109 : Upper GI tract Cancers Flashcards
T or F: In esophageal cancers worldwide, adenocarcinoma is the more common cell type.
False
Squamous cell carcinoma
Some etiologic factors associated with SCCA of esophagus
- Excess alcohol consumption (whiskey > wine, beer)
- Cigarette smoking
- Ingested carcinogens
- Mucosal damage from physical agents (extremely hot tea long-term exposure, Lye ingestion, radiation-induced strictures)
- Esophageal web with glossitis and iron deficiency (Plummer-Vinson or Paterson-Kelly syndrome)
- Hyperkeratosis and pitting of the palms and soles
Some etiologic factors associated with ADENOCARCINOMA of esophagus
- Chronic GERD
- Obesity
- Barrett’s esophagus
- Male sex
- Cigarette smoking
Part of the esophagus where adenocarcinoma arises?
Distal third of esophagus
From squamous epithelium –> columnar mucosa
T or F: Adenocarcinoma of esophagus behave clinically like gastric adenocarcinomas, hence they are associated with Helicobacter pylori infections.
False
NOT associated with H. pylori
Percentage of cancer in each part of the esophagus
Upper third : 5%
Middle third: 20%
Lower third: 75%
Incidence of adenoCA in esophagus is increasing in the US more than SCCA
T or F: SCCA and adenoCA of esophagus can be distinguished radiographically or endoscopically
False
CANNOT be distinguished
Percentage of esophageal circumference infiltrated with cancer when difficulty of swallowing begin to appear?
> 60%
By the time symptoms appear, disease is already very advanced
Esophageal CA most commonly spreads to what adjacent organs?
- Adjacent and supraclavicular lymph nodes
- Liver
- Lungs
- Pleura
- Bone
Procedure that should be performed in ALL patients SUSPECTED of having an esophageal abnormality to visualize and identify the tumor, and also to obtain histopathologic confirmation of diagnosis
Esophagoscopy
a. Endoscopic inspection of larynx, trachea, and bronchi should also be carried out
b. Endoscopic examination of fundus of stomach is imperative as well
Imagings used to determine extent of tumor spread to the mediastinum and para-aortic lymph nodes
CT scan of chest and abdomen
Endoscopic ultrasound
Imaging that provides useful assessment of the presence of distant metastatic disease with accurate information regarding spread to mediastinal lymph nodes, helpful in defining radiation therapy fields
Positron emission tomography (PET) scan
Prognosis for patients with esophageal carcinoma
Poor
5-year survival after diagnosis is 10%
Goal of treatment for esophageal CA
Symptom control
Surgical resection in esophageal cancer
Feasible only in 45% of cases
Associated with frequent residual tumors
Increased post-op mortality due to many complications
T or F: Chemotherapy with radiation therapy produces better survival outcome than radiotherapy alone
True
Patient presented with esophageal CA, however the tumor is unresectable. What major issues in the management should you be concerned or need to prioritize?
- Dysphagia (endoscopic dilatation, radiation therapy)
- Malnutrition (gastrostomy or jejunostomy)
- Tracheoesophageal fistulas (stenting)
T or F: Gastric cancer is associated among lower socioeconomic class and intake of dietary carcinogens
True
Frequencly of the different stomach cancers
Adenocarcinoma: 85%
Lymphomas, MALT: <15%
Leiomyosarcoma, GIST : 1-3%
2 types of gastric adenocarcinoma
- Diffuse type
2. Intestinal type
Type of gastric adenoCA common in younger patients, develops througgout the stomach, causing linitis plastica or “leather bottle” appearance, and carries poorer prognosis
Diffuse type
Cell cohesion is absent, and individual cells infiltrate and thicken the stomach wall without forming a discrete mass
Type of adenoCA which are frequently ulcerative, more common in the ANTRUM and LESSER curvature of stomach, often initiated by H. pylori infection
Intestinal type
Part of the stomach where most gastric CA originate
Proximal third of stomach (40%)
30% distal stomach
20% midportion
10% entire stomach
Factor in the causation of gastric carcinoma due to long-term ingestion of high concentrations of nitrates in dried, smoked, and salted foods
Nitrate-converting bacteria
T or F: Increased gastric acidity is an endogenous factor that favors the growth of nitrate-converting bacteria in stomach
False
Decreased gastric acidity
Others: prior antrectomy, atrophic gastritis and/or pernicious anemia
T or F: Infection with H. pylori increases risk of gastric cancer by sixfold.
True
A germline mutation in this gene, inherited in autosomal dominant pattern, normally codes for a cell adhesion protein, results in high incidence of occult diffuse-type gastric cancers in young asymptomatic carriers
E-cadherin gene (CDH1)
T or F: A palpable abdominal mass may be an early sign caused by diffuse type of gastric cancer
False
There may be no early physical signs
Palpable mass indicates long-standing growth and predicts regional extension
How do gastric CA metastasize?
- Direct extension
- Lymphatics
- Hematogenous
Gastric CA that metastasize to the ovary
Krukenberg’s tumor
Gastric CA that metastasize to the periumbilical region
“Sister Mary Joseph node”
Gastric CA that metastasize to the peritoneal cul-de-sac
Blumer’s shelf palpable on rectal or vaginal examination
Most common site for hematogenous spread of tumor in Gastric CA
Liver