pathology of tumours of the upper GIT

Question 1

what happens to the epithelium of the oesophagus in Barrett’s oesophagus?

Answer 1

repeated gastro-eosophageal reflux irritates the squamous epithelium of the oesophagus and causes transformation to columnar epithelium of the intestine

Question 2

what term is used to describe the change in epithelium seen in Barrett’s?

Answer 2

METAPLASIA!

Question 3

What is metaplasia?

Answer 3

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

Question 4

what type of cancer does Barrett’s oesophagus predispose to?

Answer 4

adenocarcinoma

Question 5

what has the trend been in the UK oesophageal cancer incidence?

Answer 5

increase, highest rates in males

Question 6

describe the changes from a normal oesophageal squamous epithelium to neoplastic oesophageal glandular epithelium

Answer 6

reflux affects normal squamous epithelium
this causes metaplastic glandular epithelium
continuing reflux plus other factors causes dysplastic glandular epithelium
continuing reflux and other factors causes neoplastic glandular epithelium
aka normal - metaplastic - dysplastic - neoplastic

Question 7

what are the risk factors for adenocarcinoma of the oesophagus?

Answer 7

obesity

severe reflux

Question 8

what are the risk factors for squamous cell carcinoma of the oesophagus?

Answer 8

smoking
heavy alcohol intake
these risk factors together are synergistic

Question 9

what structures are close to the oesophagus that could be affected by carcinoma?

Answer 9

SVC
aorta
lymph vessels
trachea

Question 10

do people with oesophageal cancer tend to present late or early and how does this affect 5 year survival?

Answer 10

late

the older sb presents with oesophageal cancer, the poorer their 5 yr survival

Question 11

what has the trend been in the UK concerning gastric cancer?

Answer 11

incidence has decreased (could be that some cancers that were once classed as gastric cancers are now glassed as oesophageal and could also contribute to the rise o=in oesophageal cancers)

Question 12

where in the world is gastric cancer most common?

Answer 12

eastern asia

eastern europe

Question 13

what type of foods predispose to gastric cancer?

Answer 13

smoked
pickled
processed

Question 14

what age to people usually get gastric cancer?

Answer 14

disease of older age

after the age of 40

Question 15

what other factors apart from food could lead to gastric cancer?

Answer 15

Helicobacter pylori
pernicious anaemia
genetic changes

Question 16

what are the stages of changes from normal gastric mucosa to invasive carcinoma?

Answer 16

normal gastric mucosa - intestinal metaplasia - dysplasia - intramucosal carcinoma - invasive carcinoma

Question 17

what is linitus plastica?

Answer 17

diffuse spread of cancer cells in the stomach making the wall of the stomach very thick and fibrosed

Question 18

what is in situ cancer of the stomach?

Answer 18

cancer that is contained within the gastric mucosa

Question 19

what is early gastric cancer?

Answer 19

cancer of the stomach that has not spread to the muscular wall (muscularis propria)
it can spread to the lymph nodes, but just not to the muscular wall to be called early

Question 20

what is late gastric cancer?

Answer 20

cancer that has spread to the muscular wall ie muscularis propria