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F24 103 Intro to Oncology & W&L > Digestive System Cancers > Flashcards

Digestive System Cancers Flashcards

1
Q

Esophageal cancer accounts for what % of cancers in the US

A

1%

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2
Q

What sex is most likely to develop Esophageal cancer?

A

Men are 3-4 times more likely than women to develop esophageal tumors

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3
Q

What race is more likely to develop Esophageal cancer, and at what %?

A

African Americans 50% more likely over white people

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4
Q

At what age is Esophageal cancer most likely found in?

A

Most tumors are seen in patients aged 55-85

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5
Q

At what stage is Esophageal cancer mostly diagnosed in, and what is the 5 year survival rate?

A

It is usually diagnosed at an advanced stage and is almost uniformly fatal
21% 5-year survival rate

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6
Q

What countries have the greatest frequency of Esophageal cancer?

A

Greatest frequency in China, northern Iran, and South Africa

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7
Q

What percent of esophageal cancer is associated with GERD?

A

30% of esophageal cancer associated with GERD

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8
Q

What are some common causes of esophageal cancer?

A

SCC (squamous cell carcinoma) – excessive alcohol and tobacco use – synergistic effect

Adenocarcinoma (neoplasia of epithelial tissue that has glandular origin)– tobacco use

Barrett esophagus/syndrome (Damage to the lower portion of the esophagus caused by long term GERD)

GERD
30% of esophageal cancer associated with GERD
Diets low in fresh fruits and vegetables, high in nitrates
Obesity

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9
Q

Rare/less common causes of esophageal cancer?

A
  1. Achalasia – lower 2/3 loss of peristaltic activity (A rare disorder making it difficult for food and liquid to pass into the stomach) – 5-20% risk of SCC (squamous cell carcinoma)
  2. Tylosis – rare genetic disorder causes excessive skin growth on palms and soles – 40% lifetime risk of developing esophageal cancer in some patients. When associated with esophageal cancer, it’s called Howel-Evans syndrome.

3.Plummer-Vinson syndrome – iron-deficiency anemia, post-cricoid dysphagia, upper esophageal webs

  1. Caustic injury (tissue damage caused by a chemical reaction with a caustic substance, such as an acid or base)
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10
Q

Symptoms of esophageal cancers

A

90% of patients have dysphagia and weight loss

50% of patients have painful swallowing

Symptoms of locally advanced disease include vomiting blood, coughing blood, coughing and/or hoarseness

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11
Q

Esophageal cancers patterns of spread are:

A

*Esophageal lesions usually spread longitudinally

*Early spread to lymph is common, occasionally causing skip metastases (as in you could have a lesion in the upper portion and one in the lower portion but not in between)

*Tumors invade adjacent structures in locally advanced disease

*Distant metastases occur in many organs, but lung and liver are most common

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12
Q

Esophageal cancer treatments

A
  1. Radiation therapy in combination with chemo is the treatment of choice
  2. Surgery is limited to middle and lower lesions, but is a difficult procedure and has high morbidity and mortality rates
    *Even after a curative resection, most patients have distant failure with spread to lungs, liver or bone
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13
Q

What is a consequence of radiation to esophagus in regards to their ability to eat

A

eating thru a tube (peg tube?)

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14
Q

Although less common in the US, gastric cancer is the _______ leading cause of cancer death globally; __________ is the highest-risk geographic block

A

second

Eastern Asia

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15
Q

What are the risk factors of Gastric cancer?

A

Risk factors include diet, smoking and alcohol consumption, certain genetic disorders, infections (H. pylori and Epstein-Barr), and pernicious anemia

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16
Q

Most Gastric cancer tumors are ______________.

A

Most tumors are adenocarcinomas

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17
Q

Treatment for Gastric cancer is mostly…

A

Mostly surgery & chemo

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18
Q

5 year survival rate for Gastric cancer is?

A

36% 5 year survival rate

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19
Q

What do 95% of Pancreatic cancer tumors begin?

A

95% of tumors begin in exocrine cells

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20
Q

What is the 5 years survival rate of Pancreatic cancer?

A

It has a poor prognosis, with a five-year survival rate of only 5%

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21
Q

What is the most common tumor type for Pancreatic cancer?

A

The most common tumor type is ductal adenocarcinomas (80%)

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22
Q

What is the clinical presentation of Pancreatic cancer?

A

Clinical presentation includes jaundice, abdominal pain, anorexia, and weight loss

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23
Q

At what stage is Pancreatic cancer typically found?

A

Typically, tumors present at a late stage with inoperable advanced disease

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24
Q

Pancreatic cancer is the ________ leading cause of cancer death in the US.

A

It is the fourth leading cause of cancer death in US and is considered one of the deadliest malignancies

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25
Q

What percent of Pancreatic cancer patients are over 70 years of age?

A

70% of patients are over 70 years of age

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26
Q

What are the known causes of Pancreatic cancer?

A

Although there is no known cause, it is associated with cigarette smoking, hereditary factors, obesity, a high-fat diet, and type 2 diabetes

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27
Q

Pancreatic cancer lesions occur most frequently in the_________ and ___________ in the anatomy of the pancreas.

