Session 10 - Cancers of the GI tract and imaging Flashcards Preview

Semester 3 - Gastrointestinal > Session 10 - Cancers of the GI tract and imaging > Flashcards

Flashcards in Session 10 - Cancers of the GI tract and imaging Deck (61):
1

Name five common GI malignancies

• Oesophagus
• Stomach
• Large intestine
• Pancreas
• Liver

2

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

3

Give the two main features of oesophageal carcinoma

• Progressively worsening Dysphagia

Weight loss

4

Give three investigations for oesophageal carcinoma

• Endoscopy
• Biopsy
• Barium

5


Give the two main types of oesophageal cancer

• Squamous cell carcinoma
• Adenocarcinoma

6

Which is the most common type of oesophageal cancer

Squamous cell

7

Where is oesophageal adenocarcinoma found

• Lower third of the oesophagus
• Association with Barrett's oesophagus

Progresses through dysplasia

8

What is the prognosis of oesophageal cancer?

• Advance disease presentation in most cases
• 40% resectable
• 5% five year survival

9

What causes oesophageal carcinoma

• HPV
• Tannins
• Vitamin A deficiency

10

How common is gastric cancer?

• Second most common GI malignancy
• 15% of cancer deaths worldwide

Men >women

11

What countries is the incidence of gastric cancer highest?

• Japan
• Columbia
• Finland

12

What condition is gastric cancer associated with?

Gastritis

13

What blood group is gastric cancer most commonly associated with?

• Blood group A

14

Give three symptoms of gastric cancer

• Epigastric pain
• Vomiting

Weight loss

15

Give three investigations for gastric cancer

• Endoscopy
• Biopsy

Barium

16

Give three macroscopic features of gastric cancer

• Fungating
• Ulcerating
• Infiltrative
○ Linitis plastica

17

What is linitis plastica?

• A rare type of stomach adenocacrinoma
• Tumour spreads to muscles of stomach making it thicker and more rigid

18

Give two microscopic features of gastric cancer

• Intestinal
○ Variable degree of gland formation
• Digguse
○ Single cells and small groups, signet ring cells

19

What is early gastric cancer?

• Confined to sub-mucosa
• Good prognosis

20

Describe advanced gastric cancer?

• Far spread of cancer

10% 5 year survival

21

Give four methods of spread of gastric cancer?

• Direct
• Lymph nodes
• Liver
• Trans-coelomic
○ Periotneum

Ovaries

22

Outline direct spread of gastric cancer

• Through gastric wall into duodenum, transverse colon, pancreas

23

Outline the development of gastric cancer

• Normal gastric mucosa
• H pylori infection
• Acute gastritis
• Chronic active gastritis
• Atrophic gastritis
• Intestinal metaplasia
• Dysplasia
• Advanced gastric cancer

24

What is intestinal metaplasia in gastric cancer?

• Metaplasia of gastric cells to intestinal

25

What is the association of gastric cancer with H.pylori?

H.pylori causes chronic inflammation which is strongly associated with gastric cancer

26

Give three treatments for gastric cancer

• Surgery
• Chemotherapy

Herceptin

27

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

28

How does the prognosis of gastric lymphoma compare to gastric carcinoma?

Much better

29

What is a gastrointestinal stromal tumour?

• Derived from interstitial cells of cajal

Caused by C-kit mutation which makes it vulnerable to targeted treatment

30

What is the behaviour of gastrointestinal stromal tumours?

• Pleomorphism
• Mitoses

Necrosis

31

What is a key feature of gastric lymphoma

• Gastro-intestinal haemorrhage

32

Give four types of tumours of the large intestine

• Adenomas
• Adenocarcinomas
• Polyps
• Anal carcinoma

33

Give three types of adenomas in the large intestine

• Benign, neoplastic lesions in the large bowel
• Familial adenomatous polyposis
• Gardner's syndrome

34

Give two macroscopic features of adenoma of the large intestine

• Sessile (immobile)

OR pedunculated (small growth on stalk)

35

Give two microscopic features of adenoma of the large intestine

• Variable degree of dyplasia

Malignant potential

36

What is the most common risk factor for large intestinal adenoma?

• Advancing age

37

What is familial adenomatous polyposis?

• An autosomal dominant condition on chromosome 5
• Large number of adenomas form giving high risk of cancer

38

What is gardner's syndrome?

• Similar to familial adenomatous polyposis
• Bone and soft tissue tumours also

39

What is the most common type of GI malignancy?

• Colorectal adenocarcinoma

40

Give two macroscopic features of colorectal adenocarcinoma

• Rectosigmoid fungating/stenotic

41

Give two microscopic features of colorectal adenocarcinoma

• Mucinous

Signet ring cell types

42

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

43

Give two ways in which colorectal adenocarcinoma is staged

• Dukes staging
• TMN

44

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

45

Give three main mutations in colorectal adenocarcinoma

• FAP - Chromosome 5
• Ras mutations
• P53 loss/inactivation
• K-ras - Guides treatment with cetuximab

46

At what age is colorectal adeno carcinoma?

• Peak at 60-70
• High in UK/USA, low in Japan

47

Give two diseases which predispose a patient to colorectal adenocarcinoma

• Ulcerative carcninoma
• Crohn's disease

48

Give four predisposing aeitological factors to colorectal adenocarcinoma

• Low residue diet
• Slow transit time
• High fat intake
• Genetic predisposition

49

Give three carcinomas of the large intestine of the colorectal adenocarcinoma

• Carinoid tumoure
○ Rare and unpredictabel neuro-endocrine tumour
• Lymphoma
○ Rare, may be primary
• Smooth muscle/stromal tumours
○ Rare and unpredictable

50

Outline the morphology of pancreatic carcinoma

• 2/3 in the head
• Firm pale mass with a necrotic centre

May infiltrate adjacent structures

51


What is the histology of a pancreatic carcinoma

• 80% are ductal adenocarcinomas
• Well formed glands
• Some may contain zymogen granules

All have poor prognosis

52

Give three symptoms of pancreatic cancer

• Weight loss
• Jaundice

Trousseau's signDARK RED PATCH

53

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

54

Give four islet cell tumours

• Insulinoma
• Glycagonoma
• Vasoactive intestinal peptideoma
• Gastrinoma

55

What does insulinoma cause?

• Hypoglycaemia

56

What is a characteristic sign of glycagonoma

• Characteristic skin rash - Thrombophlebitis migrans

57

What syndrome is associated with gastrinoma

Zollinger - Ellison syndrome (Ectopic gastrin production)

58

Give three types of benign liver tumour

• Hepatic adenoma
• Bile duct adenoma
• Haemangioma

59

Give three types of malignant liver tumours

• Hepatoceullarcarcinoma
• Cholaniocarcinoma - liver flukes
• Hepatoblastoma

60

What are the four most common GI malignancies in order

• Colorectal
• Stomach
• Pancreas
• Oesophagus

61

What are two types of malignant tumour

• Primary
• Malignant