16) Common GI Malignancies Flashcards Preview

Gastrointestinal Tract > 16) Common GI Malignancies > Flashcards

Flashcards in 16) Common GI Malignancies Deck (52)
1

Which organs are common GI malignancies found in?

Oesophagus
Stomach
Large intestine
Pancreas
Liver

2

What percentage of malignancies in UK are oesophageal carcinoma?

2%

3

How does oesophageal carcinoma present?

Dysphagia (worsening as tumour grows)
Weight loss

4

What investigations may be used for suspected oesophageal carcinoma?

Endoscopy, biopsy, barium

5

What is the most common type of oesophageal carcinoma and where does it occur?

Squamous cell carcinoma
May occur at any level

6

What is the second most common type of oesophageal carcinoma and where does it occur?

Adenocarcinoma
Lower third, associated with Barrett's oesophagus

7

How does an oesophageal adenocarcinoma progress?

Arises in metaplastic epithelium of Barrett's oesophagus and progresses through dysplasia

8

Why is the prognosis of oesophageal carcinoma so bad?

Advanced disease at presentation, as usually spread through oesophageal wall
Only 40% resectable

9

What is the five year survival of oesophageal carcinoma?

5%

10

What treatment can be given in oesophageal cancer to relieve symptoms?

Local radiotherapy to shrink tumour
Tube passed through tumour to facilitate swallowing

11

What things is gastric cancer associated with?

Blood group A
Gastritis

12

How does gastric cancer present?

Vague symptoms: epigastric pain, vomiting, weight loss

13

What investigations may be done if gastric cancer is suspected?

Endoscopy, biopsy, barium

14

What are some macroscopic features of gastric cancer?

Fungating
Ulcerating
Infiltrative (linitis plastica)

15

What two types of microscopic gastric cancer can be seen?

Intestinal
Diffuse

16

What are the features of intestinal gastric cancer?

Variable degree of gland formation

17

What are the features of diffuse gastric cancer?

Single cell or small groups
Signet ring cells

18

Why are the nuclei of signet ring cells at the peripheries?

Signet ring cell is full of mucins so pushes nucleus

19

Describe early gastric cancer:

Confined to mucosa/submucosa
Good prognosis

20

Describe advanced gastric cancer:

Further spread, 10% five year survival

21

How can gastric cancer spread?

Direct - through gastric wall
Lymph nodes
Liver
Trans-coelomic - into peritoneal cavity, can deposit here and spread to ovaries

22

What structures may be affected by the direct spread of gastric cancer?

Duodenum, transverse colon and pancreas

23

What treatment is there for gastric cancer?

Surgery (curative)
Chemotherapy
Herceptin (HER receptor)

24

How is H. pylori associated with gastric cancer?

Chronic inflammation and metaplasia can lead to cancer

25

What other GI cancer is associated with H. pylori?

Gastric lymphoma

26

How can gastric lymphoma be treated?

Eradication of H. pylori may lead to tumour regression
Otherwise, chemotherapy and surgery

27

What cell type are GI stromal tumours derived from?

Interstitial cells of Cajal - pacemaker cells for peristalsis

28

What specific targeted treatment may be used to treat GI stromal tumours?

Imatinib

29

What unpredictable behaviour may a GI stromal tumour show?

Pleomorphism
Mitoses
Necrosis

30

Why are large intestinal adenomas dangerous?

Malignant potential
Precursor to adenocarcinoma

31

What is familial adenomatous polyposis?

Autosomal dominant condition leading to thousands of adenomas and a high risk of cancer

32

What prophylaxis may be used in FAP?

Prophylactic colectomy

33

What is Gardner's syndrome?

Similar to FAP with bone and soft tissue tumours

34

How is the adenoma-carcinoma sequence proved?

Synchronous lesions
Metachronous lesions - after one more likely to get other
Anatomical distribution is similar

35

What is the commonest GI malignancy?

Colorectal adenocarcinoma

36

What is the macroscopic appearance of colorectal adenocarcinoma?

60-70% rectosigmoid
Fungating
Stenotic

37

What is the microscopic appearance of colorectal adenocarcinoma?

Moderately differentiated
Mucinous
Signet ring cell

38

How can colorectal adenocarcinoma spread?

Through bowel wall to adjacent organs e.g. bladder
Lymphatics to mesenteric lymph nodes
Portal venous system to liver

39

What staging is used in colorectal adenocarcinoma?

Dukes'
TNM

40

Describe the Dukes' staging of colorectal adenocarcinoma:

A - confined to bowel wall
B - through wall (outer layer of muscle)
C - lymph nodes involved
(C1/C2 highest node clear/involved)

41

Give examples of some mutations found in colorectal adenocarcinoma:

FAP, ras, p53 loss/inactivation

42

What are some risk factors for colorectal adenocarcinoma?

Low fibre diet
High fat intake
Genetics
IBD

43

What treatments are there for colorectal adenocarcinoma?

Surgery with local radiotherapy
Resection of liver deposits
Chemotherapy (palliative)

44

Where may colorectal adenocarcinoma metastasise to?

Liver

45

Describe the morphology of carcinoma of the pancreas:

2/3 in head
Firm pale mass with necrotic, haemorrhagic and cystic surface
May infiltrate adjacent structures e.g. spleen

46

What is the most common type of carcinoma of the pancreas?

Ductal adenocarcinoma

47

What are some symptoms of carcinoma of the pancreas?

Weight loss
Jaundice
Trousseau's sign - blood clots on skin

48

What tumour may block the bile duct causing jaundice?

Carcinoma of the Ampulla of Vater

49

Name some islet cell tumours:

Insulinoma
Glucagonoma
VIPoma
Gastrinoma

50

What is the most common cancer in liver?

Metastasis

51

What benign tumours of the liver are there?

Hepatic adenoma
Bile duct adenoma

52

What malignant tumours of the liver are there?

Hepatocellular carcinoma
Cholangiocarcinoma