Block 3 cancers

Upper GI

Squamous Cell Carcinoma of the Tongue

Usually older men who smoke, drink, have HPV, radiation

white or red, various forms, irregular

Big, hyperchromatic nuclei, keratin pearls

More posterior=worse prognosis.

EtOH causes TP53, p63, and NOTCH1 mutations, HPV causes p16

Salivary gland tumors

Pleomorphic Adenoma

Encapsulated, found in parotid. Gray-white with myxoid tissue

Fibromyxoid and chondoid tissue, glandular components

Treat with transection, recurs if you don't get it all. Careful of facial nerve.

Most often in women ages 20-50.

Warthin Tumor

Usually in men over 40 in parotid. Smoking is risk factor. Painless swelling of gland.

Tan with white fibrotic center

Cystic spaces lined with pink epithelium (onocytes) around lymphoid tissue w/ germinal centers

Mucoepidermoid carcinoma

20s-40s, no sex difference

11:19 translocation- MECT1-MAML2 gene

See mucocytes and epideromoid cells

Low grade cured by surgery, 90% survive 5 years. High grade 50%.

Esophageal cancer

Adenocarcinoma- weight loss and dysphagia, associated with Barrett's esophagus. Usually in distal 1/3 of esophagus

SCC- more often in middle. Usually polypoid, can be flat or excavated. Can obstruct or excavate to neighboring tissue

Very bad prognosis

Gastric Carcinoma

2 growth patterns

Prognosis depends on degree of infiltration.

Often seen in lesser curvature of antro-pyloric area, local spread

Intestinal

Diffuse

exophytic/excavated

Typical adenocarcinoma appearance

flat/infiltrative

signet-ring appearance

Risk factors- smoking, diet, SES, H. pylori

Krukenburg Tumor- met to ovary

Lower GI

Small Bowel Tumors

Adenocarcinoma is most common

Carcinoid tumor

Low-grade tumor of diffuse endocrine system

usually in deep mucosa/submucosa, often at appendix

secretes serotonin/somatostatin, get flushing, sweating, abd. pain, diarrhea, bronchospasm

Symptoms mean substances got past liver metabolism, means malignancy

See islands of uniform cells with scant pink cytoplasm and oval stippled nuclei

location important- foregut usually mild and resectable, midgut are aggressive and malignant, esp. ileum, hindgut usually incidental finding, proximal colon is rare but bad.

Colon cancer

Polyposis

FAP

Adenomas

Adenocarcinoma

FJP

Peutz-Jehgers

Tubular adenoma

Villous Adenoma

Tubulovillous adenoma

symptoms of cramping, hematochezia, and diarrhea. Almost always advances to malignancy.

hundreds of adenomatous polyps with stalks. Usual defect is APC gene

hyperchromatic cells with big nuclei

mucus-filled cysts composed of dilated glands lined by colonic columnar epithelium

leukocyte infiltration and granulation tissue

symptoms same as FAP, low risk of malignancy

Crowded, multiply branched villi or complex glandular formations are covered by a single layer of well-differentiated, tall, columnar epithelium.

smooth muscle in lamina propria

pigmentation around mucous membranes, 2-3% risk of adenocarcinoma

Polypoid lesion with raspberry like head

Closely aggregated long glands with dark lining cells w/ pseudostratified nuclei

90% in colon, can test with Guaic test

broad, sessile, involve whole mucosa

long villi with same dark cells with stratified nuclei

Has features of both

Left- obstruction, "napkin-ring"

Right- anemia, weight loss, abd. pain

Blood in stool is most common sign, may need guaiac test

back to back glands with nuclear crowding

HNPCC- MSH2, MLH1 mutations, stop mismatch repair.

Liver and Gallbladder

Liver Adenomas- associated with OCT, can turn malignant

HCC

Risk factors- HBV, HCV, alcohol, aflatoxin, NASH

well differentiated, see high AFP

Gallbladder carcinoma

Rare, seen in old ladies with porcelain gallbladder

Poor prognosis, usually adenocarcinoma

associated with couvoiser's sign

Pancreas

Benign

malignant potential, usually in women

Serous/mucinous cystadenoma

uncommon, usually in body or tail.

Adenocarcinoma

Risks- smoking, family history, chronic pancreatitis

See couviuser's sign, painless jaundice, Trousser's syndrome

usually in head, see glands in stoma, perineural invasion

Islet cell tumors

Rare, similar to carcinoid. Can be benign or malignant, functional or not

Insulinoma- usually benign, get hypoglycemia

Gastrinoma- 30s-60s, half are malignant

can lead to Zollinger-Ellison: high acid secretion leads to intractable peptic ulcer disease