Pathology of GI tumours Flashcards
Oesophageal cancer
(oesophagus = squamous epithelium
stomach = glandular epithelium)
On endoscopy of oesophagus, islands of white in red. (white is normal).
Biopsy of red areas = glandular epithelium
What does CELLO stand for and what do we call it in England?
Columnar lined lower oesophagus
Barrett’s oesophagus
what is metaplasia?
change in differentiation of a cell from one fully-differentiated type to a different fully-differentiated type
If acid refluxes, squamous cells don’t have layer of protective mucin, and get killed by acid. Leaves gap called…
ulcer
What causes reflux?
Diaphragm not developed quite right (if symptoms from young)
Obesity and raised intra-abdominal pressure
There is a large risk of having an a________ with Barrett’s oesophagus
Adenocarcinoma (glandular tissue)
Continuing gastro-oesophageal reflux with metaplastic oesophageal glandular epithelium can lead to…
dysplastic oesophageal glandular epithelium
Continuing gastro-oesophageal reflux with dysplastic oesophageal glandular epithelium can lead to..
neoplastic oesophageal glandular epithelium
eosinophilic oesophagitis
benign inflammation of oesophagus
Symptoms of oesophageal cancer
Heartburn
Barrett’s oesophagus
Risk factors of oesophageal cancer
smoking, heavy alcohol intake, severe reflux, obesity.
Survival rates of oesophageal cancer
Poor
What factors are associated with gastric cancer
Helicobacter (doesn’t absolutely cause it, but can induce change in epithelium causing intestinal metaplasia, dysplasia and neoplasia)
Smoke
Pickled/smoked food?
What is linitus plastica?
thickened wall of stomach, invasion of cancer. Stomach won’t inflate with air. Adenomacarcinoma.
Are there normally early or late presentation of oesophageal and gastric cancer?
Late presentation
Is it common or rare to have tumours of small intestine?
Rare (perhaps to do with fewer stem cells present?)
What rare inherited condition leads to colorectal cancer?
Familial adenomatous polyposis
What is familial adenomatous polyposis?
Thousands of adenomas, bound to have mutation.
Most given colonectomy
If levels of b___c____ rise in cell, then apc complex binds and breaks down to apc so decreased levels
beta catenin
Mutation in apc gene leads to beta catenin causing epithelial proliferation and then development of an a____
adenoma
What is hereditary nonpolyposis colorectal cancer (HNPCC)?
No DNA repair protein produced so accumulate abnormalities from mutations leading to cancer
Reasons for identifying HMPCC cancers
Risk of further cancers
Identify relatives
Some chemotherapy drugs won’t work for these patients
What are macroscopic features of colorectal cancer
38% are in rectosigmoid junction, rectum and anus so can be felt by digital rectal examination.
Rest will be doing colonoscopy
colorectal staging and prognosis
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%
