Tumours of the Upper GI

Question 1

Name some of the benign and malignant tumours of the upper GI?

Answer 1

Benign - Mesenchymal tumours and squamous papillomas.

Malignant - Squamous cell carcinoma and adenocellcarcinoma.

Question 2

What are some of the benign and malignant tumours of the stomach

Answer 2

Benign - Polyps and mesenchymal.

Malignant - Carcinoma, lymphoma, carcinoid and mesenchymal.

Question 3

What are some of the benign tumours of the oesophagus?

Answer 3

• Leiomyomas (most common),
• Fibromas,
• Lipomas

Question 4

What are some of the malignant tumours of the oesophagus

Answer 4

Squamous cell carcinoma (90% of all) and adenocarcinoma. More rare ones include - carcinoid tumour, malignant melanoma, lymphoma and sarcoma.

Question 5

What are some of the factors associated with squamous cell carcinoma?

Answer 5

Dietary - Deficiency of vitamins, fungal contamination of foodstuffs and high content of nitrites/nitrosamines.
Lifestyle - Burning hot beverages/food, alcohol and tobacco.
Oesophageal Disorders - long-standing oeophagitis and achalasia.
Genetic predisposition.

Question 6

Describe the morphology of squamous cell carcinoma

Answer 6

• Small, grey-white, plaque-like thickenings that become tumorous masses. Three patterns;
  1) Protruded polypoid exophytic (60%),
  2) Flat, diffuse, infiltrative (15%),
  3) Excavated, ulcerated (25%)

Question 7

Describe the histology of squamous cell carcinoma

Answer 7

• Pleomorphism, hyperchromatism and mitotic figures (THINK MALIGNANT) also whether is has low/high grade dysplasia (presence of abnormal cells)

Question 8

What are some clinical features of squamous cell carcinoma?

Answer 8

• Dysphagia,
• Extreme weight loss (cachexia),
• Haemorrhage and sepsis,
• Cancerous tracheoesophageal fistula,
• Metastases (cervical, mediastinal, paratracheal, tracheobronchial and gastric and celiac).

Question 9

Describe the morphology and histology of adenocarcinoma

Answer 9

Morphology - Flat or raised patches or nodular masses, may be infiltrative or deeply ulcerative.
Histology - Mucin-producing glandular tumours

Question 10

Describe the TNM staging

Answer 10

Tis - Carcinoma in situ,
T1 - Invasion of submucosa,
T2 - invasion of muscularis propria,
T3 - Invasion of adventitia,
T4 - Invasion of adjacent structures.

N0 - no node spread,
N1 - Regional node metastases.

M0 - no distant spread,
M1 - Distant metastases

Question 11

What are the clinical features of adenocarcinomas

Answer 11

• Dysphagia,
• Progressive weight loss,
• Bleeding,
• Chest pain,
• Vomiting,
• Heartburn,
• Regurgitation.
  (DPBCVHR)

Question 12

Describe in more detail some of the benign tumours of the stomach

Answer 12

Polyps (Nodule or mass that projects above the level of the surrounding mucosa), they can be non neoplastic or neoplastic (malignant potential). Therefore all must be biopsied.
RARE tumours include leiomyomas and schwannomas

Question 13

What are some factors associated with gastric carcinomas?

Answer 13

Environmental - infection of H.pylori, diet, low socioeconomic status and smoking.

Host - Chronic gastritis, gastric adenomas, barrett oesophagus.

Genetic - Slight increase in blood group A, fam history, HNCCS and familial gastric carcinoma syndrome

Question 14

Where are the most common sites for gastric carcinomas?

Answer 14

• Pylorus and antrum (60%), Cardia (25%) and the remainder in the body and fundus.

Question 15

How are gastric carcinomas classified?

Answer 15

1) Depth of invasion (early or advanced),
2) Macroscopic growth pattern (exophytic, flat or depressed, excavated and linitis plastica - Diffuse infiltrative),
3) Histological subtype

Question 16

Define exophytic

Answer 16

It is an outwards growth beyond surface epithelium

Question 17

Describe the Lauren classification of the histopathology of gastric carcinomas

Answer 17

Intestinal type - Composed of neoplastic intestinal glands resembling those of colonic adenocarcinoma.
Diffuse Type - Composed of gastric type mucous cells. Mucin formation expands malignant cells and pushes nucleus to periphery.
Mixed type (combo of intestinal and diffuse

Question 18

Describe the spread of gastric carcinomas

Answer 18

• All eventually penetrate the wall and spread to regional and more distant LNs;
• Supraclavicular nodes,
• Local invasion into duodenum, pancrease and retroperitoneum.
• Metastasis to liver and lungs is common and to the ovaries forming krukenberg tumour

Question 19

What are clinical features of gastric tumours?

Answer 19

• Asymptomatic until late,
• Weight loss,
• Abdo pain,
• Anorexia,
• Vomiting,
• Altered bowel habits,
• Dysphagia,
• Anaemic symptoms,
• haemorrhage

Question 20

Describe features of gastric lymphomas

Answer 20

• B-cell lymphomas of mucousa associated lymphoid tissue (MALT lymphomas).
  Morphology - Commonly occurs in mucosa or superficial submucosa and can infiltrate lamina propria and surround gastric glands with atypical lymphocytes