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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
What is the association of gastric cancer with H.pylori?
H.pylori causes chronic inflammation which is strongly associated with gastric cancer
26
Give three treatments for gastric cancer
* Surgery * Chemotherapy Herceptin
27
What is gastric lymphoma?
* 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
How does the prognosis of gastric lymphoma compare to gastric carcinoma?
Much better
29
What is a gastrointestinal stromal tumour?
• Derived from interstitial cells of cajal Caused by C-kit mutation which makes it vulnerable to targeted treatment
30
What is the behaviour of gastrointestinal stromal tumours?
* Pleomorphism * Mitoses Necrosis
31
What is a key feature of gastric lymphoma
• Gastro-intestinal haemorrhage
32
Give four types of tumours of the large intestine
* Adenomas * Adenocarcinomas * Polyps * Anal carcinoma
33
Give three types of adenomas in the large intestine
* Benign, neoplastic lesions in the large bowel * Familial adenomatous polyposis * Gardner's syndrome
34
Give two macroscopic features of adenoma of the large intestine
• Sessile (immobile) OR pedunculated (small growth on stalk)
35
Give two microscopic features of adenoma of the large intestine
• Variable degree of dyplasia Malignant potential
36
What is the most common risk factor for large intestinal adenoma?
• Advancing age
37
What is familial adenomatous polyposis?
* An autosomal dominant condition on chromosome 5 | * Large number of adenomas form giving high risk of cancer
38
What is gardner's syndrome?
* Similar to familial adenomatous polyposis | * Bone and soft tissue tumours also
39
What is the most common type of GI malignancy?
• Colorectal adenocarcinoma
40
Give two macroscopic features of colorectal adenocarcinoma
• Rectosigmoid fungating/stenotic
41
Give two microscopic features of colorectal adenocarcinoma
• Mucinous Signet ring cell types
42
Give three ways in which colorectal adenocarcinoma spreads
* Direct through bowel wall to adjacent organs * Via lymphatics to mesenteric lymph nodes Via portal venous system to liver
43
Give two ways in which colorectal adenocarcinoma is staged
* Dukes staging | * TMN
44
Outline duke's staging of colorectal adenocarcinoma
* A - Confined to bowel wall * B - Through wall, lymph nodes clear * C - Lymph node involvement * C1/C2 - Highest node clear/ involved
45
Give three main mutations in colorectal adenocarcinoma
* FAP - Chromosome 5 * Ras mutations * P53 loss/inactivation * K-ras - Guides treatment with cetuximab
46
At what age is colorectal adeno carcinoma?
* Peak at 60-70 | * High in UK/USA, low in Japan
47
Give two diseases which predispose a patient to colorectal adenocarcinoma
* Ulcerative carcninoma | * Crohn's disease
48
Give four predisposing aeitological factors to colorectal adenocarcinoma
* Low residue diet * Slow transit time * High fat intake * Genetic predisposition
49
Give three carcinomas of the large intestine of the colorectal adenocarcinoma
``` • Carinoid tumoure ○ Rare and unpredictabel neuro-endocrine tumour • Lymphoma ○ Rare, may be primary • Smooth muscle/stromal tumours ○ Rare and unpredictable ```
50
Outline the morphology of pancreatic carcinoma
* 2/3 in the head * Firm pale mass with a necrotic centre May infiltrate adjacent structures
51
What is the histology of a pancreatic carcinoma
* 80% are ductal adenocarcinomas * Well formed glands * Some may contain zymogen granules All have poor prognosis
52
Give three symptoms of pancreatic cancer
* Weight loss * Jaundice Trousseau's signDARK RED PATCH
53
Describe a carcinoma of the ampulla of vater
• Bile duct blocked with a small tumour, leading to jaundice and early presentation when the tumour is still treatable
54
Give four islet cell tumours
* Insulinoma * Glycagonoma * Vasoactive intestinal peptideoma * Gastrinoma
55
What does insulinoma cause?
• Hypoglycaemia
56
What is a characteristic sign of glycagonoma
• Characteristic skin rash - Thrombophlebitis migrans
57
What syndrome is associated with gastrinoma
Zollinger - Ellison syndrome (Ectopic gastrin production)
58
Give three types of benign liver tumour
* Hepatic adenoma * Bile duct adenoma * Haemangioma
59
Give three types of malignant liver tumours
* Hepatoceullarcarcinoma * Cholaniocarcinoma - liver flukes * Hepatoblastoma
60
What are the four most common GI malignancies in order
* Colorectal * Stomach * Pancreas * Oesophagus
61
What are two types of malignant tumour
* Primary | * Malignant

Semester 3 - Gastrointestinal (28 decks)

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