Transcript Pictorial lesson in GI cancers

Pictorial lesson in GI
Cancers
Oesophageal Cancer
Staging of Oesophageal Cancer
Incidence in USA by pathology
Squamous cell carcinoma

Endoscopic
view of the
oesophagus
shows a tiny,
early ulcer
which proved
on biopsy to
be malignant.
Squamous cell carcinoma

An established,
infiltrating, welldifferentiated
lesion exhibits
islands of
malignant
epithelium
invading deep
into oesophageal
muscle.
Squamous cell carcinoma


Endoscopic
view shows
circumferential
involvement of
the
oesophagus
with friable
tumour.
Note the
narrowed
lumen.
CASE: Squamous cell carcinoma


A 62-year-old man with
progressive dysphagia and
marked weight loss was
found on endoscopy to
have a poorly
differentiated tumour of
the middle third of the
oesophagus.
Barium swallow film shows
narrowing of the
oesophagus with mucosal
destruction, consistent
with oesophageal cancer
Case



CT scan reveals
regional
metastases and a
large primary
mass obstructing
the oesophagus.
Complete clinical
remission was
achieved in 3
months after
combination
chemotherapy
plus radiotherapy.
Unfortunately,
liver metastases
subsequently
occurred.
Squamous cell carcinoma



This sagittal section through the
larynx, trachea and anterior wall
of the Oesophagus obtained at
autopsy of a 57-year-old man
who presented with a short
history of dysphagia.
A barium swallow revealed
neoplastic obstruction of the
oesophagus; the patient died
soon afterward from
bronchopneumonia.
A solid, raised, pale tumour (6 x
2 x 2 cm), arising in the
oesophagus, has infiltrated the
posterior wall of the trachea,
forming a nodular projection into
the tracheal lumen.
Case



Adenocarcinoma. Weight loss
and right upper abdominal
pain, with minimal dysphagia,
developed in a 58-year-old
man.
Upper GI endoscopy showed a
constricting, poorly
differentiated lesion of the
lower third of the
oesophagus. Barium swallow
film defines the extent of the
lesion (arrows).
On CT scan, a large liver
metastasis
Treatment
 Depends
on stage, but includes
surgery, radiotherapy, chemotherapy
and laser treatment
Gastric Cancer
Gastric Cancer

Barium swallow
study shows a
large fundal
carcinoma
Malignant gastric ulcer

This antral
lesion
exhibits
heaped-up
nodular
margins,
particularly
suggestive
of
malignancy
Adenocarcinoma.

This
intestinaltype tumour
exhibits wellformed
malignant
glandular
elements
Adenocarcinoma

Barium swallow
study reveals a
large polypoid
lesion in the body
of the stomach,
causing a filling
defect.
Diffuse adenocarcinoma - linitis
plastica




Barium study shows the
typical appearance of an
extensive linitis plastica
involving the entire
stomach, which appears
fixed and narrowed.
No peristalsis was observed
and barium flowed out of
the stomach quickly.
The mucosal edge is only
slightly irregular; ulceration
of the mucosa may be
minimal or absent in this
type of carcinoma.
(Arrow indicates the gastric
fundus.)
Case




Diffuse adenocarcinoma (linitis
plastica).
This gastrectomy specimen,
opened anteriorly, is from a 64year-old man who had a 3-year
history of dyspepsia. Barium
swallow and endoscopy revealed
a gastric carcinoma.
There is diffuse infiltration of the
pylorus and body of the stomach
by pale tumour, as well as
marked luminal narrowing,
although the tumour has no
exophytic component.
Note the irregular infiltration of
the muscle coat.
Pancreatic Cancer
Staging of pancreatic carcinoma
Pancreatic carcinoma

Barium study
shows a
tumour mass in
the head of the
pancreas
invading the
duodenal loop
and producing
changes in the
fold pattern.
Pancreatic carcinoma

Abdominal
CT scan
shows a
large focal
mass in the
tail of the
pancreas
Hepatic Tumours
Staging of hepatocellular
carcinoma (including intrahepatic
bile ducts)
Multifocal hepatocellular carcinoma
in haemochromatosis



A 61-year-old man with
haemochromatosis and a 12year history of hepatomegaly
and diabetes mellitus died
after developing liver failure
with ascites.
Section through the right lobe
of the liver shows an illdefined micronodular
cirrhosis, associated with
deep brick-red parenchymal
pigmentation.
Scattered throughout the
posterior region are many
pale nodules of carcinoma.
Primary hepatic angiosarcoma


