GI Neoplasia

7/29/2019 GI Neoplasia

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GASTROINTESTINAL

SYSTEM-NEOPLASIA


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Sites of gastrointestinal

neoplasms

Esophagus

Stomach

Small intestine

Colon

Rectum


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Ca esophagus

Risk factors- Alcohol,tobacco,

smoking

Dietary-low intake of vitamin A&C

riboflavin, fresh fruits andvegetables

China-pickled vegetables

Barretts esophagus

Incidence-10% of all GI cancers80% -SCC 20%-adenoCa

Site: Located in the middle 1/3 rd or

distal esophagus.


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Early eso. Ca-A tumor that has notextended beyond thesubmucosa

With no metastases to lymph nodes,

good prognosis.

Advanced eso. Ca-extension beyond

the submucosa

Early detection to improve survival -

changes of dysplasia.


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GROSS APPEARANCE

Fungating- protruding into the lumenof the esophagus.

Ulcerative-undermining ulcer with

raised edges Scirrhous-infiltrating tumor leading to

stenosis or obstruction


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Microscopic appearance


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Barretts esophagus

Complication of long standinggastroesophageal reflux

Risk factor for esophageal

adenocarcinoma Classified as Long >3cm

short


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Barrett esophagus

Diagnosis based

on:

1)Endoscopic

evidence ofcolumnar lining

above the GE

junction

2)Histologic evidenceof intestinal

metaplasia


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Stomach tumors

Epithelial tumors

Intraepithelial neoplasia: Adenoma

Adenocarcinoma

Small cell carcinoma

Neuroectodermal tumor

Non epithelial

Leiomyoma

schwannoma

Malignant Lymphoma


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Ca Stomach

Second most common tumor in theworld.

Incidence: Japan ,chile ,Costa rica

Common in lower socioeconomicgroups

M:F-2:1


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Risk factors

Environmental factors:

Infection by H.pylori

Diet-Nitrites derived from nitrates

smoked food

lack of fresh fruits,vegetables

Cigarette smoking

Host factors:

Chronic gastritis

Reflux


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Contd..

Gastric adenomas

Barrett esophagus

Genetic factors:

Increased risk with blood group A

Family history of gastric cancer

HNPCC

Familial gastric carcinoma

syndrome


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Carcinoma of stomach: ulcero-

infiltrative


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Carcinoma of

stomach:proliferative


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Carcinoma of stomach:linitis

plastica: signet ring cell type


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Microscopic appearance


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Less common gastric tumours

Gastric Lymphoma/MALT Lymphoma -

5% of malignancies

Stomach is commonest site for

extranodal lymphoma.


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GIST(Gastrointestinal stromal

tumours) Rare tumors

Cell of origin-Interstitial cells of Cajal

which control gastrointestinal

peristalsis. IHC-95% stain with c-Kit,70 % stain

with CD34


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Morphology

Gross-May be

solitary or multiple

extend either into

the serosa or thelumen

C/S tan ,firm to

soft,hemorrhagic

changesseen.necrosis or

cystic changes

seen


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Microscopy

Cellular tumours

Exhibit spindle

cells,plump

epitheloid cells


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Colon cancer

Ascending colon

Transverse colon

Descending colon

Sigmoid colon Rectum

Anal canal


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CARCINOMA OF COLON &

RECTUMEtiologyDiet & Lifestyle-highly caloric food rich in animal

fat with a sedentary lifestyle.

Meat and alcohol consumption, smoking.

Inverse association- vegetable consumption,

prolonged use of NSAIDs, estrogen replacement

therapy, physical activity.

Vegetables-anti-carcinogens, anti-oxidants, fiber,

folate, inducers of detoxifying enzymes and

reduced contact time with colorectal epithelium

due to faster transit.


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Chronic inflammation-IBDs-ulcerative colitis- 8 to 10 years,earlyonset, pan-colitis

Crohns disease-3 fold increase, early

onset,long duration Therapeutic pelvic irradiation

Adenomas-precursor lesions-defined bypresence of intra-epithelial neoplasia-hypercellularity with enlarged hyperchromatic

nucleiVillous adenomas, high-grade dysplasia

Familial adenomatous polyposis-100 colo-rectal polyps


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Precancerous lesions:

Familial adenomatous polyposis


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FAP

Uncommon autosomal dominantdisorders

Gene present on 5q21 chromosome

(APC) Classified into

classic,attenuated,gardner,turcot

syndrome Minimum 100 polyps necessary for

diagnosis(majority are tubular

adenomas)


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Contd..

Cancer preventive measures include

Early detection and prophylactic

colectomy in first degree relatives.

HNPCC-autosomal dominant ,familial

syndrome (described by Lynch)/Lynch

syndromedefect in gene repair and microsateelite

instability.Increased risk of colon

cancer and extra


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Adenomas

Types

Tubular adenomas

Tubulo villous adenomas

Villous adenomas


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Villous adenoma


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Right colon: Ascending colonFluid feces can pass the mass-presentlate.Exophytic mass- fungating with intra-

luminal growth Left colon Transverse & Descending

colonSolid feces- constipation, abdominal

distensionPresent earlier due to obstruction-annular growthEndophytic-ulcerative growth with

predominant intra-mural growth.


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Gross appearance


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CARCINOMA

Epithelium

More common

Middle & old age Lymph node

metastases

Slow growth Blood borne

metastases late

Radio-sensitive

SARCOMA

Connective tissue

Less common

Young Uncommon

Rapid growth

Early

Radio-resistant

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GI Neoplasia