A

Lesions occur most frequently in the head and neck of the pancreas

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28
Q

Pancreatic cancer

  • make cards about staging *
A

It is locally invasive with direct extension into duodenum, stomach or colon at diagnosis

Spread to the liver and local lymph nodes is also common
Pancreatic tumors tend to be aggressive and resistant to chemo and radiation therapy

https://www.cancer.org/cancer/types/pancreatic-cancer/detection-diagnosis-staging/staging.html

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29
Q

Liver cancer primary tumors are typically a result of:

A

Primary liver tumors are typically the result of a chronic hepatitis B or C infection, cirrhosis due to alcohol consumption, or obesity

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30
Q

Liver cancer arise predominantly from what cells?

A

Arise predominantly from the parenchymal liver cells or hepatocytes (90%) and are called hepatocellular carcinoma (HCC)

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31
Q

Liver cancer rates increasing fastest in what gender?

A

HCC continues to increase rapidly in the United States, with rates increasing fastest in men.

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32
Q

Liver cancer secondary metastatic tumors are _________ times more common than primary liver cancer?

A

Secondary metastatic tumors are also very common in the liver, 20 times more common than primary liver cancer.

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33
Q

Liver cancer presenting symptoms:

A

Presenting symptoms include: pain, hepatomegaly, palpable lump in the abdomen, jaundice, unexplained weight loss, itching, and vomiting

34
Q

Liver cancer prognosis depends on what?

A

Prognosis depends mostly on the stage of cancer and the patient’s general health status

35
Q

Gallbladder cancer tumors are most commonly___________

A

Most tumors are adenocarcinomas (90%)

36
Q

Gallbladder cancer is most common among ___________people.

A

This cancer is most common among elderly women, especially those of Native American descent

37
Q

Gallbladder cancer is strongly associated with:

A

It is also strongly associated with gallstones and polyps

38
Q

Gallbladder cancer is commonly detected early. True or False

A

It is difficult to detect early, and the prognosis is generally very poor

39
Q

At what age do ________ % of people get diagnosed with Colorectal cancer?

A

90% occurs in people over 50

40
Q

Colorectal cancer is the ___________leading cause of death in the US?

A

It is the second leading cause of cancer death in the US

41
Q

Risk factors for Colorectal cancer are:

A

Risk factors include: a high fat/low fiber diet, obesity, smoking, excessive alcohol, minimal physical activity, chronic ulcerative colitis, FAP

42
Q

Risk factor in regards to relatives with Colorectal cancer?

A

People with a first-degree relative who has had colorectal cancer are at an increased risk

43
Q

What does Intraperitoneal & retroperitoneal mean in regards to Colorectal cancer treatment/prognosis?

A

Major factor in treatment and prognosis is whether lesion is retroperitoneal or intraperitoneal

Intraperitoneal: cecum, transverse colon, and sigmoid have a complete mesentery and serosa and are freely mobile; these tumors have a greater chance of full excision

Retroperitoneal: ascending/descending colon and hepatic/splenic flexures; these tumors spread early outside the bowel and surgery more difficult

44
Q

Colorectal cancer is seperated into____________

A

We separate colon and rectal cancers since the symptoms, diagnosis, and treatment are different

45
Q

The rectum is ___________, making invasion of local structures ____________in regards to metastasis of Colorectal cancer.

A

The rectum is continuous with the sigmoid and begins at S3 with the lower ½ to 2/3 located retroperitoneally, making invasion of local structures common (prostate, bladder, vagina, sacrum)

46
Q

Colorectal cancer is mostly treated in what anatomical position in radiation therapy?

A

mostly treated supine now because we can treat thru the table.

47
Q

Colorectal cancer presentation:

A

Rectum presentation:
*Rectal bleeding or blood in stool
*Change in bowel habits, spasms with feeling of need to empty bowel, pain

Colon presentation:
*Left side tumors – similar to rectal symptoms
*Right side tumors – abdominal pain often with abdominal mass, nausea, vomiting, occult blood (blood in feces not visually apparent) and anemia

48
Q

Colorectal cancer treatment includes:

A

Surgery is the treatment of choice when possible

Post-op radiation therapy in combination with chemo is advocated due to fail rate of surgery alone

Chemotherapy for high-risk patients

49
Q

How does colorectal cancer usually spread?

A

It usually spreads via direct extension, lymphatics or blood

50
Q

Most common type of Colorectal cancer tumor is?

A

Adenocarcinoma (90-95%) is the most common type of tumor

51
Q

Approx. what percent of patients have nodal involvement at diagnosis of Colorectal cancer?

A

Approx. 50% of patients have nodal involvement at diagnosis

52
Q

What is the most common distal metastasis of Colorectal Cancer?

A

Blood-borne spread to liver is most common distal metastasis, with lung being second
Peritoneal seeding

53
Q

Anal cancer often seen in what population?

A

It is more often seen in older women, but incidence rates are increasing in men under 45

This is attributed to homosexuality and anal intercourse

54
Q

Anal cancer common causes:

A

It is also associated with genital warts/infections, HPV, anal intercourse before age 30, and immunosuppression

55
Q

Most common clinical presentation of Anal cancer:

A

The most common clinical presentation is rectal bleeding

56
Q

Anal tumors is most commonly__________ by what percent?

