02-02-23 - Gastrointestinal tumours (upper tract) Flashcards
(29 cards)
Learning outcomes
- Describe common tumours of oesophagus
- Describe common tumours of stomach
What are the 2 types of benign tumours of the oesophagus?
What are the 2 types of malignant tumours of the oesophagus?
What are the 2 types of benign tumours of the stomach?
What are the 4 types of malignant tumours of the stomach?
- 2 types of benign tumours of the oesophagus (account for 5% of oesophagus tumours)
1) Mesenchymal Tumours
2) Squamous papillomas - 2 types of malignant tumours of the oesophagus:
1) Squamous Cell Carcinoma
2) Adenocarcinoma - 2 types of benign tumours of the stomach:
1) Polyps (Non-neoplastic or Adenomas)
2) Mesenchymal - 4 types of malignant tumours of the stomach:
1) Carcinoma
2) Lymphoma
3) Carcinoid
4) Mesenchymal
What are 8 benign tumours of the oesophagus?
How are they often found?
- 8 benign tumours of the oesophagus:
1) Leiomyomas (most common) – tumour of smooth muscle cells
2) Fibromas – tumour of fibrous tissue
3) Lipomas – tumour of fat tissue
4) Haemangiomas
5) Neurofibromas
6) Lymphangiomas
7) Mucosal polyps
8) Squamous papillomas - They are often found accidentally through endoscopy/gastroscopy
What are the 2 main types of Malignant Tumours of the Oesophagus?
What are 4 rare types of malignant tumours of the oesophagus?
- 2 main types of Malignant Tumours of the Oesophagus:
1) Squamous Cell Carcinoma (90% of all)
2) Adenocarcinoma - 4 rare types of malignant tumours of the oesophagus:
1) Carcinoid tumour
2) Malignant melanoma
3) Lymphoma
4) Sarcoma
What groups does squamous cell carcinoma affect the most?
What country in the world is most affected?
- Squamous cell carcinoma is more common in those > 50
- It is more prevalent in men than women (ranges from 2:1 to 20:1) - 5 per 100 000 population in males and 1 per 100 000 in females (Average in Europe)
- Most common place in the world for occurrence is Iran
- Can be common in places that drink hot tea, as hot trauma is a risk factor
What are 3 dietary risk factors for squamous cell carcinoma?
What are 2 lifestyle risk factors for squamous cell carcinoma?
What are 2 oesophageal condition risk factors for squamous cell carcinoma?
What else are risk factors for squamous cell carcinoma?
- 3 dietary risk factors for squamous cell carcinoma:
1) Deficiency of vitamins (A, C, riboflavin, thiamine, pyridoxine)
2) Fungal contamination of foodstuffs (e.g dried mets)
3) High content of nitrites/nitrosamines - 2 lifestyle risk factors for squamous cell carcinoma:
1) Burning-hot beverages or food
2) Alcohol and tobacco - 2 oesophageal condition risk factors for squamous cell carcinoma:
1) Long-standing oesophagitis
2) Achalasia – difficult swallowing/drinking - Genetic Predisposition can also be a risk factor for squamous cell carcinoma
What % of squamous cell carcinoma occurs in the upper, lower, and middle thirds of the oesophagus?
How does squamous cell carcinoma present in endoscopy/gastroscopy?
What 3 patterns can squamous cell carcinoma present in?
What % makes up each type?
- % of squamous cell carcinoma occurs in the upper, lower, and middle thirds of the oesophagus:
1) 20% in the upper third
2) 50% in the middle third, and
3) 30% in the lower third of the oesophagus - Squamous cell carcinoma presents as small, gray-white, plaque-like thickenings that become tumorous masses in gastroscopy/endoscopy
- 3 patterns can squamous cell carcinoma present in (morphology):
1) Protruded polypoid exophytic (60%)
* Quick symptoms
2) Flat, diffuse, infiltrative (15%)
* Difficult to spot
3) Excavated, ulcerated, (25%)
How can the morphology of squamous cell carcinoma be identified?
- The morphology of squamous cell carcinomas can be identified using a barium swallow x-ray
What are the 3 histological features of squamous cell carcinoma?
What is degree of atypica? How is it classified?
- 3 histological features of squamous cell carcinoma:
1) Pleomorphism
* Different size/shape of cell nuclei
2) Hyperchromatism
* Invading darker cells
3) Mitotic figures
* Nuclei can be darker because cells are active and multiplying faster
- Degree of atypica is a measure of how much cancerous cells imitate their normal counterparts
- Dysplasia is disorganized growth
- Degree of atypica can be measured through their grade of dysplasia
- Cells can have a low grade of dysplasia and be relatively similar to their normal counterparts or a high grade of dysplasia and be very abnormal
What are 5 clinical features of squamous cell carcinoma?
What is the prognosis of squamous cell carcinoma?
- 5 clinical features of squamous cell carcinoma:
1) Dysphagia
2) Extreme weight loss (cachexia)
3) Haemorrhage and sepsis
4) Cancerous tracheoesophageal fistula
5) Metastases (lymph nodes):
* Cervical
* Mediastinal
* Paratracheal
* Tracheobronchial
* Gastric and celiac
- The prognosis of squamous cell carcinoma is a 5% overall five-year survival
What part of the oesophagus does adenocarcinoma affect?
What age does it affect?
What can adenocarcinomas arise from?
