GI Malignancies

Question 1

What are the most common GI malignancies?

Answer 1

Oesophageal, gastric, large intestine, pancreas and liver

Most common is colorectal carcinoma

Question 2

How does oesophageal carcinoma present clinically?

Answer 2

dysphagia - progressively worsening as tumour grows and occludes lumen

weight loss as it affects the ability to eat and swallow

Question 3

How do you investigate oesophageal carcinoma?

Answer 3

endoscopy, biopsy and barium swallow

Question 4

What two types of carcinomas occur in the oesophagus?

Answer 4

Squamous cell carcinoma or adenocarcinoma

squamous cell is most common and can occur at any level

adenocarcinoma is associated with the lower third of the oesophagus and barrett’s oesophagus

Question 5

What is the prognosis of oesophageal carcinoma?

Answer 5

Poor due to clinical presentation usually occurs at advanced stages of disease. The tumour can directly spread through the oesophageal wall and only 40% can be resected (cut out)

Question 6

How common is gastric cancer?

Answer 6

Common - 15% worldwide

Question 7

Is gastric cancer more common in men or women?

Answer 7

Men

Question 8

Where worldwide is gastric cancer most common?

Answer 8

Japan, Columbia (high prevalence of H. pylori infectons), Finland

Question 9

With which blood group is gastric cancer most commonly associated?

Answer 9

A

Question 10

With what disease is gastric cancer associated?

Answer 10

Gastritis and H. pylori infections

Question 11

How does gastric cancer present clinically?

Answer 11

Vague symptoms

Epigastric pain, vomiting, weight loss

Question 12

How would you investigate gastric cancer?

Answer 12

Endoscopy, biopsy, barium swallow

Question 13

What are the macroscopic features of gastric cancer?

Answer 13

Fungating (a fungating lesion is marked by ulcerations and areas of necrosis)

Ulcerating

Infiltrative -> linitis plastica

Question 14

What are the microscopic features of gastric cancer?

Answer 14

Gastric tissue resembles intestinal with variable degree of gland formation, and is diffuse with single cells and small groups, as well as signet ring cells

Question 15

What is the difference between early and advanced gastric cancer?

Answer 15

Early gastric cancer is confined to the mucosa/sub-mucosa and has a good prognosis

Advanced gastric cancer has spread and has a poor prognosis

Question 16

How can gastric cancer spread?

Answer 16

Directing through gastric wall -> duodenum, transverse colon or pancreas

via lymph nodes

to the liver

trans-coelomic - around the peritoneum, or to the ovaries

Question 17

Where can gastric cancer spread to in females that it cant in males

Answer 17

Ovaries

Question 18

What types of tumours can you get in the large intestine? (remember that the large bowel extends from cecum -> anus)

Answer 18

Adenomas - benign neoplastic lesions in the large bowel, FAP, Gardner’s syndrome

Adenocarcinomas

Polyps

Anal carcinoma

Question 19

What are benign neoplastic lesions in the large bowel?

Answer 19

Dysplastic changes

Macroscopic appearance - sessile (direct attachement at base without stalk like if it were pedunculated) or pedunculated

microscopic changes - variable degree of dysplasia

Can become malignant

Can come about due to genetic syndromes - and incidence increases with age

Question 20

What is FAP?

Answer 20

Familial adenomatous polyposis

Autosomal dominant condition on chromosome 5 -> formation of thousands of adenomas in the large intestine

Increase risk of malignancy - especially colorectal carcinoma

Question 21

What is Gardner’s syndrome?

Answer 21

Similar to FAP, autosomal dominant condition that causes bone and soft tissues (large colon) tumours

Question 22

What are the macroscopic features of colorectal carcinoma?

Answer 22

fungating or stenosis of the sigmoid colon and rectum

Question 23

What are the microscopic features of colorectal adenocarcinoma?

Answer 23

there are different types of colorectal adenocarcinomas - they can be mucinous or signet ring cell types - histology varies depending on the type

Question 24

How does colorectal adenocarcinoma spread?

Answer 24

through bowel wall to adjacent organs such as the bladder

via lymphatics -> mesenteric lymph nodes

via portal venous system -> liver

Question 25

What is the staging for colorectal adenocarcinoma?

Answer 25

Duke's ``` A - confined to wall B - through wall, no lymph involvement C - lymph node involved C1 - highest lymph node clear C2 - high lymph node involved ```

Question 26

What mutations give rise to colorectal adenocarinoma?

Answer 26

Ras mutations, p53 mutations, FAP - mutation on chromosome 5 -> lots of adenomas -> can lead to colorectal adenocarcinoma

Question 27

What IBD conditions can give rise to colorectal adenocarcinoma?

Answer 27

UC and Crohn's

Question 28

Apart from mutations, what else can cause colorectal adenocarcinoma?

Answer 28

Low residue diet - one that reduces frequency and volume of stool production and prolongs gut transit time slow gut transit time high fat intake

Question 29

What is the prognosis of colorectal carcinoma?

Answer 29

Prognosis worsens with increasing Duke's staging. Metastases to liver are common in advance stages

Question 30

Apart from colorectal adenocarcinoma, what other malignant tumours can you get in the large intestine?

Answer 30

Carcinoid tumour - unpredictable neuro-endocrine tumour that is rare Lymphoma - primary and secondary but rate Smooth muscle/stromal tumours - rare and unpredictable

Question 31

Where in the pancreas is pancreatic carcinoma most common?

Answer 31

in the head of the pancreas

Question 32

What are the macroscopic features of pancreatic cancer?

Answer 32

Firm pale mass - necrotic core that may infiltrate other structures that are adjacent e.g. the spleen

Question 33

What is the most common type of pancreatic cancer?

Answer 33

Ductal adenocarcinoma

Question 34

What are the microscopic features of ductal adenocarcinoma

Answer 34

well formed glands

Question 35

What are the microscopic features of acinar adenocarcinoma?

Answer 35

zymogen granules

Question 36

What is the prognosis of pancreatic carcinoma?

Answer 36

Poor

Question 37

What can carcinoma of the ampulla of vater present as clinically?

Answer 37

Jaundice due to obstruction of the bile duct - early presentation = good prognosis

Question 38

What are the types of islet cell tumours?

Answer 38

Insulinoma -> hypoglycaemia Glycagonoma -> characteristic skin rash Vasoactive intestinal peptideoma Gastrinoma

Question 39

What are the types of benign tumours of the liver?

Answer 39

- Hepatic adenoma - Bile duct adenoma - Hemangioma (benign tumour of blood vessels -> red birth mark)

Question 40

what are the types of malignant tumours of the liver?

Answer 40

Hepatocellular carcinoma Cholangiocarcinoma Hepatoblastoma (rare, in children, tissue resembles fetal liver cells, mature liver cells or bile duct cells)