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Gastrointestinal > Session 10 > Flashcards

Session 10 Flashcards

1
Q

What are the 2 types of oesophageal carcinoma

A

Adenocarcinoma (Lower third)

Squamous cell carcinoma (Anywhere)

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2
Q

What are the clinical features of oesophageal carcinoma?

A

Dysphagia that progressively worsens

Weight

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3
Q

How can you investigate maliganancys of the GI tract?

A 
Barium swallow
CT
X-Ray
Ultrasound
Barium enema
Endoscopy
Colonoscopy
Biopsies
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4
Q

What may have a link to an increased risk of Oesophageal carcinoma (Adenocarcinoma)?

A

Barrett’s oesophagus (Metaplasia of stratified squamous epithelium to simple columnar epithelium with goblet cells which are usually found in the lower GI tract)

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5
Q

What causes Barrett’s oesophagus?

A

Thought to be due to acid reflux

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6
Q

Why is it harder to remove oesophageal carcinomas?

A

Usually patient presents later so worse prognosis

Close to mediastinal structures (eg heart) so high risk of injury when operating

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7
Q

What are some of the clinical features of gastric cancer?

A

Epigastric pain
Vomiting
Weight loss
Not in all cases

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8
Q

What are some of the macroscopic features of gastric cancer?

A

Fungating
Ulcerating
Infiltrating

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9
Q

What are some of the microscopic features of gastric cancer?

A

Intestinal cells - varying degree of gland formation

Diffuse cells - Single cells in small groups called signet ring cells. Make lots of mucin

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10
Q

What gastric cancer has good prognosis?

A

Early (confined to the mucosa/sub mucosa)

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11
Q

What gastric cancer has poor prognosis?

A

Advanced (Further spread through the gastric wall to lymph nodes, peritoneal cavity where it can go to the ovaries and liver)

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12
Q

How can gastric cancer spread?

A

Directly
Via lymph nodes
Via the hepatic portal system
Trans-coelomic to ovaries and peritonium

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13
Q

What is Veirkov’s node?

A

Gastric metastases in the subclavian lymph node

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14
Q

How can you treat gastric cancer with Herceptin?

A

Some patients have raised HER2 levels with gastric cancer so can give a HER2 blocker (Herceptin) to shrink the tumour.

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15
Q

What is associated with Gastric cancer?

A

Chronic inflammation due to Helicobacter pylori

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16
Q

What type of gastric malignancy has a stronger association with Helicobacter pylori?

A

Gastric lymphoma. May be able to treat with antibiotics as tumour regresses when the Helicobacter pylori is treated and the cells are clonal so will have Helicobacter pylori antibodies

17
Q

What are gastrointestinal stromal tumours?

A

Uncommon tumours derived from interstitial cells of Cajal (Serves as a pacemaker for peristalsis)
Have a C-kit mutation so susceptible to Tyrosine kinase inhibitors allowing targetted treatment
Can treat with surgery
Have unpredictable behaviour (eg pleomorphic, ulcerate)

18
Q

How can patients with gastrointestinal stromal tumours present?

A

GI bleeding due to the ulcer bleeding

19
Q

What are the tumours you can get in the large intestine?

A

Adenomas
Adenocarcinoma
Polyps (Anything that sticks into the lumen)
Anal carcinoma

20
Q

How do large intestine adenomas present?

A

As Polyps - can be sessile (flat) or pedunculated (stick out)
Can progress to adenocarcinomas

21
Q

What is unique about large intestine adenomas?

A

They are dysplastic and have varying degrees of dysplasia

22
Q

What is familial adenomatous polyposis?

A

Autosomal dominant
Develop 1000s of polyps by 20
Each polyp has a change of becoming malginanct
Can remove the whole large intestine to decrease chances of polyps becoming cancerous

23
Q

What are Metachronus lesions of the large intestine?

A

Adenomas and Adenocarcinomas are developing at the same time

24
Q

What are Adenomas with invasion?

A

There is early stage colon cancer growing in the adenoma. It can then destroy the adenoma it grew from.

25
Q

What is the Pectinate line? (Also called Dentate line)

A

Above the line is classified as colonic tissue (Columnar epithelium)
Below the line is classified as anal tissue (Stratified squamous epithelium)

26
Q

What type of cancer causes an ‘apple core’ stricture on barium tests?

A

Colorectal adenocarcinoma in the sigmoid

27
Q

How can colorectal adenocarcinomas spread?

A

Directly through the bowel wall to adjacent organs eg the bladder
Via lymphatics to lymph nodes
Via the portal venous system to the liver

28
Q

What are some of the genetic abnormalities that may be present in colorectal adenocarcinomas?

A

Ras mutations
p53 loss/inactivation
K-ras (Patients will respond well to cetuximab if they have this gene so targeted treatment)
N-ras

29
Q

What can increase the risk of colorectal adenocarcinomas?

A

Low residue diet (Cancerous agents touch the eipthelium)
Slow transit time (Cancerous agents are in the lumen for longer and touch the epithelium for longer)
High fat intake
Genetic predisposition

30
Q

What are some of the other large intestine tumours?

A

Carcinoid tumour (Rare, neuroendocrine tumour)
Lymphoma (Rare, Can be primary or metastases)
Smooth muscle/Stromal tumours (Rare)
*All are unpredictable)

31
Q

What are some of the signs of Pancreatic cancer?

A

Weight loss
Jaundice
Trousseau’s sign (Red patches that suggest malignancy)
Usually picked up in late stages

32
Q

What are some of the properties of a carcinoma of the pancreas?

A

Usually in the head of the pancreas
Firm pale masses
Necrotic
Haemorrhagic
Cystic
Can infiltrate adjacent structures such as the spleen
Hard to operate due to where it is and patients presenting late

33
Q

What are some of the histiological properties of a carcinoma of the pancreas?

A

Mainly ductsal adenocarcinomas
Form well formed glands that can make mucin
Some are acinar tumours containing zymogen granules

34
Q

What are some of the properties of carcinoma of the Ampulla of Vater?

A

Usually presents early with jaundice due to obstruction of the common bile duct
Pale stools
Dark urine
Dilatation of the common bile duct

35
Q

What are some of the properties of Islet cell tumours?

A

Insulinoma leading to hypoglycaemia
Glucagonomas leading to characteristic skin rash
Gastrinoma leading to hypogastrinaemia

36
Q

What are the 2 types of tumours you can get in the liver?

A

Benign

Malignant

37
Q

What are the types of benign tumours you can get in the liver?

A 
Hepatic adenoma (Which is associated with increased oestrogen or steroid use)
Bile duct adenoma/haemartoma
38
Q

What are the types of Malignant tumours you can get in the liver?

A

Hepatocellular carcinoma
Hepatoblastoma (Childhood malignancy)
Cholangiocarcinoma

Gastrointestinal (13 decks)

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