GI Tumours (upper tract) Flashcards
What are the main types of benign oesophgeal tumour?
- Mesenchymal tumours
- Squamous papillomas
- Leiomyomas
- Fibromas
- Lipomas
- Haemangiomas
- Neuorfibromas
- Lymphangiomas
- Mucosal polys
- Squamous papillomas
What are the main types of malignant oesophgeal tumours?
- Squamous cell carcinoma
- Adenocarcinoma
What are the rare types of maligant oesophgeal tumours?
- Carcinoid tumour
- Malignant melanoma
- Lymphoma
- Sarcoma
What are the main types of benign tumour of the stomach?
- Polyps
- Non-neoplastic
- Adenomas
What are the main types of malignant tumours of the stomach?
- Carcinoma
- Lymphoma
- Carcinoid
- Mesenchymal
What is the incidence of squamous cell carcinoma of the oeosphagus?
- > age 50
- 5 per 100,000 population in males and 1 per 100,000 in females (average in Europe)
- Male = 2:1
- Female = 20:1
- Geographical variation
- Iran, Central China, South Africa and Southern Brazil
What are the main factors assoicated with SSC of the oesophagus?
- Dietary
- Deficiency of vitamins (A, C, thiamine, pyridoxine)
- Fungal contamination of food stuffs
- High content of nitrites/nitrosamines
- Lifestyle
- Burning-hot beverages or food
- Alcohol and tobacco
- Oesophageal Disorders
- Long-standing oesophagitis and achalasia
- Genetic predisposition
What is the likelihood of SSC occuting in each third of the oesophagus?
- 20% in the upper third
- 50% in the middle third
- 30% in the lower third of oesophagus
What is the gross morphology of SCC of the oesophagus?
Small, grey-white, plaque-like thickenings that become tumorous masses
What are the 3 main patterns of morphology of SCC of the oesophagus?
- Protruded polypoid exophytic (60%)
- Flat, diffuse, infiltrative
- Excavated, ulcerated
Describe the histology of SCC
- The squamous epithelium
- Pleiomorphism
- Hyperchromatism
- Miotic figures
- The degree of atypia:
- Low grade dysplasia
- High grade dysplasia
Describe the clinical features 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 prognosis of oesophageal SCC?
5% overall five-year survival
What part of the oesophagus does adenocarcinoma affect?
The lower third of the oesophagus
originates from the glandular tissue
What does adenocarcinoma of the oesophagus arise from?
- Arise from Barrett Mucosa (10%)
- Intestinal metaplasia caused by gastric reflux
What is the average age of onset of oesophgeal adenocarcinoma?
Age 40, with a median age of 60
What are two main causative factors assoicated with adenocarcinoma?
tobacco and obesity
Describe the morphology of oesophgeal adenocarcinoma
- Flat or raised patched or nodular masses
- May be infiltrative or deeply ulcerative
- Histology:
- Mucin-producing glandular tumours
Describe the T of TNM staging
T is carcinoma in situ
T1 = invasion of submucosa
T2 = invasion of muscularis propria
T3 = invasion of adventitia
T4 = invasion of adjacent structures
Describe the N of TNM staging
N0 = no node spread
N1 = regional node metastases
Describe the M of TNM staging
M0 = No distant metastases
M1 = Distant metastases
What are the main clinical features of oesophgeal adenocarcinoma?
- Dysphagia
- Progressive weight loss
- Bleeding
- Chest pain
- Vomiting
- Heartburn
- Regurgitation
- Prognosis: 20% overall five-year survival
What is a polyp?
Nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum
Describe non-neoplastic polyps
- Most are small and sessile (without a stalk)
- Hyperplastic surface epithelium
- Cystically dilated glandular tissue
90% of polyps
Describe neoplastic polyps
Contains proliferative dysplastic epithelium
Malignant potential
Sessile (without stalk) or pedunculated (stalked)
What are the three main types of polyp found in the stomach?
- non-neoplastic
- neoplastic - adenomas
- Leiomyomas and Schwannomas
What contributes 90-95% of malignant tumours of the stomach
gastric carcinoma
What are the environmental factors assoicated with gastric carcinoma?
- Infection by H.pylori
- Diet
- Low socioeconomic status
- Cigarette smoking
What are the host factors assoicated with gastric carcinoma?
- Chronic gastritis
- Gastric adenomas
- Barrett Oesophagus
What are the genetic factors assoicated with gastric carcinoma?
- Slightly increased risk with blood group A
- Family History
- Hereditary nonpolyposis colon cancer syndrome
- Familial gastric carcinoma
What is the morphology of the location of gastric carcinoma?
- Pylorus and antrum; 50% to 60%
- Cardia; 25%
- With the remainder in the body and fundus
- The lesser curvature is involved in about 40% and the greater curvature in 12%
What are gastric carcinomas classified by?
- Depth of invasion
- Early and advanced
- Macroscopic growth pattern
- Histological subtype
What are the three main types of macroscopic growth patterns?
Exophytic - into lumen
Flat or depressed
Excavated - into mucosa
What is Linitis plastica “(leather bottle)”?
- Diffuse infiltrative gastric carcinoma
- Mucosal erosion
- Markedly thickened gastric wall
What are the three types of histopathology of adenicarcinoma (Lauren Classification)
- Intestinal type
- Diffuse type mixed type
Describe the intestinal type of adenocarcinoma
- Composed of neoplastic intestinal glands resembling those of colonic adenocarcinoma
- Cells often contain apical mucin vacuoles and abundant mucin may be present in gland lumens
Describe the difuse type of adenocarcinoma
- 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 oattern
- Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a ‘signet ring’
What is the expected spread of gastric carcinoma?
- All gastric carcinomas eventually penetrate the wall and spread to regional and more distant lymph nodes
- Supraclavicular (Virchow) node
- Local invasion of gastric carcinoma into the duodenum, pancreas and retroperitoneum
- Metastases to the liver and lungs are common
- Metastases to the ovaries called Krukenburg Tumour
What are the clinical features of gastric carcinoma?
- Asymptomatic until late
- Weight loss
- Abdominal pain
- Anorexia
- Vomiting
- Altered bowel habits
- Dysphagia
- Anaemic symptoms
- Haemorrhage
What is the prognosis of gastric carcinoma?
- PROGNOSIS five-year survival:
- Early gastric cancer is 90%-95%
- Advanced gastric cancer < 15%
What is gastric lymphoma?
- 5% of all gastric malignancies
- B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas)
- >80% are associated with chronic gastritis and H. pylori infection
- Prognosis: 50% five-year survival
What is the morphology of gastric lymphoma?
- Commonly occurs in the mucosa or superficial submucosa
- Lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction
- The “lymphoid epithelioid” lesion
