Gastrointestinal intraepithelial neoplasia

Last updated

Gastrointestinal intraepithelial neoplasia (GIN or GIIN) is also known as gastrointestinal dysplasia. Gastrointestinal dysplasia refers to abnormal growth of the epithelial tissue lining the gastrointestinal tract including the esophagus, stomach, and colon. Pancreatic, biliary, and rectal Intraepithelial Neoplasia are discussed separately. The regions of abnormal growth are confined by the basement membrane adjacent to the epithelial tissue and are thought to represent pre-cancerous lesions.  

Contents

In the GI tract, tumor progression is thought to occur in a series of steps. [1] It begins with normal tissue and long-term inflammation causes the cells to undergo atrophy, metaplasia, dysplasia, and finally, becomes an adenoma or carcinoma. [2]  Given this progression, these lesions represent a potentially cancerous growths and an important opportunity to prevent gastrointestinal cancer.

Epidemiology

Cancers of the GI tract (esophageal, gastric, and colorectal) are on the rise. Over the last 30 years there has been an increase in incidence of adenocarcinoma of the esophagus, gastroesophageal junction, and gastric cardia. [3] Gastric cancer is the fourth most common malignant tumor and third most common cause of cancer related death. When gastric cancer is caught early, the five year survival rate is estimated to be around 90%. [4] [5] However when diagnosed at an advanced stage, survival falls to less than 30%. Colorectal cancer has demonstrated an increasing incidence in younger populations with the US lifetime risk estimated to be about 4%. [6] Colorectal cancer is the second most common cause of cancer related deaths with the highest burden found in Australia, New Zealand, Europe, and North America. [7] [8]  

Signs and symptoms

Signs and symptoms vary based on the location of the tumor and as this is a pre-cancerous stage, many patients are asymptomatic. Symptoms associated with all types of GI cancers include weight loss, abdominal pain, and anemia. Specific symptoms include:

Esophageal lesion:

Gastric lesion:

Colorectal lesions:

Risk factors

Risk factors also vary significantly based on the location and type of tumor. Risk factors for esophageal cancer include GERD, obesity, excessive alcohol use, and smoking. Other risks identified include high temperature foods, exposure to polycyclic aromatic hydrocarbons, and esophageal dysbiosis. [3] [12] [13] [14]

Risks for gastric cancer include chronic gastritis or inflammation. This can be caused by H. pylori infection, autoimmune gastritis, [15]   high salt diet, and smoking. [16]

Colorectal cancer risk increases with increased consumption of red meat, low fiber diet, alcohol use, and obesity. A number of conditions may also increase your risk of colorectal cancer such as irritable bowel disease, familial adenomatous polyposis, lynch syndrome, and cystic fibrosis. [3]

Diagnosis

Diagnosis of these lesions is made through histologic examination of tissue samples obtained via endoscopic biopsy. When examining the samples, the histologist looks for evidence of dysplasia which is defined as “unequivocal neoplastic epithelium confined to the basement membrane”. [17]

According to the WHO classification of Digestive System Tumors, these lesions are classified based on a two tier system. [18] The two tiers or classifications are low or high grade dysplasia. Low grade dysplasia means that the tissue maintains the glandular structure, cellular variance (pleomorphism) is mild or absent, nuclei maintain basal polarity and mitotic activity is not markedly increased. Where as high grade dysplasia includes features such as complex glandular architecture, marked deviation from the cells typical appearance (unusually large nuclei with prominent nucleoli), loss of typical cellular structure, and frequent mitotic figures.

Classification/grading

Paris Classification

The Paris Classification system, established in 2002, is used to classify superficial neoplastic lesions of the gastrointestinal tract based on their endoscopic appearance. This system of classification is clinically significant as it enables estimation of the depth of tumor invasion. [19]

TypeDescriptionSubclasses
1Polypoidp: protruded, pedunculated

s: sessile

2Nonpolypoida: slightly elevated

b: flat

c: slightly depressed

3Excavated

Stomach

Vienna Classification

The Vienna classification of gastrointestinal neoplasia was published in 2000 in an attempt to resolve differences in diagnoses between Eastern and Western trained pathologists. This system utilizes cytological and architectural severity and depth of invasion. [20]

CategoryClassificationSubclasses
1Negative for neoplasia/dysplasia
2Indefinite for neoplasia/dysplasia
3Non-invasive low grade neoplasia (low grade adenoma/dysplasia)
4Non-invasive high-grade neoplasiaCategory 4
  1. High grade adenoma
  2. Non-invasive carcinoma
  3. Suspicion of invasive carcinoma
5Invasive neoplasiaCategory 5
  1. intramucosal carcinoma
  2. Submucosal carcinoma

