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Neoplasms of The Gastrointestinal Tract: Laura W. Lamps, M.D
Neoplasms of The Gastrointestinal Tract: Laura W. Lamps, M.D
Tract
Laura W. Lamps, M.D.
Esophagus
• Clinical presentation
• insidious onset, asymptomatic early
• gradual and late onset of dysphagia and obstruction
• spread by local extension and lymphatic routes
• 5% alive at 5 years
Esophagus-SCC (cont’d)
• Risk Factors
• chronic esophagitis
• tobacco use
• alcohol, especially hard liquor
• nitrosamines
• genetic factors: abnormal p53 in 50% of esophageal cancers
Infiltrating nests of keratinizing esophageal squamous cell carcinoma
Esophagus-adenocarcinoma
• 15-20% of esophageal carcinoma, but greater than 50% in distal third
of esophagus
• Barrett’s esophagus and Barrett’s with dysplasia are recognized
precursor lesions
• Clinically, usually through the esophageal wall and in lymph nodes at
time of diagnosis
Ulcerated esophageal adenocarcinoma
Gastric
mucosa Esophageal
mucosa
Gastric tumors-polyps
• Uncommon; 0.4% of adults at autopsy as compared to colon polyps in
25-50% of adults at autopsy
• Hyperplastic- response to damage
• Fundic gland-small hamartoma
• hyperplastic and fundic gland polyps are not believed to
have malignant potential
• Adenomatous-malignant potential!
Pedunculated gastric
adenoma
Gastric Carcinoma
• Classification
• Diffuse type
• no well defined risk factor
• Intestinal type
• Prognosis-invasion is most important factor
• early: limited to mucosa and submucosa; 90-95%
survival at 5 years
• late: beyond submucosa; less than 10% survival at 5
years
Gastric Carcinoma
• Intestinal
• patients greater than 50, male>female
• arises from metaplastic glands in chronic gastritis;
associated with H. pylori
• incidence decreasing in USA
• Diffuse (signet ring cell, linitis plastica)
• younger patients, no gender preference
• not associate with H. pylori
• incidence unchanged
Gastric Carcinoma
• 90-95% of stomach malignancies
• variable incidence: Asia, S. America > USA
• Location: lesser curvature of antropyloric region is most common, BUT
an ulcerated lesion of the greater curvature is more likely to be
malignant
Ulcerated gastric adenocarcinoma
Thickened “linitis plastica”
type adenocarcinoma infiltrating gastric wall
Intestinal type gastric
adenocarcinoma
Diffuse signet-ring cell adenocarcinoma
Tumors of Small & Large Bowel
• Classification the same for small and large intestines
• polyps; nonneoplastic
• epithelial neoplasm
• benign adenomatous polyps
• adenocarcinoma
• carcinoid
• mesenchymal neoplasms
• lymphoma
• Tumors of large bowel are more common
Bowel: Nonneoplastic Polyps
• Hyperplastic • Hamartomatous
• asymptomatic • Peutz-Jegher (AD)
• less than 5 mm • multiple, throughout GI tract
• single or multiple • mucocutaneous pigmentation
• increased risk of GI and non-
• rectosigmoid GI cancers
• virtually no malignant • Juvenile:
potential • children < 5
• can be quite large
• rectum
• no malignant potential
Hyperplastic polyp
Adenomatous Polyps
result of epithelial proliferation and dysplasia
• Three types: tubular, villous, mixed
• Risk of malignancy related to size, histologic type, and severity of
dysplasia
• May be asymptomatic; commonly present with bleeding
• small or large, pedunculated or sessile, usually in colon
• Since they are considered premalignant, all should be removed
Large pedunculated adenomatous polyp from the colon
Hyperchromatic, test-tube shaped glands from adenomatous colon polyp
Hereditary Colon Cancer Syndromes
• Familial Adenomatous Polyposis
• autosomal dominant
• mutation in APC gene on 5q21
• 100-2500 polyps throughout GI tract
• virtually 100% risk of carcinoma
• HNPCC (Lynch Syndrome)
• autosomal dominant
• increased risk of GI and non-GI cancers
Hundreds of polyps in a colon from a patient with
Familial Adenomatous Polyposis
Colon Adenocarcinoma
• Right colon:
• increasing incidence, especially in elderly
• usually polypoid
• present with bleeding, anemia
• Left colon:
• annular, napkin ring lesions
• present with decreased stool caliber, obstruction
• Less than half of cancers are detectable by protoscopic exam
Colon Adenocarcinoma
• Risk Factors:
• increasing age
• inflammatory bowel disease
• hereditary syndromes
• dietary (low fiber, high fat)
Constricting “napkin ring” colon adenocarcinoma
Large fungating colonic
adenocarcinoma
Cribriformed, malignant glands in
photomicrograph of colonic adenocarcinoma
Staging of Colon Adenocarcinoma: most important
prognostic factor
Astler-Coller Classification