What are the characteristic signs of oesophageal cancer?
- Dysphagia
- Weight loss
How do you investigate a suspected oesophageal carcinoma?
- Endoscopy
- Biopsy
- Barium swallow
What is the commonest type of oesophageal carcinoma?
-Squamous cell carcinoma
Where does adenocarcinoma of the oesophagus occur?
-Lower thrid
Why is the prognosis for oesophageal cancer poor?
- Many present at late stages
- Can spread directly through oesophageal wall
- Many patients are elderly and not suitable for resection
Describe the prognosis of gastric cancer
-Poor with less than 20% 5 year survival
Does gastric cancer affect females or males more?
-males
What bacteria is associated with gastric cancer and strongly with gastric lymphoma?
-H.pylori
What are the clinical features of gastric cancer?
- Vague symptoms
- Vomiting
- Weightloss
How do you investigate suspected gastric cancer?
- Endoscopy
- Biopsy
- Barium
Describe the macroscopic features of a gastric cancer
-Fungating, ulcerating, infiltrative
What are the two types of gastric cancer?
- Intestinal
- Diffuse
What is characteristic histologically of diffuse gastric cancer?
- Signet ring cells full of mucin
- Cells arranged singly or in small groups
How does gastric cancer spread?
- Directly
- Lymph nodes
- Haematogenous to liver
- Transcoelomic to peritoneum/ovaries
What are krunkenberg tumours?
-Tumours of the overy which have metastasised from a primary site
What are the possible treatments for gastric cancer?
- Surgery
- Chemotherapy
- Herceptin
What is the most common GI lymphoma?
-Gastric lymphoma
What lymph nodes involvement is associated with gastric cancer?
-Virchows node (left supraclavicular)
What are gastro-intestinal stromal tumours?
-Mesenchymal neoplasm which mainly occurs in the stomach
What types of tumours occur in the large intestine?
- Adenomas
- adenocarcinomas
- Polyps
- anal carcinoma
Describe the histiological features of an adenoma
-Can be sessile or pedunculated with a variable degree of dysplasia
Name a genetic condition associated with adenomas
-Familial adenomatous polyposis
What is the adenoma-carcinoma sequence?
-The stepwise development of adenocarcinomas from adenomas
Describe features of right sided colorectal adenocarcinomas
-Fungating and unlikely to cause obstruction
Describe features of left sided colorectal adenocarcinomas
-Stenotic and likely to cause obstruction
Where do colorectal adenocarcinomas commonly occur?
-Distally in rectum and sigmoid
What is an applecore stricture characteristic off?
-Colorectal adenocarcinoma
How do colorectal adenocarcinomas spread?
- Directly through the bowel wall to adjacent organs
- Lympatics
- Portal system to liver
Describe dukes staging
- A-> in the wall
- B-> through the wall
- C-> involves lymph nodes
At what age do adenocarcinomas usually present?
-60-70
Describe some risk factors for colorectal adenocarciomas
- Slow transit time
- Low residue diet
- High fat intake
- Genetic predisposition
What metastases are common in advanced colorectal carcinoma?
-Liver
Name 3 other large intestinal tumours besides adencarcinoma
- Carcinoid tumour
- Lymphoma
- Stromal tumour (lyomyoma)
Why is the prognosis of pancreatic carcinoma so poor?
- Very difficult to diagnose until very late stage
- Early symptoms are vague
What are the presenting features of pancreatic tumour?
- Weight loss
- Jaundice
- Trousseau’s sign
Where do most pancreatic carcinomas occur?
-In the head
How does a pancreatic carcinoma appear on inspection?
- Pale firm mass until cut
- Inside is necrotic, haemorrhagic
In what cells do pancreatic tumours most often arise?
-Ductal
Why can pancreatic cancer give a silvery stool?
-Malnutrition and lack of bile
What types of islet cell tumours are there?
- Insulinoma
- Glucagonoma
- VIPoma
- Gastrinoma
Which clinical presentation is caused by a gastrinoma?
-Zollinger-ellison syndrome
Name 2 benign tumours of the liver
- Hepatic adenoma
- Haemangioma
Name 2 malignant tumours of the liver
- Hepatocellular carcinoma
- Cholangiocarcinoma
What is the most common GI cancer?
-Colorectal
What are the two types of oesophageal cancer?
- Squamous cell
- Adenocarcinoma