4. Pathology of the Stomach Peptic Ulcer & Gastric Malignacies

Question 1

Gastric malignancy

Answer 1

stomach (gastric) cancer is the cancer that starts in the cells lining the stomach

Question 2

the most common gastric cancer is

Answer 2

adenocarcinoma

Question 3

gastric adenocarcinoma

Answer 3

cancer in cells that produce mucus

Question 4

is the early stage of gastric adenocarcinoma asymptomatic

Answer 4

yes

Question 5

what are symptoms associated in the late stage of gastric adenocarcinoma

Answer 5

indigestion
nausea or vomitting
dysphagia
GI bleeding
unintentional weight loss

Question 6

How is gastric adenocarcinoma treated

Answer 6

surgery (resection)
chemotherapy
radiation

Question 7

how is gastric adenocarcinoma divided

Answer 7

location
by micrograph

Question 8

what are possible locations of gastric adenocarcinoma

Answer 8

Gastric cardia cancer begins in the top inch of the stomach, just below where it meets the esophagus

Non-cardia gastric cancer is cancer that begins in all other sections of the stomach.

Question 9

what are possible classifications of gastric adenocarcinoma based on micrographs

Answer 9

Intestinal adenocarcinomas are well differentiated = the cancer cells look similar to normal cells under a microscope.

ØDiffuse adenocarcinomas are undifferentiated or poorly
differentiated = the cancer cells look different from
normal cells under a microscope

Question 10

Most common benign tumors

Answer 10

adenoma

Question 11

Most common malignant tumors:

Answer 11

Adenocarcinoma

Question 12

Adenocarcinoma most commonly occur in what location of the stomach

Answer 12

antrum

Question 13

what are the risk factors for Adenocarcinoma

Answer 13

H. pylori
Smoking
Nitrites
Smoked food
Menetrier’s disease
(E-cadherin)

Question 14

What actions on the gastric epithelial do H. pylori and gastric cancer cause

Answer 14

oxidative stress + increased DNA damage =
inflammation of epithelial cells =
Impairment of DNA repair pathways = deactivation of tumor suppression gene and oncogenesis

Question 15

What actions through the modulation of immune-inflammatory pathways do H. pylori and gastric cancer cause

Answer 15

Increase in:
Smad7
ROS, RNS
IL-17, IL-21
NF-kB activity

Question 16

What response cells are involved with H. pylori and gastric cancer

Answer 16

dendritic cells
neutrophil
macrophage
t-cells

Question 17

What is sodium nitrites commonly ingested with

Answer 17

preserved foods (meats)

Question 18

What are nitrates commonly ingested with

Answer 18

nitrate consumed through the diet is converted to nitrite by bacteria

Question 19

the combination of nitrite from processed meats and low pH of stomach acid creates

Answer 19

nitric oxide

Question 20

How can smoking lead to gastric cancer

Answer 20

3 ways:

1. (increase) inflammation
2. (increase) NAchR - stimulation of growth factor = angiogenesis
3. DNA damage can happen through the NachR - instability of genetics - angiogenesis = deactivation of suppression gene

Question 21

Are nitrites by themselves safe?

Answer 21

yes

Question 22

through what mechanism do nitrites become harmful

Answer 22

nitrites become harmful with they react with amines, found in the stomach. together they make nitroamines

Question 23

Why are nitroamines harmful

Answer 23

nitroamines increase the risk of DNA damage

Question 24

the combination of nitrite and low pH of stomach acid creates what

Answer 24

nitric oxide

Question 25

DNA damage from n-alkylnitrosamine compounds can form

Answer 25

colon carcinoma

Question 26

What two compunds are of concerned with smoked meats

Answer 26

PAH - Polycyclic aromatic hydrocarbon HCA - heterocyclic amines

Question 27

Why HCA and PAH involved in cancer development

Answer 27

the carcinogens at high temps can damage DNA which increases cancer development

Question 28

what is menetrier disease

Answer 28

overexpression of tumor growth factor-a TGF-a, a ligand for tyrosine kinase epidermal growth factor receptor

Question 29

What are characteristics of menetrier disease

Answer 29

giant mucosal folds in the proximal part of the stomach

Question 30

what happens in menetrier disease

Answer 30

decreased acid decreased digestion decreased albumin (hypoalbumena)

Question 31

How does e-cadherin affect gastric cancer

Answer 31

e-cadherin involves cell-to-cell junctions with it we have abnormal growth of cells(dysplasia) leading to gastric cancer

Question 32

how many ways can adenocarcinoma be diagnosed

Answer 32

depth of invasion histology growth pattern

Question 33

what are the 2 stages of depth of invasion to diagnose adenocarcinoma?

Answer 33

Early and late

Question 34

what are the 2 histology types to diagnose adenocarcinoma?

Answer 34

intestinal and diffused

Question 35

What layers of the stomach are involved in the early depth of invasion of an adenocarcinoma diagnosis?

Answer 35

2 - mucosa + submucosa

Question 36

What layers of the stomach are involved in the late(advanced) depth of invasion of an adenocarcinoma diagnosis?

Answer 36

4 - mucosa + submucosa + serosa + muscularis propria

Question 37

what is the histological appearance of intestinal type adenocarcinoma?

Answer 37

glandular

Question 38

what is the predilection of intestinal type adenocarcinoma?

