GIT - stomach and intestinal neoplasms

Question 1

polyps in the stomach

Answer 1

• fundic gland polyps

- hyperplastic polyps

Question 2

fundic gland polyp

- micro characteristics

Answer 2

• dilated glands lined by oxyntic (fundus) epithelium
  reduced acidity -> oxyntic glandular hyperplasia
• shortened foveolar (mucus producing cells in the stomach)

Question 3

hyperplastic polyps

Answer 3

common, benign
usually affect older age group (50-60)
precedes chronic erosive gastritis
multiple polyps could signify gastric atrophy
- elongated/dilated foveolar
- presence of inflammatory cells in lamina propria + edema and patchy necrosis

Question 4

adenocarcinoma in stomach

Answer 4

adeno: glandular differentiation

late clinical presentation w/ poor response to chemotherapy

Question 5

clinical symptoms of adenocarcinoma

Answer 5

common GIT symptoms - very hard to detect early

• weight loss
• abdominal pain
• anorexia
• vomiting
• less frequent bowel habits - black tarry stools cause stools remain in GIT for longer
• dysphagia

Question 6

possible macroscopic growth patterns of adenocarcinoma (3)

Answer 6

• exophtic: protrusion of tumour mass into lumen
• flat/depressed
• excavated - erosive, caved in -> may even perforate stomach

Question 7

peptic ulcer gross features

Answer 7

flat, straight & vertical ulcer edge, level w/ the rest of the stomach
base is flat/ hemorrhagic

Question 8

adenocarcinoma subtypes** + which has better prognosis

Answer 8

• INTESTINAL: severe intestinal metaplasia & dysplasia. associated w/ atrophic gastritis
  well formed glands lined by columnar epithelial cells
  better prognosis**
  affect older men more
• DIFFUSED: affecting younger pts (women, < 50). poorly differentiated
  cells are infiltrative
  presence of signet ring cells (large vacuole)
  usually due to H.pylori infection
  poor prognosis

Question 9

describe growth and spread of adenocarcinoma

- which part of the stomach more likely to be the site of adenocarcinoma

Answer 9

affect distal stomach more (pylorus and antrum)
lesser curvature

widespread metastasis
- may metastasise to supraclavicular lymph node -> Trousseau’s sign

Question 10

intestinal polyp

Answer 10

• Hamartomatous polyp (benign)
  Peutz-Jeghers Syndrome - early diagnosis
  presentation: increased pigmentation around the lips, genitalia, buccal mucosa feet and hands

Question 11

adenomas in the intestines

Answer 11

proliferating neoplastic glands
more polyps = increased risk of it turning malignant

growth patterns:
- tubular/ villous/ tubulovillous
villous adenoma has highest risk of turning malignant

Question 12

cancers in the intestines

Answer 12

• colorectal cancer

- adenocarcinoma

Question 13

colorectal cancer (CRC) clinical presentation

Answer 13

• abdominal pain - intestinal obstruction and bowel perforation*
• altered bowel habits
• bleeding
• metastatic spread - to umbilical wall
• fistula formation
• weakness - cause of the anemia
• anemia - blood in stools
• weight loss
• obstruction: cause vomiting, constipation, abdominal distention and pain simultaneously*

Question 14

CRC cause

Answer 14

APC gene mutation: 5q21
disrupts tumour suppressor gene

Familial Adenomatous Polyposis (FAP)

Question 15

adenocarcinoma gross appearance

Answer 15

polypoidal, fungating, ulcerated

proximal: larger polypoid tumours w/ exophytic mass
distal: circumferential growth, apple core lesions

Question 16

adenocarcinoma microscopy

Answer 16

poorly differentiated, irregular glands
invasion of surrounding stroma
glands lined by malignant cells (pleomorphic nuclei, hyperchromatic, mitotic figures)

desmoplastic response (fibrotic, connective tissue)

• eosinophils
• extracellular mucin

Question 17

FAP

Answer 17

autosomal dominant inherited syndrome

causes many adenomas in the colorectal

adenoma -> colonic polyposis -> cancer

Question 18

TNM staging of CRC

Answer 18

T = tumour size
T1 - invades submucosa
T2 - invades muscularis propria
T3 - invades through muscularis propria into pericolorectal tissue
T4 - penetrates visceral peritoneum/ invades other organs

N = number of lymph nodes affected

M = metastasis
for CRC: M1b: also includes spread to distant parts of the peritoneum

Question 19

neuroendocrine tumours = carcinoid

=symptoms

Answer 19

neuroendocrine tumour -> overproduction of serotonin -> affects GIT

symptoms of carcinoid syndrome:

• flushing
• diarrhoea/ more frequent bowel movements
• bronchoconstriction
• abdominal cramping
• right sided cardiac valve disease
• peripheral edema

Question 20

H.pylori causing adenocarcinoma

Answer 20

• causes chronic gastritis -> injury to the gastric mucosa -> atrophy -> inhibit bicarbonate secretion -> decrease mucosal protection
• causes antral gastritis -> increase gastrin release -> more gastric acid produced -> mucosal injury

repeated destruction and re-generation -> metaplasia -> dysplasia -> adenocarcinoma

Question 21

why need to stage tumour

Answer 21

• determine prognosis (higher stage poorer prognosis)
• determine treatment:
  low stage - EMR (endoscopic mucosal resection)
  high stage - surgery, radio/chemo therapy