Download Errors in Surgical Pathology

Introduction
• 30-40% of all cancers arise from the
epithelial lining of the aerodigestive tract.
• 51% & 38% of cancer deaths of men and
women are from lung and GI tract.
• These cancers are discovered late, are also
aggressive and resistant to chemo- and
radiation therapy.
Lung cancer
• In men, the incidence is slightly lower than
that of prostate cancer but mortality is 3
times higher.
• In women, the incidence is less than half
that of breast cancer but mortality is slightly
higher.
Etiology
• Tobacco smoking
• Uranium
• Radon
Types
• Non-small cell
carcinoma
– Squamous cell
carcinoma
– Adenocarcinoma
– Large cell
undifferentiated
– Others
• Small cell carcinoma
– Aggressive
– Chemotherapysensitive
– Neuroendocrine
differentiation
Esophageal cancer
• Mostly squamous cell carcinoma.
Adenocarcinoma is less common.
• 1-2% of all cancer deaths in USA
• Occurs in adults (>50 yo)
• Male:Female = 3:1
Risk factors
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•
•
•
•
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Retarded passage of food
Long-standing esophagitis
Alcohol consumption
Tobacco abuse
Loss of tumour suppressor gene (p53)
Others
Squamous cell carcinoma
Pathogenesis
Mild
Moderate
Severe
Esophageal adenocarcinoma
Chronic Reflux
Gastric
adenocarcinoma
Intestinal
metaplasia
(Barrett's
esophagus
)
Primary
Esophageal
Direct
extension
Dysplasia
Adenocarcinoma
Gastric cancer
•
•
•
•
Worldwide, high incidence in Japan
Declining incidence & mortality
3% of all cancer deaths in USA
Five year survival <10%
Risk factors
• Chronic atrophic gastritis
• Dietary factors
• Chronic gastritis (Helicobacter pylori)
Pancreatic cancer
• Almost equal incidence rate as gastric
cancer
• One of the most lethal of all human cancers
• 5 year survival is <5%
• Most cases occur in the head of pancreas
Colorectal cancer
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•
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98% of large bowel cancers
Almost always in an adenoma
Familial or sporadic
Worldwide distribution, high in NA
Peak incidence 60-70 years of age
Adenoma-carcinoma
sequence
Normal Mucosa
First hit
Mucosa at risk
Second hit
Adenoma
Adenocarcinoma
Invasive adenocarcinoma
Risk factors
• Low vegetable diet
• High content of carbohydrates, fat and
protein
• Decrease protective micronutrients
(vitamins A, C & E)
• Familial
Types
• Sporadic (the majority)
• Hereditary/familial
– Familial adenomatosis polyposis (FAP)
syndrome
– Hereditary non-familial polyposis