Answer 38

mean age men

Question 39

what are the risk factors of intestinal-type adenocarcinoma?

Answer 39

diet high in smoked and salted foods pickled vegetables lack of citrus fruits green leafy vegetables cigarette smoking

Question 40

intestinal-type adenocarcinoma is associated with

Answer 40

chronic gastritis H pylori autoimmune gasritis partial gastrectomy gastric adenomas

Question 41

what is the histology of intestinal-type adenocarcinoma?

Answer 41

bulky tumors that are either tubular or papillary

Question 42

what is the predilection of diffuse type adenocarcinoma?

Answer 42

mean age 48 for men and women but more common in young

Question 43

what is the clincial appearance of diffuse type adenocarcinoma?

Answer 43

poorly differentiated discohesive malignant cells

Question 44

what is another name for diffuse type adenocarcinoma?

Answer 44

linitis plastica or signet ring cell adenocarcinoma

Question 45

Why is diffuse type adenocarcinoma refered to as linitis plastica?

Answer 45

because of its thickened and rubbery hard gastric wall due to an extensive infiltration with signet ring cells

Question 46

what happens with diffuse adenocarcinoma enters systemic circulation

Answer 46

it travels and effects other parts of the body which will be known as krukenburg tumor

Question 47

whats an example of a krukenburg tumor

Answer 47

ovarian has signet rings cellular stroma background (fibroblasts)

Question 48

what is the Borrmann classification

Answer 48

classifies gastric cancer

Question 49

the Borrmann classification has how many types

Answer 49

4

Question 50

the Borrmann classification least aggressive

Answer 50

type 1

Question 51

the Borrmann classification most aggressive

Answer 51

type 4

Question 52

the Borrmann classification type 1

Answer 52

polypoid (minimal invasion)

Question 53

the Borrmann classification type 2

Answer 53

fungating carcinoma (raised margin, shallow ulceration)

Question 54

the Borrmann classification type 3

Answer 54

ulcerated carcinoma (infiltration of malignant cells)

Question 55

the Borrmann classification type 4

Answer 55

infiltrating carcinomas (more diffused malignant cells that affect the stomach rapidly and has a leather appearance)

Question 56

What is GIST

Answer 56

a soft tissue carcinoma cancer in the nerve cells that are found in the walls of the stomach

Question 57

Where does GIST arise from

Answer 57

interstitial cell of Cajal that is located in the muscularis propria

Question 58

ICC or interstitial cells of Cajal are sometimes referred to as

Answer 58

pacemakers of the GI tract

Question 59

what is the predilection of GIST

Answer 59

elder males

Question 60

increased GIST is associate with

Answer 60

Neurofribromatosis type I and carneys triad

Question 61

signs of Neurofribromatosis type I

Answer 61

cafe au lait spots soft bumps

Question 62

carneys triad

Answer 62

3 types of endocrine tumors happening at once - lungs, stomach, adrenal

Question 63

what is the pathogenesis of GIST

Answer 63

tyrosine kinase gene c-KIT (70%) platelet derived growth factor receptor alpha (10%)

Question 64

activation of tyrosine kinase gene c-KIT does what

Answer 64

promote tumor proliferation inhibit tumor suppressor genes

Question 65

what are the 3 forms of GIST

Answer 65

spindle cell epithelioid cells mixed

Question 66

foregut carcinoid tumor

Answer 66

stomach duodenum

Question 67

midgut carcinoid tumor

Answer 67

jejunum and ileum (aggressive)

Question 68

Hindgut carcinoid tumor

Answer 68

appendix and colorectum (large intestines)

Question 69

Most commonly associated lymphomas

Answer 69

2; MALT and diffuse large B-cell gastric lymphoma

Question 70

where does MALT originate

Answer 70

H. pylori chronic gastritis

Question 71

MALT untreated becomes what

Answer 71

diffused B

Question 72

MALT lymphoma can mimic what

Answer 72

(6) erythematous gastritis ulcer scar polyp ulcer mass thickened fold

Question 73

How do you treat MALT

Answer 73

antibiotics surgery radiation therapy chemotherapy targeted therapy

Question 74

What are the two types surgical procedures for gastrectomy

Answer 74

total partial

Question 75

what is a partial gastrectomy

Answer 75

plyorus preservation by removal of part of the stomach

Question 76

what type of surgery is gastric bypass surgery

Answer 76

temporary; puts less pressure on the stomach

Question 77

what are surgical procedures for gastrectomy complications

Answer 77

anatomic leak bile reflux dumping syndrome malnutrition internal hernia narrowing at the attachment site post surgery gastroparesis

Question 78

anatomic leak

Answer 78

leak at the attachment site

Question 79

bile reflux

Answer 79

bile flows backwards into stomach

Question 80

dumping syndrome

Answer 80

food travels to your small intestine before it is broken down enough

Question 81

internal hernia

Answer 81

part of your small intestine bulge through the membrane that attaches your intestine to your abdominal wall

Question 82

narrowing at the attachment site

Answer 82

the site that connects your partial stomach or esophogus and small intestine narrows

Question 83

post surgery gastroparesis

Answer 83

the stomach doesnt process food as quickly as it should

Question 84

what is the recovery time for gastrectomy

Answer 84

2 months

Question 85

regaining energy levels and getting used to new habits after a gastrectomy takes

Answer 85

3 to 6 months or even longer