Tumours Of The Upper GIT

Question 1

Benign Tumours of the Oesophagus

Answer 1

• Leiomyomas
• fibromas
• lipomas
• haemangiomas
• neurofibromas
• lymphangiomas
• mucosal polyps
• squamous papillomas

Question 2

TNM STAGING

Answer 2

• T0 - no evidence of primary tumour
• Tis - carcinoma in situ (intraepithelial)
• T1 - invades lamina propria or submucosa
• T2 - invades muscularis propria or subserosa (not visceral peritoneum)
• T3 - penetrates visceral peritoneum but not adjacent structures
• T4 - invades adjacent structures (spleen, colon etc)
• N0 - no lymph node metastasis
• N1 - 1-6 lymph nodes
• N2 - 7-15 lymph nodes
• N3 - more than 15 lymph nodes
• M0 - no distant metastasis
• M1 - distant metastasis, in portal lymph nodes, mesenteric, retroperitoneal, or more distant.

Question 3

Squamous Cell Carcinoma

Answer 3

• Factors associated; diet (deficiency of vitamins (A, C, riboflavin, thiamine, pyridoxine), fungal contamination, high nitrite/nitrosamine content), lifestyle (alcohol, tobacco, burning-hot beverages), oesophageal disorders (long-standing oesophagitis, achalasia), genetic predisposition.
• Morphology - most common in middle third of oesophagus. Small, grey-white, plaque-like thickenings that become tumourous masses. 3 patterns: protruded polypoid exophytic, flat diffuse infiltrative, & excavated ulcerated.
• clinical features - dysphagia, extreme weight loss, haemorrhage, sepsis, cancerous tracheoesophageal fistula. Metastases- cervical, mediastinal, paratracheal, tracheobronchial, gastric and coeliac.
• Prognosis - 5% overall 5-year survival

Question 4

Adenocarcinoma

Answer 4

• Lower third of oesophagus, arises from barrett’s mucosa. Tobacco and obesity increase risk.
• Morphology - fat or raised patches or nodular masses. May be infiltrative or deeply ulcerative. Mucin-producing gladular tumours.
• Clinical features - dysphagia, progressive weight loss, bleeding, chest pain, vomiting, heart burn, regurgitation.
• Prognosis - 20% overall 5-year survival rate.

Question 5

Benign Tumours of the Stomach

Answer 5

• Non-neoplastic polyps - most are small and sessile, hyperplastic surface epithelium or cystically dilated glandular tissue.
• Neoplastic polyps - contains proliferative dysplastic epithelium with malignant potential. Can be sessile or pedunculated.
• Leiomyomas
• Schwannomas

Question 6

Gastric Carcinoma

Answer 6

• 90-95% of malignant tumours of the stomach, 2nd most common tumour in the world.
• Risk factors - Environmental (H.Pylori infection, diet, low socioeconomic status, smoking), Host (chronic gastritis, gastric adenomas, barrett’s oesophagus), and genetic factors (blood type A, family history, HNPCC, familial gastric carcinoma syndrome).
• Pylorus and Antrum > Cardia > Body and Fundus
• Classified based on depth of invasion, macroscopic growth pattern (exophytic, flat or depressed/linitis plastica, excavated), histological subtype. Or by Intestinal Type (neoplastic intestinal glands containing apicl mucin vacuoles, abundant mucin), Diffuse Type (gastric-type mucous cells permeated in the mucosa and wall in infiltrative growth pattern) or Mixed.
• All gastric carcinomas eventually penetrate the wall and speead to regional and more distant lymph nodes.
• Clinical features - asymptomatic until late, weight loss, abdo pain, anorexia, vomiting, altered bowel habits, dysphagia, anaemia, haemorrhage.
• Prognosis - caught early 90-95%, advanced <15%.

Question 7

Gastric Lymphoma

Answer 7

• 5% of gastric malignancies. >80% associated with chronic gastritis and H. pylori infection. Usually B-Cell Lymphomas of MALT.
• Prognosis - 50% 5-year survival rate.
• Morphology - commonly occurs in mucosa or superficial submucosa. Lymphocytic infiltrate of the lamina propria surrounds gastric glands massively infiltrated with atypical lymphocytes and undergoing destruction.