Gastrointestinal intraepithelial neoplasia
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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.
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.
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:
- trouble swallowing (dysphagia)
- painful swallowing (odynophagia)
- regurgitation of food
- aspiration of food
- hoarseness
- cough[9][10]
Gastric lesion:
- early satiety
- nausea
- vomiting.
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]