Typically, these tumours
may appear as (a) a
surface vascular tumour or
as a hemorrhagic tumour
mass.
They are associated with
industrial exposure to vinyl
chloride and the
radiographic contrast agent
Thorotrast and usually
comprise multicentric
hemorrhagic nodules.
Lung metastases


Chest film of a 19-year-old
Asian man who presented
with hepatocellular
carcinoma shows the welldefined pulmonary nodules
characteristic of metastatic
deposits. Rapid disease
progression occurred
within 2 months.
Metastases are unusual
with hepatoma but do
occur to the bones, lung
and brain.
Bowel Cancer
Familial adenomatous polyposis


FAP is a genetic
disorder greatly
increasing the risk of
bowel cancer.
Barium enema study
demonstrates
multiple, small polyps
throughout the colon.
Familial adenomatous polyposis

Innumerable
adenomatous
polyps, increasing
in size and density
from proximal
(upper left) to
distal (lower right)
Carcinoma in ulcerative colitis


Malignancies
developing in
ulcerative colitis may
present as an
infiltrative plaque, or
a polypoid mass
The cumulative risk of
cancer increases
dramatically with the
duration of ulcerative
colitis. After 20 years,
there is a 15%
incidence of colon
cancer, which
increases to 50%
after 40 years.
Carcinoma in ulcerative colitis

They may also
develop as a
stricture.
Modified Dukes' staging
classification of colorectal cancer.
Staging


Stages B3 and C3 (not shown) signify
perforation or invasion of contiguous
organs or structures (T4).
The TNM classification provides a more
accurate staging system: Dukes B is a
composite of better (T2N0) and worse
(T3N0, T4N0) prognostic groups as is
Dukes C (TxN1 or TxN2).
Survival by Stage
Adenocarcinoma of caecum



Intestinal obstruction
occurs late in the course of
the disease.
Although this lesion
(arrows) is relatively large,
there was no obstruction
to retrograde filling of the
ileum and no dilatation of
the small intestine.
Symptoms may include
anaemia or dyspepsia and
weight loss reminiscent of
a benign or malignant
gastric ulcer.
Adenocarcinoma of caecum

Large,
fungating
tumours, as
seen here, are a
less common
presentation of
colorectal
tumours; they
predominate in
the caecum.
Adenocarcinoma

Moderately
differentiated
tumours are
marked by gland
(acinar)
formation by
malignant
epithelium;
there is
considerable
nuclear
pleomorphism
within individual
cells
Adenocarcinoma of sigmoid colon

Barium
enema shows
an annular
stenosing
lesion of the
distal sigmoid,
producing a
characteristic
'apple core'
appearance
Adenocarcinoma of colon.


This specimen exhibits
an annular, stenosing
lesion with dilatation
of the colon proximal
to it.
This appearance may
be seen at any site
and is facilitated by
circumferential spread
of the tumour through
submucosal (or
serosal) lymphatic
channels
Treatment
 Surgical,
even if palliative to relieve
obstruction
 Adjuvant chemotherapy if node
positive or at increased risk of
metastases
Adenocarcinoma of rectum

This lower
rectal lesion
demonstrates
the most
common
macroscopic
appearance of
colorectal
cancers as wellcircumscribed
lesions with
raised edges
and an
ulcerated
centre.
Treatment
 Combination
of surgery, radiotherapy
and chemotherapy, depending on
extent of disease
Anal Cancer
Staging of Anal Cancer
Anatomy of the lower rectum and
anal canal.


The anal canal
extends from
the anorectal
ring to an area
about halfway
between the
dentate
(pectinate)
line and the
anal verge.
The anal
margin
consists of the
area distal to
the anal canal,
including the
perianal skin
Squamous cell carcinoma of anal
margin



Squamous cancers of the
anus are divided into tumours
arising in the anal canal (most
often above the dentate line)
and those arising in the skin
at the anal margin, as shown
here.
This lesion measures 1cm
across. Neoplasms at this site
tend to be slow growing and
metastasize to inguinal lymph
nodes.
They have a 5-year survival
rate of approximately 70%.
Anal Cancer
 Treatment
is potentially curative with
combined chemo radiotherapy
 These
tumours are often HPV related
and associated with immunosupression.
Malignant melanoma of anal canal




This specimen is from a 74-year-old
woman who presented with a brief
history of episodic rectal bleeding.
A hard mass was palpable in the
lateral wall of the anal canal and an
abdominoperineal resection was
performed.
The anal canal has been opened to
show a flattened, ovoid nodule (2 cm
in diameter) arising at about the level
of the dentate line. The edge of the
tumour shows obvious melanotic
pigmentation and an irregular streak
of pigment extends from the nodule to
the anal margin.
Anorectal melanoma is rare,
accounting for about 1% of anal
cancers.