Week 10 - GI cancer Flashcards by Becky Mladenovic

Demographics of oesophageal carcinomas

Affects males more

China and around the Caspian Sea

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Causes of oesophageal carcinomas

HPV

Vitamin A deficiency

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Clinical features of oesophageal carcinomas

Progressive dysphagia

Weight loss

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Investigations for oesophageal carcinomas

Upper GI endoscopy
Biopsy
Barium

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Types and location of oesophageal carcinomas

Squamous cell carcinoma most common - anywhere in oesophagus
Adenocarcinoma - lower 1/3

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Prognosis of oesophageal carcinomas

5% 5 year survival rate

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Spread of oesophageal carcinoma

Directly through oesophageal wall and distally (towards Z line)

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Demographics of gastric cancer

More common in males
Japan, Columbia and Finland
Blood group A

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Prognosis of gastric cancer

Poor as asymptomatic until advanced
Advanced - 10% 5 year survival
Early - good prognosis

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Clinical features of gastric cancer

Vomiting
Weight loss
Epigastric pain
Malena

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Investigations of gastric cancer

Upper GI endoscopy
Biopsy
Barium

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Macroscopic appearance of gastric cancer

Fungating
Ulcerating
Infiltrative (linitis plastica)

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Microscopic appearance of gastric cancer

Intestinal type - degree of gland formation

Diffuse type - signet ring cells

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Difference between early and advanced gastric cancer

Early is confined to mucosa and submucosa

Advanced has invaded into the muscularis externa

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Spread of gastric cancer

Direct
Lymph nodes (Virchow’s nodes)
Liver
Transcoelomic to peritoneum or ovaries

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Treatment of gastric cancer

Surgery
Chemotherapy
Herceptin

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Risk factors for gastric cancer

Male
Smoking
H pylori infection

Describe gastric lymphoma

Strongly associated with H pylori
Eradication of H pylori may lead to tumour regression
Better prognosis than gastric cancer

Describe GI stromal cancers

Uncommon

Derived from interstitial cells of Cajal (pacemaker cells)

Behaviour of GI stromal cancers

Unpredictable:
Pleomorphism
Mitoses
Necrosis

Treatment for GI stromal cancers

Imatinib

Have C-kit mutation

What are tumours of the large intestine

Adenomas 
Adenocarcinomas
Polyps
Anal carcinoma 
Carcinoid (neuro-endocrine tumour)
Lymphoma - usually spread from somewhere else
Stromal (smooth muscle tumour)

What are large intestine adenomas

Benign neoplastic lesions with malignant potential (adeno-carcinoma sequence)

Macroscopic appearance of large intestine adenomas

Sessile - no stalk
Or
Pedunculated - stalk

Describe genetic conditions associated with adenomas

Familial adenomatous polyposis - autosomal dominant mutation on chromosome 5, high risk of cancer Gardner's syndrome - similar to FAP with bone and soft tissue tumours

Macroscopic appearance of colorectal adenocarcinomas

Fungating - in the right side | Stenotic - in the left side

Microscopic appearance of colorectal adenocarcinomas

Mucinous types | Signet ring cell types

Spread of colorectal adenocarcinomas

Directly through bowel wall to adjacent structure e.g bladder Lymphatics to mesenteric LNs Portal venous system to liver

Staging methods of colorectal adenocarcinomas

TNM | Dukes staging

Describe Dukes staging

A - confined to bowel wall B - through bowel wall C1 - LN involvement but not highest lymph node C2 - highest LN involvement

Risk factors for FAP

ras mutation | p53 inactivation

Causes of colorectal adenocarcinomas

FAP High dietary fat Slow transit time - longer contact time for carcinogens UC or Chron's disease

Treatment for colorectal adenocarcinomas

Surgery Chemo Resect liver metastases Local radiation for rectal cancer

Describe pancreatic cancer

``` Most are ductal adenocarcinomas 2/3 in head Firm pale masses with a necrotic centre May be haemorrhagic or cystic Poor prognosis ```

Spread of pancreatic cancer

Direct to adjacent structures e.g spleen

Symptoms of pancreatic cancer

Weight loss Jaundice if in head Trousseau's sign - carpal spasm after cuffing upper arm

Describe acinar pancreatic cancers

Contain zymogen granules

Describe ampulla of Vater carcinomas

Good prognosis - detected early | Bile duct is blocked leading to jaundice and steatorrhoea

Types of islet cell tumours

Insulinoma - hypoglycaemia Glucogonoma - characteristic skin rash Vasoactive intestinal peptideoma (VIPoma) /Verner Morrison syndrome - watery diarrhoea, hypokalaemia, achlorydria Gastrinoma/Zollinger Ellison syndrome

Malignant liver tumours

Hepatocellular carcinoma Cholangiocarcinoma Hepatoblastoma

Benign liver tumours

Hepatic adenoma Hamartoma - bile duct adenoma Haemangioma