Session 9 GI malignancies and pathology

• Barrett's esophagus is a condition in which the lining of the oesophagus becomes damaged by acid reflux, which causes the lining to thicken and become red.
• what are investigations that will help you manage a patient with oesophageal malignancy?

  • Barium swallow
  • Endoscopy and lesion biopsy
  • Endoscopic Ultrasound (EUS)
  • Staging purposes- CT, PET, CT scans
• Treatment - oesophageal malignancy/carcinoma

  • Oesophagectomy
  • Endoscopic mucosal resection (EMR) and radio-ablation for mucosa confined tumours
  • Neoadjuvant chemoradiotherapy given for advanced tumours to achieve complete surgical excision
  • Stenting to enable swallowing
  • Radiotherapy
  • Adjuvant chemotherapy for metastatic disease – targeted treatments (trials), Her2 guiding treatment in adenocarcinomas
  • Palliative brachytherapy and radiotherapy
• Gastric Carcinoma causes?

  • Infection – H.pylori infection and also EBV infection.
  • Pernicious anaemia and autoimmune gastritis
  • Gastric ulcers
  • Previous gastric surgery
  • Smoking
  • Genetic factors
  • Diet-low intake of fresh fruit and vegetables and high intake of salt preserved foods or smoked foods (N nitroso compounds and benzopyrene).
• Gastric Cancer Spread?

  • Direct extension to adjacent organs (pancreas, liver, spleen, transverse colon, greater omentum)
  • Lymphatic spread- regional lymph nodes (supraclavicular lymph node involvement-Virchow’s node)
  • Haematogenous spread-liver (most common), lung peritoneum , adrenals, ovary
  • Trans-coelomic - Peritoneum, Ovaries (Krukenberg tumours)
• Gastric Cancer -Treatment

  • Surgery
  • Chemotherapy
  • Herceptin
• Trichobezoar = ball of swallowed hair
• Genetic Conditions predisposing intestinal malignancy?

  • Familial adenomatous polyposis (FAP)
  • Lynch Syndrome (formerly known as HNPCC - Hereditary Nonpolyposis Colonic cancer)
  • Gardner’s syndrome
• Familial adenomatous polyposis (FAP)?

  • Autosomal dominant
  • chromosome 5
  • High risk of cancer
• Is there a difference in site of colorectal carcinoma and the clinical presentation?

  • Rectal lesions-ulcerated present as rectal bleeding.
  • Left sided lesions -stenosing lesions and as such present with obstruction(alteration of bowel habit colicky abdominal pain) relatively early.
  • Right sided tumours -polypoidal and fungating and present as anaemia due to recurrent occult bleeding and often late presentation (due to more distensibility of the right side and the fluid nature of the faeces).
• Targeted therapy/personalised medicine colorectal adenocarcinomas

  • Kras
  • Mismatch repair genes
• When there is metastatic colorectal disease, if the patient has a mutated form of Kras, she/he will not respond to EGFR inhibitors such as cetuximab, and other forms of treatment are required.

  However, if the patient has the “wild type Kras”, EGFR treatment is an option
• The liver lobule and 2 important cells in the sinusoids?

  • Kupffer cells - Phagocytes, cleaning the blood
  • Stellate (Ito) cells - Initiate fibrosis when stimulated
• Hesselbach's triangle?

  1. Inferiorly: The inguinal ligament
  2. Medially: The lateral border of the rectus abdominis muscle
  3. Laterally: The inferior epigastric vessels
• borders of inguinal canal?

  1. Superiorly: Inferior border of the internal oblique muscle and the transversus abdominis muscle.
  2. Inferiorly: Superior border of the inguinal ligament.
  3. Anteriorly: External oblique aponeurosis.
  4. Posteriorly: Transversalis fascia, conjoint tendon (medial part), and the iliopubic tract (lateral part).

  • In males, spermatic cord runs through it.
  • In females, round ligament