Tumours of Upper GI Tract Flashcards
What are the malignant tumours of the oesophagus?
- squamous cell carcinoma (90%)
- adenocarcinoma
What are the factors associated with squamous cell carcinoma?
Diet:
- vitamin deficiency
- fungal contamination of food
- high content of nitrites
Lifestyle:
- burning hot beverages or food
- alcohol/tobacco
Oesophageal disorders:
- long-standing oesophagitis and achalasia
Genetic predisposition
Describe the distribution of cases of SSC in the different parts of the oesophagus
- 20% in upper third
- 50% in middle third
- 30% in lower third
Describe the morphology of SSC in the oesophagus
- small, gray-white, plaque like thickening that become tumour masses
3 patterns:
- protruded polyploid exophytic (60%)
- flat, diffuse, infiltrative
- excavated, ulcerate`d
What are key histological features of SSC?
- pleomorphism (variability in size and shape)
- hyperchromatism (nuclei stain darker)
- mitotic figures
- low-high grade dysplasia
What are the clinical features of SSC?
- dysphagia
- extreme weight loss
- haemorrhage and sepsis
- cancerous tracheoesophageal fistula
- metastases (lymph nodes):
- cervical
- mediastinal
- paratracheal
- tracheobronchial
- gastric and coeliac
Where does adenocarcinoma occur and the associated factors?
- lower third of the oesophagus
- tobacco and obesity
Describe the morphology and key histological features of adenocarcinoma
Morphology:
- flat or raised patches or nodular masses
- may be infiltrative or deeply ulcerative
Histology:
- mucin-producing glandular tumours
What are the clinical features of adenocarcinomas
- dysphagia
- weight loss
- bleeding
- chest pain
- vomiting
- heart burn
- regurgitation
Describe non-neoplastic polyps
- most small and sessile (without a stalk)
- hyperplastic surface epithelium
- cystically dilated glandular tissue
Describe neoplastic polyps-adenomas
- contains proliferative dysplastic epithelium
- malignant potential
- sessile (without a stalk) or pedunculated (stalked)
What are the factors associated with gastric carcinomas?
Environmental:
- infection by H. pylori
- diet
- low socioeconomic status
- cigarette smoking
Host:
- chronic gastritis
- gastric adenomas
- Barrett oesophagus
Gastric Factors:
- blood group A
- family history
- HNPCC
- FAP
Describe the distribution of cases of gastric carcinomas in the different parts of the stomach
- pylorus and antrum (50-60%)
- cardia (25%)
- reaminder in body and fundus
Describe the morpphology of gastric carcinomas
- exophytic
- flat/depressed
- excavated
Describe Adenocardcinoma Lauren classification
Intestinal type:
- composed of neoplastic intestinal glands resembling colonic adenocarcinoma
- calls contain apical mucin vacuoles, abundant mucin may be present in gland lumen
Diffuse type:
- composed of gastric-type mucous cells that permeate mucosa and wall as indiviual cells or clusters in infiltrative growth pattern
- mucin formation expands malignant cells and pushes nucleus to the periphery
Mixed type