What are risk factors for adenocarcinomas?
- Adenocarcinoma affects the lower third of the oesophagus
- Start to appear at 40 years old, with a median age of 60
- Adenocarcinomas can arise from the Barrett mucosa (Makes up 10% of cases of adenocarcinomas)
- Barrett’s oesophagus is Intestinal metaplasia caused by gastric reflux
- Metaplastic columnar epithelium that predisposes to cancer development replaces the stratified squamous epithelium
- Risk factors for adenocarcinomas are tobacco and obesity
What are 2 morphological features of adenocarcinomas?
Describe the histology of adenocarcinomas
- 2 morphological features of adenocarcinomas:
1) Flat or raised patches or nodular masses
2) May be infiltrative or deeply ulcerative - A feature of the histology of adenocarcinomas is mucin-producing glandular tumours
Describe TNM staging of oesophageal cancers
- TNM staging of oesophageal cancers
- Related to invasion and how deep cells have gone through the oesophagus:
- T is carcinoma in situ
- T1 invasion of submucosa
- T2 invasion of muscularis propria
- T3 invasion of adventitia
- T4 invasion of adjacent structures
- N0 no node spread
- N1 regional node metastases
- M0 no distant spread
- M1 distant metastases
What are 7 clinical features of adenocarcinomas?
What is the prognosis of adenocarcinomas?
- 7 clinical features of adenocarcinomas:
1) Dysphagia
2) Progressive weight loss
3) Bleeding
4) Chest pain
5) Vomiting
6) Heartburn
7) Regurgitation - Prognosis of adenocarcinomas - 20% overall five-year survival
What are 2 types of benign tumours of the stomach?
How can polyps affect the emptying of the stomach?
What can adenomas develop into?
- 2 types of benign tumours of the stomach:
1) Polyps:
* Nodule or mass that projects above the level of the surrounding mucosa, usually in the antrum
- Non neoplastic polyps (90%)
- Most are small and sessile (without a stalk)
- Hyperplastic surface epithelium
- Cystically dilated glandular tissue
- Neoplastic polyps – adenomas (5-10%)
- Contains proliferative dysplastic epithelium
- Malignant potential
- Sessile (without a stalk) or pedunculated (stalked).
2) Leiomyomas and Schwannomas – rare
- Polyps can affect the emptying of the stomach by affecting the pyloric sphincter
- Adenomas (non-cancerous tumours) can become cancerous
What % of malignant tumours are gastric carcinomas?
How common is it in the world?
- 90% to 95% of malignant tumours of the stomach are gastric carcinomas/adenocarcinomas
- It is the second most common tumour in the world, with it being most common in Japan
What are 4 environmental factors associated with gastric carcinoma?
What are 4 genetic factors associated with gastric carcinoma?
What are 3 host conditions associated with gastric carcinoma?
- 4 environmental factors associated with gastric carcinoma:
1) Infection by H. pylori
2) Diet
3) Low socioeconomic status
4) Cigarette smoking - 4 genetic factors associated with gastric carcinoma:
1) Slightly increased risk with blood group A
2) Family history
3) Hereditary nonpolyposis colon cancer syndrome
4) Familial gastric carcinoma syndrome - 3 host conditions associated with gastric carcinoma:
1) Chronic gastritis
2) Gastric adenomas
3) Barrett oesophagus
What parts of the stomach can be affected by gastric carcinomas?
What 3 things are gastric carcinomas classified on the basis of?
- Parts of the stomach can be affected by gastric carcinomas:
1) Pylorus and antrum - 50% to 60%
2) Cardia - 25%
3) Body and fundus – 5 to 25% - 3 things are gastric carcinomas classified on the basis of:
1) Depth of invasion
* Early and Advanced
2) Macroscopic growth pattern
3) Histological subtype
What are the 3 stages in the macroscopic growth patterns of gastric carcinomas?
- 3 stages in the macroscopic growth patterns of gastric carcinomas:
1) Exophytic
2) Flat or depressed / Linitis plastica
3) Excavated
Morphology of exophytic gastric carcinoma
Describe the morphological features of an excavated gastric carcinoma
- Morphological features of an excavated gastric carcinoma:
- Ill-defined, central ulcer surrounded by irregular, heaped-up borders
Describe the 3 morphological features of Linitis plastica, “(leather bottle) gastric carcinomas
- 3 morphological features of Linitis plastica, “(leather bottle) gastric carcinoma:
1) Diffuse infiltrative gastric carcinoma
2) Mucosal erosion
3) Markedly thickened gastric wall
Describe the barium meal x-ray of gastric carcinomas
- The barium meal x-ray of gastric carcinomas looks as if part of the stomach has been eaten away
What are the 3 types in the Adenocarcinoma Lauren histopathological Classification?
Describe each type
- 3 types in the Adenocarcinoma Lauren histopathological Classification:
1) Intestinal type
* Composed of neoplastic intestinal glands resembling those of colonic adenocarcinoma
* Cells often contain apical mucin vacuoles, and abundant mucin may be present in gland lumens
2) Diffuse type
* Composed of gastric-type mucous cells, which generally do not form glands, but rather permeate the mucosa and wall as scattered individual cells or small clusters in an “infiltrative” growth pattern
* Mucin formation expands the malignant cells and pushes the nucleus to the periphery, creating a “signet ring”
3) Mixed type