Japanese Society for Gastroenterological Endoscopy classification

The classification system commonly used to classify early gastric cancers was established in 1998 in Japan. This system utilizes visual and endoscopic features for classification and was developed to better assess which lesions were at higher risk of invasion. [21]

TypeTypeSubclasses
1Polypoid/protuberant1p: pedunculated

1ps/sp: Subpedunculated

1s: sessile

2Flat2a: superficial elevated

2b: flat

2c: flat depressed

3Ulcerated
4Lateral spreading tumor

References

  1. ↑ Correa P. Human gastric carcinogenesis: a multistep and multifactorial process--First American Cancer Society Award Lecture on Cancer Epidemiology and Prevention. Cancer Res. 1992;52(24):6735-6740.
  2. ↑ Fearon, Eric R.; Vogelstein, Bert (June 1990). "A genetic model for colorectal tumorigenesis". Cell. 61 (5): 759–767. doi: 10.1016/0092-8674(90)90186-I . PMID   2188735. S2CID   22975880.
  3. 1 2 3 Napier, Kyle J (2014). "Esophageal cancer: A Review of epidemiology, pathogenesis, staging workup and treatment modalities". World Journal of Gastrointestinal Oncology. 6 (5): 112–120. doi: 10.4251/wjgo.v6.i5.112 . ISSN   1948-5204. PMC   4021327 . PMID   24834141.
  4. ↑ Ferlay, Jacques; Shin, Hai-Rim; Bray, Freddie; Forman, David; Mathers, Colin; Parkin, Donald Maxwell (2010-06-17). "Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008". International Journal of Cancer. 127 (12). Wiley: 2893–2917. doi:10.1002/ijc.25516. ISSN   0020-7136. PMID   21351269.
  5. ↑ Kamangar, Farin; Dores, Graça M.; Anderson, William F. (2006-05-10). "Patterns of Cancer Incidence, Mortality, and Prevalence Across Five Continents: Defining Priorities to Reduce Cancer Disparities in Different Geographic Regions of the World". Journal of Clinical Oncology. 24 (14). American Society of Clinical Oncology (ASCO): 2137–2150. doi:10.1200/jco.2005.05.2308. ISSN   0732-183X. PMID   16682732.
  6. ↑ Global Burden of Disease 2019 Cancer Collaboration; et al. (2022-03-01). "Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019". JAMA Oncology. 8 (3): 420–444. doi:10.1001/jamaoncol.2021.6987. ISSN   2374-2437. PMC   8719276 . PMID   34967848.{{cite journal}}: CS1 maint: numeric names: authors list (link)
  7. ↑ Siegel, Rebecca L.; Miller, Kimberly D.; Wagle, Nikita Sandeep; Jemal, Ahmedin (2023). "Cancer statistics, 2023". CA: A Cancer Journal for Clinicians. 73 (1). Wiley: 17–48. doi: 10.3322/caac.21763 . ISSN   0007-9235. PMID   36633525.
  8. 1 2 Siegel, Rebecca L.; Miller, Kimberly D.; Goding Sauer, Ann; Fedewa, Stacey A.; Butterly, Lynn F.; Anderson, Joseph C.; Cercek, Andrea; Smith, Robert A.; Jemal, Ahmedin (2020-03-05). "Colorectal cancer statistics, 2020". CA: A Cancer Journal for Clinicians. 70 (3). Wiley: 145–164. doi: 10.3322/caac.21601 . ISSN   0007-9235. PMID   32133645.
  9. ↑ Obermannová, R.; Alsina, M.; Cervantes, A.; Leong, T.; Lordick, F.; Nilsson, M.; van Grieken, N.C.T.; Vogel, A.; Smyth, E.C. (2022). "Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up". Annals of Oncology. 33 (10): 992–1004. doi:10.1016/j.annonc.2022.07.003. PMID   35914638.
  10. ↑ Cavallin, Francesco; Scarpa, Marco; Cagol, Matteo; Alfieri, Rita; Ruol, Alberto; Sileni, Vanna Chiarion; Ancona, Ermanno; Castoro, Carlo (2018). "Esophageal Cancer Clinical Presentation: Trends in the Last 3 Decades in a Large Italian Series". Annals of Surgery. 267 (1): 99–104. doi:10.1097/SLA.0000000000002048. ISSN   0003-4932. PMID   27759616.
