neoplastic disease of the GI tract part 2 W8

Question 1

symptoms of GI neoplasia?

Answer 1

tiredness (anaemia)
bleeding
anorexia, vomiting
weight loss
pain caused by obstruction
dysphagia
alteration in bowel habit

Question 2

oesophagus carcinoma types?

Answer 2

squamous cell carcinoma (most common worldwide)
adenocarcinoma (most common UK)

Question 3

oesophageal squamous cell carcinoma risk factors

Answer 3

depends on population studied.
tobacco and alcohol
diet and very hot beverages
genetic factors

Question 4

oesophageal adenocarcinoma features?

Answer 4

mostly associated with acid reflux and Barrett’s oesophagus
tobacco and alcohol less important
obesity, male sex

Question 5

what is Barrett’s oesophagus?

Answer 5

chronic acid/bile reflux causes phenotypic change in stem cell population at base of oesophageal epithelium
metaplasia from squamous cell epithelium to columnar epithelium
over time develops further into gastric/intestinal pathway
dysplasia and neoplasia associated with intestinal pathway

Question 6

prognosis of oesophageal carcinoma?

Answer 6

tumour stage most important
good prognosis for tumours confined to the mucosa
many tumours picked up late
10-20% survival for adenocarcinomas involving deep muscularis propria

Question 7

GI cancer staging?

Answer 7

not expected to memorise details for each site but should know that:
T = anatomical depth of tumour invasion
N = number of involved lymph nodes
M = presence of distant metastases

Question 8

gastric adenocarcinoma incidence?

Answer 8

geographical variations
highest in Japan, east Asia, eastern Europe, S America
low in N America, N Europe, Africa
increases with age
males > females
10% familial link

Question 9

gastric adenocarcinoma aetiology?

Answer 9

diet, H pylori, bile reflux

Question 10

2 main histological patterns observed in gastric adenocarcinoma?

Answer 10

intestinal
diffuse

Question 11

gastric adenocarcinoma - intestinal type features?

Answer 11

majority of cases in high incidence areas
increased risk in patients with FAP

Question 12

gastric adenocarcinoma - diffuse type features?

Answer 12

relatively more common in low incidence areas
often younger patients
female >male
mutation or inactivation of CDH1 gene a common feature
may show linitis plastica (leather bottle stomach) appearance

Question 13

non-neoplastic gastric polyps types?

Answer 13

fundic gland polyps (common) - often associated with PPIs

hyperplastic/regenerative (common) - associated with gastritis

others…

Question 14

neoplastic gastric polyps types?

Answer 14

adenoma
adenocarcinoma
lymphoma
neuroendocrine (“carcinoid”) tumours
gastrointestinal stomal tumours (GISTs)

Question 15

neoplasia of the small intestine types? (uncommon)

Answer 15

adenocarcinoma
neuroendocrine tumours
GISTs
lymphoma

Question 16

what are neuroendocrine tumours? features?

Answer 16

epithelial tumours associated with the synthesis of hormone or neurotransmitter-like substances
range from well-differentiated benign tumours through to aggressive and poorly differentiated malignancies such as small cell carcinoma
difficult to predict behaviour
risk depends on size, site, grade.

Question 17

Gastrointestinal stromal tumours?

Answer 17

soft tissue tumour that can arise anywhere in the GI tract
related to pacemaker cells in muscularis propria
malignant tumours a type of sarcoma

stomach commonest site
difficult to predict behaviour
risk depends on site, size, proliferative activity.