastica look like?

A
  • Leather bottle
  • Diffuse infiltrative gastric carcinoma
  • Mucosal erosion
  • Markedly thickened gastric wall
37
Q

What are intestinal type adenocarcinomas (lauren classification)?

A
  • 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
38
Q

What are diffuse type adenocarcinomas (lauren classification)?

A
  • 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”
39
Q

How do gastric carcinomas spread and where do they spread to?

A
  • 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
40
Q

WHat is a Krukenberg tumour?

A

Gastric tumour which has spread to the ovaries

41
Q

How are gastric carcinomas classified (in terms of tumours)?

A

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)

42
Q

How are gastric carcinomas classified in terms of lymph node involvement?

A

N0 - no LN involvement
N1 - 1-6 lymph nodes
N2 - 7-15
N3 - more than 15

43
Q

How are gastric carcinomas classified in terms of metastasis?

A

M0 - no distant metastasis

M1 - Distant metastasis, in portal LN, mesenteric, retroperitoneal or more distant

44
Q

What are the clinical features of gastric carcinomas?

A
  • Aymptomatic until late
  • Weight loss
  • Abdo pain
  • Anorexia
  • Vomitting
  • Altered bowel habits
  • Dysphagia
  • Anaemic symptoms
  • Haemorrhage
45
Q

What is the prognosis like for gastric carcinoma?

A

5 year survival

  • CAught early - 90 - 95%
  • Advanced gastric cancer < 15%
46
Q

What is gastric lymphoma?

A
  • 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
47
Q

What is the morphology of gastric lymphomas?

A
  • 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
48
Q

What does gastric lymphomas look like under the microscope?

A
  • Mucosa looks normal

- Underneath the lymphocytes accumuate with epitheloid groups of cekls

MD3002 Pathology (19 decks)

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