Pathology of GI tumours

Question 1

Oesophageal cancer

Answer 1

(oesophagus = squamous epithelium
stomach = glandular epithelium)

On endoscopy of oesophagus, islands of white in red. (white is normal).
Biopsy of red areas = glandular epithelium

Question 2

What does CELLO stand for and what do we call it in England?

Answer 2

Columnar lined lower oesophagus
Barrett’s oesophagus

Question 3

what is metaplasia?

Answer 3

change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type

Question 4

If acid refluxes, squamous cells don’t have layer of protective mucin, and get killed by acid. Leaves gap called…

Answer 4

ulcer

Question 5

What causes reflux?

Answer 5

Diaphragm not developed quite right (if symptoms from young)
Obesity and raised intra-abdominal pressure

Question 6

There is a large risk of having an a________ with Barrett’s oesophagus

Answer 6

Adenocarcinoma (glandular tissue)

Question 7

Continuing gastro-oesophageal reflux with metaplastic oesophageal glandular epithelium can lead to…

Answer 7

dysplastic oesophageal glandular epithelium

Question 8

Continuing gastro-oesophageal reflux with dysplastic oesophageal glandular epithelium can lead to..

Answer 8

neoplastic oesophageal glandular epithelium

Question 9

eosinophilic oesophagitis

Answer 9

benign inflammation of oesophagus

Question 10

Symptoms of oesophageal cancer

Answer 10

Heartburn
Barrett’s oesophagus

Question 11

Risk factors of oesophageal cancer

Answer 11

smoking, heavy alcohol intake, severe reflux, obesity.

Question 12

Survival rates of oesophageal cancer

Answer 12

Poor

Question 13

What factors are associated with gastric cancer

Answer 13

Helicobacter (doesn’t absolutely cause it, but can induce change in epithelium causing intestinal metaplasia, dysplasia and neoplasia)

Smoke
Pickled/smoked food?

Question 14

What is linitus plastica?

Answer 14

thickened wall of stomach, invasion of cancer. Stomach won’t inflate with air. Adenomacarcinoma.

Question 15

Are there normally early or late presentation of oesophageal and gastric cancer?

Answer 15

Late presentation

Question 16

Is it common or rare to have tumours of small intestine?

Answer 16

Rare (perhaps to do with fewer stem cells present?)

Question 17

What rare inherited condition leads to colorectal cancer?

Answer 17

Familial adenomatous polyposis

Question 18

What is familial adenomatous polyposis?

Answer 18

Thousands of adenomas, bound to have mutation.
Most given colonectomy

Question 19

If levels of b___c____ rise in cell, then apc complex binds and breaks down to apc so decreased levels

Answer 19

beta catenin

Question 20

Mutation in apc gene leads to beta catenin causing epithelial proliferation and then development of an a____

Answer 20

adenoma

Question 21

What is hereditary nonpolyposis colorectal cancer (HNPCC)?

Answer 21

No DNA repair protein produced so accumulate abnormalities from mutations leading to cancer

Question 22

Reasons for identifying HMPCC cancers

Answer 22

Risk of further cancers
Identify relatives
Some chemotherapy drugs won’t work for these patients

Question 23

What are macroscopic features of colorectal cancer

Answer 23

38% are in rectosigmoid junction, rectum and anus so can be felt by digital rectal examination.
Rest will be doing colonoscopy

Question 24

colorectal staging and prognosis

Answer 24

Looking to see if invaded muscle wall into peritoneum, has it gone into lymph nodes.

T1 means not much spread of cancer all the way to T4 which is when there is a large spread of cancer.

Dukes’ stage and prognosis
A = 95% 5 year survival
B = 75% –”–
C = 35
D = 25%