276 - GI Cancer

Question 1

From which cells does pancreatic cancer most commonly arise?

Answer 1

Columnar cells (form the pancreatic ducts)

=> results in adenocarcinoma (most aggressive type)

Question 2

What percentage of pancreatic cancer is metastatic at presentation?

Answer 2

85%

Treat with palliative chemotherapy

Currently, no great immunotherapy agents for pancreatic cancer

Question 3

What is the most significant risk factor for esophageal cancer?

Answer 3

Barrett’s esophagus = acquired metaplasia of transition zone btwn squamous epithelium of esophagus and columnar cells of the stomach

other risk factors: tobacco, alcohol

Question 4

Where in the esophagus is squamous vs. adenocarcinoma more likely?

Answer 4

• Squamous: upper 2/3 of esophagus
• Adenocarcinoma: lower 1/3 of esophagus

Question 5

List 3 risk factors for cholangiocarcinoma

Answer 5

• Primary sclerosing cholangitis
• Infection
• Inflammation

Question 6

What are the 2 curative therapies for Hepatocellular Carcinoma?

Answer 6

1. Liver transplant
   
   • when only one tumor <5 cm or up to 3 tumors that are all < 3cm
2. Resection

Question 7

List 4 symptoms of pancreatic cancer

Answer 7

• Weight loss
• Pain (epigastric, radiates to the back)
• Jaundice
• Nausea/vomiting

Question 8

What symptom of cholangiocarcinoma can help differentiate it from pancreatic cancer?

Answer 8

Pruitis

Not always present; often presents similarly to pancreatic cancer

Question 9

What is the only GI cancer in which radiation has a major role in treatment?

Answer 9

Cholangiocarcinoma

• Go straight to surgery if resectable
• Neoadjuvant radiation can sterilize the surgical area
• Chemotherapy if metatstatic disease

Question 10

In which cancers is HER2 testing important?

Answer 10

Adenocarcinomas:

• Esophageal/Gastric cancer
• Breast cancer

Question 11

What is the leading cause of the incidence in HCC in the western population

Answer 11

Increasing rates of Hepatitic C and Non-alcoholic fatty liver disease

Both lead to chronic inflammation -> cirrhosis -> HCC

Question 12

What is the most concerning risk factor for the increasing incidence in pancreatic cancer?

Answer 12

Increase in diabetes an insulin resistance

Increase in alcohol use -> chronic pancreatitis is also a concern

Question 13

What is Barrett’s Esophagus?

(Histological changes)

Answer 13

Transformation of squamous -> columnar epithelium in the lower esophagus

Esophagus starts to look more like the stomach