Flashcards in 16) Common GI Malignancies Deck (52)
Which organs are common GI malignancies found in?
What percentage of malignancies in UK are oesophageal carcinoma?
How does oesophageal carcinoma present?
Dysphagia (worsening as tumour grows)
What investigations may be used for suspected oesophageal carcinoma?
Endoscopy, biopsy, barium
What is the most common type of oesophageal carcinoma and where does it occur?
Squamous cell carcinoma
May occur at any level
What is the second most common type of oesophageal carcinoma and where does it occur?
Lower third, associated with Barrett's oesophagus
How does an oesophageal adenocarcinoma progress?
Arises in metaplastic epithelium of Barrett's oesophagus and progresses through dysplasia
Why is the prognosis of oesophageal carcinoma so bad?
Advanced disease at presentation, as usually spread through oesophageal wall
Only 40% resectable
What is the five year survival of oesophageal carcinoma?
What treatment can be given in oesophageal cancer to relieve symptoms?
Local radiotherapy to shrink tumour
Tube passed through tumour to facilitate swallowing
What things is gastric cancer associated with?
Blood group A
How does gastric cancer present?
Vague symptoms: epigastric pain, vomiting, weight loss
What investigations may be done if gastric cancer is suspected?
Endoscopy, biopsy, barium
What are some macroscopic features of gastric cancer?
Infiltrative (linitis plastica)
What two types of microscopic gastric cancer can be seen?
What are the features of intestinal gastric cancer?
Variable degree of gland formation
What are the features of diffuse gastric cancer?
Single cell or small groups
Signet ring cells
Why are the nuclei of signet ring cells at the peripheries?
Signet ring cell is full of mucins so pushes nucleus
Describe early gastric cancer:
Confined to mucosa/submucosa
Describe advanced gastric cancer:
Further spread, 10% five year survival
How can gastric cancer spread?
Direct - through gastric wall
Trans-coelomic - into peritoneal cavity, can deposit here and spread to ovaries
What structures may be affected by the direct spread of gastric cancer?
Duodenum, transverse colon and pancreas
What treatment is there for gastric cancer?
Herceptin (HER receptor)
How is H. pylori associated with gastric cancer?
Chronic inflammation and metaplasia can lead to cancer
What other GI cancer is associated with H. pylori?
How can gastric lymphoma be treated?
Eradication of H. pylori may lead to tumour regression
Otherwise, chemotherapy and surgery
What cell type are GI stromal tumours derived from?
Interstitial cells of Cajal - pacemaker cells for peristalsis
What specific targeted treatment may be used to treat GI stromal tumours?
What unpredictable behaviour may a GI stromal tumour show?
Why are large intestinal adenomas dangerous?
Precursor to adenocarcinoma
What is familial adenomatous polyposis?
Autosomal dominant condition leading to thousands of adenomas and a high risk of cancer
What prophylaxis may be used in FAP?
What is Gardner's syndrome?
Similar to FAP with bone and soft tissue tumours
How is the adenoma-carcinoma sequence proved?
Metachronous lesions - after one more likely to get other
Anatomical distribution is similar
What is the commonest GI malignancy?
What is the macroscopic appearance of colorectal adenocarcinoma?
What is the microscopic appearance of colorectal adenocarcinoma?
Signet ring cell
How can colorectal adenocarcinoma spread?
Through bowel wall to adjacent organs e.g. bladder
Lymphatics to mesenteric lymph nodes
Portal venous system to liver
What staging is used in colorectal adenocarcinoma?
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)
Give examples of some mutations found in colorectal adenocarcinoma:
FAP, ras, p53 loss/inactivation
What are some risk factors for colorectal adenocarcinoma?
Low fibre diet
High fat intake
What treatments are there for colorectal adenocarcinoma?
Surgery with local radiotherapy
Resection of liver deposits
Where may colorectal adenocarcinoma metastasise to?
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
What is the most common type of carcinoma of the pancreas?
What are some symptoms of carcinoma of the pancreas?
Trousseau's sign - blood clots on skin
What tumour may block the bile duct causing jaundice?
Carcinoma of the Ampulla of Vater
Name some islet cell tumours:
What is the most common cancer in liver?
What benign tumours of the liver are there?
Bile duct adenoma