  11. ↑ Thompson, M R; O'Leary, D P; Flashman, K; Asiimwe, A; Ellis, B G; Senapati, A (2017-08-07). "Clinical assessment to determine the risk of bowel cancer using Symptoms, Age, Mass and Iron deficiency anaemia (SAMI)". British Journal of Surgery. 104 (10): 1393–1404. doi: 10.1002/bjs.10573 . ISSN   0007-1323. PMID   28634990.
  12. ↑ Abnet, Christian C.; Arnold, Melina; Wei, Wen-Qiang (2018). "Epidemiology of Esophageal Squamous Cell Carcinoma". Gastroenterology. 154 (2): 360–373. doi:10.1053/j.gastro.2017.08.023. PMC   5836473 . PMID   28823862.
  13. ↑ Pandeya, Nirmala; Williams, Gail; Green, Adèle C.; Webb, Penelope M.; Whiteman, David C. (2009). "Alcohol Consumption and the Risks of Adenocarcinoma and Squamous Cell Carcinoma of the Esophagus". Gastroenterology. 136 (4): 1215–1224.e2. doi:10.1053/j.gastro.2008.12.052. PMID   19250648.
  14. ↑ Muszyński, Damian; Kudra, Anna; Sobocki, Bartosz Kamil; Folwarski, Marcin; Vitale, Ermanno; Filetti, Veronica; Dudzic, Wojciech; Kaźmierczak-Siedlecka, Karolina; Połom, Karol (2022-11-16). "Esophageal cancer and bacterial part of gut microbiota – A multidisciplinary point of view". Frontiers in Cellular and Infection Microbiology. 12. doi: 10.3389/fcimb.2022.1057668 . ISSN   2235-2988. PMC   9709273 . PMID   36467733.
  15. ↑ Rawla, Prashanth; Barsouk, Adam (2019). "Epidemiology of gastric cancer: global trends, risk factors and prevention". Gastroenterology Review. 14 (1): 26–38. doi:10.5114/pg.2018.80001. ISSN   1895-5770. PMC   6444111 . PMID   30944675.
  16. ↑ Mantziari, Styliani; St Amour, Penelope; Abboretti, Francesco; Teixeira-Farinha, Hugo; Gaspar Figueiredo, Sergio; Gronnier, Caroline; Schizas, Dimitrios; Demartines, Nicolas; Schäfer, Markus (2023-03-06). "A Comprehensive Review of Prognostic Factors in Patients with Gastric Adenocarcinoma". Cancers. 15 (5): 1628. doi: 10.3390/cancers15051628 . ISSN   2072-6694. PMC   10000968 . PMID   36900419.
  17. ↑ Riddell, Robert H.; Goldman, Harvey; Ransohoff, David F.; Appelman, Henry D.; Fenoglio, Cecilia M.; Haggitt, Rodger C.; hren, Christer; Correa, Pelayo; Hamilton, Stanley R.; Morson, Basil C.; Sommers, Sheldon C.; Yardley, John H. (1983). "Dysplasia in inflammatory bowel disease: Standardized classification with provisional clinical applications". Human Pathology. 14 (11). Elsevier BV: 931–968. doi:10.1016/s0046-8177(83)80175-0. ISSN   0046-8177. PMID   6629368.
  18. ↑ Nagtegaal, Iris D; Odze, Robert D; Klimstra, David; Paradis, Valerie; Rugge, Massimo; Schirmacher, Peter; Washington, Kay M; Carneiro, Fatima; Cree, Ian A; the WHO Classification of Tumours Editorial Board (2020). "The 2019 WHO classification of tumours of the digestive system". Histopathology. 76 (2): 182–188. doi:10.1111/his.13975. ISSN   0309-0167. PMC   7003895 . PMID   31433515.
  19. ↑ Participants in the Paris Workshop (December 2003). "The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon". Gastrointestinal Endoscopy. 58 (6): S3 –S43. doi:10.1016/s0016-5107(03)02159-x.(subscription required)
  20. ↑ Schlemper, R J (1 August 2000). "The Vienna classification of gastrointestinal epithelial neoplasia". Gut. 47 (2): 251–255. doi: 10.1136/gut.47.2.251 .
  21. ↑ None, Japanese Gastric Cancer Association (1998). "Japanese Classification of Gastric Carcinoma". Gastric Cancer. 1 (1): 10–24. doi:10.1007/s101209800016. ISSN   1436-3305. PMID   11957040.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.