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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