Flashcards in Session 10 - Cancers of the GI tract and imaging Deck (61):
Name five common GI malignancies
• Large intestine
Outline the epidemiology of oesophageal carcinoma
• Wide geographical variation
○ Incidence low in USA and high around caspian sea and parts of china
• 2% of malignancies in the UK
Males > Females
Give the two main features of oesophageal carcinoma
• Progressively worsening Dysphagia
Give three investigations for oesophageal carcinoma
Give the two main types of oesophageal cancer
• Squamous cell carcinoma
Which is the most common type of oesophageal cancer
Where is oesophageal adenocarcinoma found
• Lower third of the oesophagus
• Association with Barrett's oesophagus
Progresses through dysplasia
What is the prognosis of oesophageal cancer?
• Advance disease presentation in most cases
• 40% resectable
• 5% five year survival
What causes oesophageal carcinoma
• Vitamin A deficiency
How common is gastric cancer?
• Second most common GI malignancy
• 15% of cancer deaths worldwide
What countries is the incidence of gastric cancer highest?
What condition is gastric cancer associated with?
What blood group is gastric cancer most commonly associated with?
• Blood group A
Give three symptoms of gastric cancer
• Epigastric pain
Give three investigations for gastric cancer
Give three macroscopic features of gastric cancer
○ Linitis plastica
What is linitis plastica?
• A rare type of stomach adenocacrinoma
• Tumour spreads to muscles of stomach making it thicker and more rigid
Give two microscopic features of gastric cancer
○ Variable degree of gland formation
○ Single cells and small groups, signet ring cells
What is early gastric cancer?
• Confined to sub-mucosa
• Good prognosis
Describe advanced gastric cancer?
• Far spread of cancer
10% 5 year survival
Give four methods of spread of gastric cancer?
• Lymph nodes
Outline direct spread of gastric cancer
• Through gastric wall into duodenum, transverse colon, pancreas
Outline the development of gastric cancer
• Normal gastric mucosa
• H pylori infection
• Acute gastritis
• Chronic active gastritis
• Atrophic gastritis
• Intestinal metaplasia
• Advanced gastric cancer
What is intestinal metaplasia in gastric cancer?
• Metaplasia of gastric cells to intestinal
What is the association of gastric cancer with H.pylori?
H.pylori causes chronic inflammation which is strongly associated with gastric cancer
Give three treatments for gastric cancer
What is gastric lymphoma?
• Commonest GI lymphoma
• Starts as a low-grade lesion, strong association with H.pylori
• Eradication of H.pylori may lead to regression of tumour
How does the prognosis of gastric lymphoma compare to gastric carcinoma?
What is a gastrointestinal stromal tumour?
• Derived from interstitial cells of cajal
Caused by C-kit mutation which makes it vulnerable to targeted treatment
What is the behaviour of gastrointestinal stromal tumours?
What is a key feature of gastric lymphoma
• Gastro-intestinal haemorrhage
Give four types of tumours of the large intestine
• Anal carcinoma
Give three types of adenomas in the large intestine
• Benign, neoplastic lesions in the large bowel
• Familial adenomatous polyposis
• Gardner's syndrome
Give two macroscopic features of adenoma of the large intestine
• Sessile (immobile)
OR pedunculated (small growth on stalk)
Give two microscopic features of adenoma of the large intestine
• Variable degree of dyplasia
What is the most common risk factor for large intestinal adenoma?
• Advancing age
What is familial adenomatous polyposis?
• An autosomal dominant condition on chromosome 5
• Large number of adenomas form giving high risk of cancer
What is gardner's syndrome?
• Similar to familial adenomatous polyposis
• Bone and soft tissue tumours also
What is the most common type of GI malignancy?
• Colorectal adenocarcinoma
Give two macroscopic features of colorectal adenocarcinoma
• Rectosigmoid fungating/stenotic
Give two microscopic features of colorectal adenocarcinoma
Signet ring cell types
Give three ways in which colorectal adenocarcinoma spreads
• Direct through bowel wall to adjacent organs
• Via lymphatics to mesenteric lymph nodes
Via portal venous system to liver
Give two ways in which colorectal adenocarcinoma is staged
• Dukes staging
Outline duke's staging of colorectal adenocarcinoma
• A - Confined to bowel wall
• B - Through wall, lymph nodes clear
• C - Lymph node involvement
• C1/C2 - Highest node clear/ involved
Give three main mutations in colorectal adenocarcinoma
• FAP - Chromosome 5
• Ras mutations
• P53 loss/inactivation
• K-ras - Guides treatment with cetuximab
At what age is colorectal adeno carcinoma?
• Peak at 60-70
• High in UK/USA, low in Japan
Give two diseases which predispose a patient to colorectal adenocarcinoma
• Ulcerative carcninoma
• Crohn's disease
Give four predisposing aeitological factors to colorectal adenocarcinoma
• Low residue diet
• Slow transit time
• High fat intake
• Genetic predisposition
Give three carcinomas of the large intestine of the colorectal adenocarcinoma
• Carinoid tumoure
○ Rare and unpredictabel neuro-endocrine tumour
○ Rare, may be primary
• Smooth muscle/stromal tumours
○ Rare and unpredictable
Outline the morphology of pancreatic carcinoma
• 2/3 in the head
• Firm pale mass with a necrotic centre
May infiltrate adjacent structures
What is the histology of a pancreatic carcinoma
• 80% are ductal adenocarcinomas
• Well formed glands
• Some may contain zymogen granules
All have poor prognosis
Give three symptoms of pancreatic cancer
• Weight loss
Trousseau's signDARK RED PATCH
Describe a carcinoma of the ampulla of vater
• Bile duct blocked with a small tumour, leading to jaundice and early presentation when the tumour is still treatable
Give four islet cell tumours
• Vasoactive intestinal peptideoma
What does insulinoma cause?
What is a characteristic sign of glycagonoma
• Characteristic skin rash - Thrombophlebitis migrans
What syndrome is associated with gastrinoma
Zollinger - Ellison syndrome (Ectopic gastrin production)
Give three types of benign liver tumour
• Hepatic adenoma
• Bile duct adenoma
Give three types of malignant liver tumours
• Cholaniocarcinoma - liver flukes
What are the four most common GI malignancies in order