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Semester 3 - Gastrointestinal > Session 10 - Cancers of the GI tract and imaging > Flashcards

Session 10 - Cancers of the GI tract and imaging Flashcards

1
Q

Name five common GI malignancies

A
  • Oesophagus
    • Stomach
    • Large intestine
    • Pancreas
    • Liver
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2
Q

Outline the epidemiology of oesophageal carcinoma

A

• Wide geographical variation
○ Incidence low in USA and high around caspian sea and parts of china
• 2% of malignancies in the UK
Males > Females

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3
Q

Give the two main features of oesophageal carcinoma

A

• Progressively worsening Dysphagia

Weight loss

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4
Q

Give three investigations for oesophageal carcinoma

A
  • Endoscopy
    • Biopsy
    • Barium
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5
Q

Give the two main types of oesophageal cancer

A
  • Squamous cell carcinoma

* Adenocarcinoma

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6
Q

Which is the most common type of oesophageal cancer

A

Squamous cell

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7
Q

Where is oesophageal adenocarcinoma found

A
  • Lower third of the oesophagus
    • Association with Barrett’s oesophagus

Progresses through dysplasia

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8
Q

What is the prognosis of oesophageal cancer?

A
  • Advance disease presentation in most cases
    • 40% resectable
    • 5% five year survival
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9
Q

What causes oesophageal carcinoma

A
  • HPV
    • Tannins
    • Vitamin A deficiency
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10
Q

How common is gastric cancer?

A
  • Second most common GI malignancy
    • 15% of cancer deaths worldwide

Men >women

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11
Q

What countries is the incidence of gastric cancer highest?

A
  • Japan
    • Columbia
    • Finland
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12
Q

What condition is gastric cancer associated with?

A

Gastritis

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13
Q

What blood group is gastric cancer most commonly associated with?

A

• Blood group A

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14
Q

Give three symptoms of gastric cancer

A
  • Epigastric pain
    • Vomiting

Weight loss

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15
Q

Give three investigations for gastric cancer

A
  • Endoscopy
    • Biopsy

Barium

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16
Q

Give three macroscopic features of gastric cancer

A

• Fungating
• Ulcerating
• Infiltrative
○ Linitis plastica

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17
Q

What is linitis plastica?

A
  • A rare type of stomach adenocacrinoma

* Tumour spreads to muscles of stomach making it thicker and more rigid

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18
Q

Give two microscopic features of gastric cancer

A

• Intestinal
○ Variable degree of gland formation
• Digguse
○ Single cells and small groups, signet ring cells

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19
Q

What is early gastric cancer?

A
  • Confined to sub-mucosa

* Good prognosis

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20
Q

Describe advanced gastric cancer?

A

• Far spread of cancer

10% 5 year survival

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21
Q

Give four methods of spread of gastric cancer?

A 
• Direct
	• Lymph nodes
	• Liver
	• Trans-coelomic 
		○ Periotneum

Ovaries

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22
Q

Outline direct spread of gastric cancer

A

• Through gastric wall into duodenum, transverse colon, pancreas

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23
Q

Outline the development of gastric cancer

A
  • Normal gastric mucosa
    • H pylori infection
    • Acute gastritis
    • Chronic active gastritis
    • Atrophic gastritis
    • Intestinal metaplasia
    • Dysplasia
    • Advanced gastric cancer
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24
Q

What is intestinal metaplasia in gastric cancer?

A

• Metaplasia of gastric cells to intestinal

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25
Q

What is the association of gastric cancer with H.pylori?

A

H.pylori causes chronic inflammation which is strongly associated with gastric cancer

26
Q

Give three treatments for gastric cancer

A
  • Surgery
    • Chemotherapy

Herceptin

27
Q

What is gastric lymphoma?

A
  • Commonest GI lymphoma
    • Starts as a low-grade lesion, strong association with H.pylori
    • Eradication of H.pylori may lead to regression of tumour
28
Q

How does the prognosis of gastric lymphoma compare to gastric carcinoma?

A

Much better

29
Q

What is a gastrointestinal stromal tumour?

A

• Derived from interstitial cells of cajal

Caused by C-kit mutation which makes it vulnerable to targeted treatment

30
Q

What is the behaviour of gastrointestinal stromal tumours?

