GASTROINTESTINAL SYSTEM-NEOPLASIA

Sites of gastrointestinal neoplasms

Esophagus Stomach Small intestine Colon Rectum

Ca esophagus
Risk factors- Alcohol, tobacco, smoking Dietary-low intake of vitamin A&C riboflavin, fresh fruits and vegetables China-pickled vegetables Barretts esophagus Incidence-10% of all GI cancers 80% -SCC 20%-adenoCa Site: Located in the middle 1/3 rd or distal esophagus.

Early eso. Ca-A tumor that has not extended 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.

GROSS APPEARANCE
Fungating- protruding into the lumen of the esophagus. Ulcerative-undermining ulcer with raised edges Scirrhous-infiltrating tumor leading to stenosis or obstruction

Microscopic appearance

Barretts esophagus
Complication of long standing gastroesophageal reflux Risk factor for esophageal adenocarcinoma Classified as Long >3cm short<3 cm

Barrett esophagus
Diagnosis based on: 1)Endoscopic evidence of columnar lining above the GE junction 2)Histologic evidence of intestinal metaplasia

Stomach tumors
Epithelial tumors Intraepithelial neoplasia: Adenoma Adenocarcinoma Small cell carcinoma Neuroectodermal tumor Non epithelial Leiomyoma schwannoma Malignant Lymphoma

Ca Stomach
Second most common tumor in the world. Incidence: Japan ,chile ,Costa rica Common in lower socioeconomic groups M:F-2:1

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

Contd..
Gastric adenomas Barrett esophagus Genetic factors: Increased risk with blood group A Family history of gastric cancer HNPCC Familial gastric carcinoma syndrome

Carcinoma of stomach: ulceroinfiltrative

Carcinoma of stomach:proliferative

Carcinoma of stomach:linitis plastica: signet ring cell type

Microscopic appearance

Less common gastric tumours

Gastric Lymphoma/MALT Lymphoma 5% of malignancies Stomach is commonest site for extranodal lymphoma.

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

Morphology
Gross-May be solitary or multiple extend either into the serosa or the lumen C/S tan ,firm to soft,hemorrhagic changes seen.necrosis or cystic changes seen

Microscopy
Cellular tumours Exhibit spindle cells,plump epitheloid cells

Colon cancer

Ascending colon Transverse colon Descending colon Sigmoid colon Rectum Anal canal

CARCINOMA OF COLON & RECTUM

Etiology Diet & 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.

Chronic inflammationIBDs-ulcerative colitis- 8 to 10 years,early onset, pan-colitis Crohns disease-3 fold increase, early onset,long duration Therapeutic pelvic irradiation Adenomas-precursor lesions-defined by presence of intra-epithelial neoplasiahypercellularity with enlarged hyperchromatic nuclei Villous adenomas, high-grade dysplasia Familial adenomatous polyposis-100 colorectal polyps

Precancerous lesions: Familial adenomatous polyposis

FAP
Uncommon autosomal dominant disorders Gene present on 5q21 chromosome (APC) Classified into classic,attenuated,gardner,turcot syndrome Minimum 100 polyps necessary for diagnosis(majority are tubular adenomas)

Contd..
Cancer preventive measures include Early detection and prophylactic colectomy in first degree relatives.

HNPCC-autosomal dominant ,familial syndrome (described by Lynch)/Lynch syndrome defect in gene repair and microsateelite instability.Increased risk of colon cancer and extra

Adenomas
Types Tubular adenomas Tubulo villous adenomas Villous adenomas

Villous adenoma

Right colon: Ascending colon Fluid feces can pass the mass-present late. Exophytic mass- fungating with intraluminal growth Left colon Transverse & Descending colon Solid feces- constipation, abdominal distension Present earlier due to obstructionannular growth Endophytic-ulcerative growth with predominant intra-mural growth.

Gross appearance

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