A
  • Pleomorphism
    • Mitoses

Necrosis

31
Q

What is a key feature of gastric lymphoma

A

• Gastro-intestinal haemorrhage

32
Q

Give four types of tumours of the large intestine

A
  • Adenomas
    • Adenocarcinomas
    • Polyps
    • Anal carcinoma
33
Q

Give three types of adenomas in the large intestine

A
  • Benign, neoplastic lesions in the large bowel
    • Familial adenomatous polyposis
    • Gardner’s syndrome
34
Q

Give two macroscopic features of adenoma of the large intestine

A

• Sessile (immobile)

OR pedunculated (small growth on stalk)

35
Q

Give two microscopic features of adenoma of the large intestine

A

• Variable degree of dyplasia

Malignant potential

36
Q

What is the most common risk factor for large intestinal adenoma?

A

• Advancing age

37
Q

What is familial adenomatous polyposis?

A
  • An autosomal dominant condition on chromosome 5

* Large number of adenomas form giving high risk of cancer

38
Q

What is gardner’s syndrome?

A
  • Similar to familial adenomatous polyposis

* Bone and soft tissue tumours also

39
Q

What is the most common type of GI malignancy?

A

• Colorectal adenocarcinoma

40
Q

Give two macroscopic features of colorectal adenocarcinoma

A

• Rectosigmoid fungating/stenotic

41
Q

Give two microscopic features of colorectal adenocarcinoma

A

• Mucinous

Signet ring cell types

42
Q

Give three ways in which colorectal adenocarcinoma spreads

A
  • Direct through bowel wall to adjacent organs
    • Via lymphatics to mesenteric lymph nodes

Via portal venous system to liver

43
Q

Give two ways in which colorectal adenocarcinoma is staged

A
  • Dukes staging

* TMN

44
Q

Outline duke’s staging of colorectal adenocarcinoma

A
  • A - Confined to bowel wall
    • B - Through wall, lymph nodes clear
    • C - Lymph node involvement
    • C1/C2 - Highest node clear/ involved
45
Q

Give three main mutations in colorectal adenocarcinoma

A
  • FAP - Chromosome 5
    • Ras mutations
    • P53 loss/inactivation
    • K-ras - Guides treatment with cetuximab
46
Q

At what age is colorectal adeno carcinoma?

A
  • Peak at 60-70

* High in UK/USA, low in Japan

47
Q

Give two diseases which predispose a patient to colorectal adenocarcinoma

A
  • Ulcerative carcninoma

* Crohn’s disease

48
Q

Give four predisposing aeitological factors to colorectal adenocarcinoma

A
  • Low residue diet
    • Slow transit time
    • High fat intake
    • Genetic predisposition
49
Q

Give three carcinomas of the large intestine of the colorectal adenocarcinoma

A 
• Carinoid tumoure
		○ Rare and unpredictabel neuro-endocrine tumour
	• Lymphoma 
		○ Rare, may be primary 
	• Smooth muscle/stromal tumours
		○ Rare and unpredictable
50
Q

Outline the morphology of pancreatic carcinoma

A
  • 2/3 in the head
    • Firm pale mass with a necrotic centre

May infiltrate adjacent structures

51
Q

What is the histology of a pancreatic carcinoma

A
  • 80% are ductal adenocarcinomas
    • Well formed glands
    • Some may contain zymogen granules

All have poor prognosis

52
Q

Give three symptoms of pancreatic cancer

A
  • Weight loss
    • Jaundice

Trousseau’s signDARK RED PATCH

53
Q

Describe a carcinoma of the ampulla of vater

A

• Bile duct blocked with a small tumour, leading to jaundice and early presentation when the tumour is still treatable

54
Q

Give four islet cell tumours

A
  • Insulinoma
    • Glycagonoma
    • Vasoactive intestinal peptideoma
    • Gastrinoma
55
Q

What does insulinoma cause?

A

• Hypoglycaemia

56
Q

What is a characteristic sign of glycagonoma

A

• Characteristic skin rash - Thrombophlebitis migrans

57
Q

What syndrome is associated with gastrinoma

A

Zollinger - Ellison syndrome (Ectopic gastrin production)

58
Q

Give three types of benign liver tumour

A
  • Hepatic adenoma
    • Bile duct adenoma
    • Haemangioma
59
Q

Give three types of malignant liver tumours

A
  • Hepatoceullarcarcinoma
    • Cholaniocarcinoma - liver flukes
    • Hepatoblastoma
60
Q

What are the four most common GI malignancies in order

A
  • Colorectal
    • Stomach
    • Pancreas
    • Oesophagus
61
Q

What are two types of malignant tumour

A
  • Primary

* Malignant

Semester 3 - Gastrointestinal (28 decks)

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