A

Squamous cell carcinoma accounts for 80% of anal tumors

57
Q

Anal Cancer spreads by:

A

Spread is by direct extension to adjacent soft tissues

Lymph spread occurs early with blood-borne metastasis to liver and lung less common

58
Q

Anal Cancers treatment:

A

The treatment of choice is a combination of radiation and chemo to provide good local control and colostomy-free survival

Surgery is no longer the first choice

59
Q

What is the principal advantage of IMRT or VMAT over conventional 3D conformal radiation in treating rectal, anal, or pancreatic cancer?

A

IMRT or VMAT provides better dose conformity to target volumes, more sparing of healthy structures (OARs), and fewer long-term radiation side effects.

60
Q

Which method reduces the dose to the small bowel during pelvic radiation therapy?

A

Prone position and treatment with a full bladder are effective in reducing the dose to the small bowel during pelvic radiation therapy.

61
Q

Which lymph node group is involved in patients with rectal cancer?

A

The principal lymph node group involved in rectal cancer is the internal iliac nodes.

62
Q

What are the main etiologic factors for adenocarcinomas of the esophagus in North America?

A

A diet high in fat and nitrates, Barrett’s esophagus, and GERD are principal etiologic factors for adenocarcinoma of the esophagus in North America.

63
Q

What blood-borne metastasis site is common in rectal, pancreatic, or esophageal cancer?

A

The liver is a common site for blood-borne metastasis from rectal, pancreatic, or esophageal cancers.

64
Q

What dose-limiting structure is of most concern during radiation treatment for esophageal cancer?

A

The spinal cord is the dose-limiting structure of most concern in thoracic radiation for esophageal cancer.

65
Q

What radiation-field design is most commonly used to avoid critical structures during radiation for esophageal cancer?

A

Conformal 3D VMAT or IMRT is most commonly used to avoid critical structures in thoracic radiation therapy.

66
Q

What are common presenting symptoms of pancreatic cancer?

A

Common presenting symptoms of pancreatic cancer include jaundice, nausea and vomiting, 10% weight loss, and anorexia.

67
Q

For irradiation of the upper abdomen for pancreatic cancer, what is the most radiosensitive dose-limiting structure?

A

The kidney is the most radiosensitive dose-limiting structure in upper abdomen irradiation for pancreatic cancer.

68
Q

Why is a 4D CT scan and respiratory gating used in simulating patients with esophageal or pancreatic cancer?

A

These techniques help assess and compensate for respiratory motion, improving precision in targeting the tumor and avoiding surrounding organs.

69
Q

What is the rationale for neoadjuvant preoperative radiation therapy for rectal cancer?

A

Neoadjuvant therapy reduces tumor size and vascularity, making surgery more effective and lowering the risk of recurrence.

70
Q

What are the theoretical advantages of proton therapy in treating esophageal cancer?

A

Proton therapy reduces radiation exposure to healthy tissues, offering better sparing of critical structures like the lungs, spinal cord, and heart.

71
Q

What techniques help reduce the radiation dose to the small bowel, and why are they important?

A

Techniques like prone positioning and full bladder treatments help displace the small bowel, minimizing radiation exposure and reducing the risk of complications.

72
Q

What can be done to ensure consistency in daily setup for esophageal cancer radiation fields?

A

Ensuring proper alignment with body casts, accurate tattoos for positioning, and regular verification images can help maintain reproducibility during treatment.

73
Q

What is the main advantage of CT simulation and 3D conformal radiation techniques?

A

These techniques provide precise imaging and treatment planning that allow better targeting of tumors while sparing healthy tissue.

74
Q

What is the purpose of chemoradiation in treating cancers?

A

Chemoradiation combines chemotherapy and radiation to shrink tumors more effectively, making them more treatable with surgery or further radiation.

75
Q

How are Barrett’s esophagus and GERD related to the development of esophageal cancer?

A

Barrett’s esophagus and GERD can cause chronic damage to the esophagus lining, leading to dysplasia and an increased risk of developing adenocarcinoma.

76
Q

What is the function of dietary modifications in patients undergoing thoracic irradiation for esophageal cancer?

A

Dietary guidelines, such as avoiding spicy or acidic foods, help reduce esophagitis and discomfort during thoracic irradiation.

77
Q

Why is pancreatic cancer often considered one of the deadliest malignancies?

A

Pancreatic cancer often presents in late stages with advanced metastasis, and most tumors are unresecatable by the time of diagnosis.

78
Q

What is the most common surgical procedure for pancreatic cancer, and what does it involve?

A

The Whipple procedure (pancreaticoduodenectomy) is the most common surgery for pancreatic cancer, involving resection of the pancreas, duodenum, and part of the stomach.

79
Q

What is the role of SBRT (Stereotactic Body Radiation Therapy) in treating locally advanced pancreatic cancer?

A

SBRT allows for precise, high-dose radiation delivery to the tumor while sparing nearby healthy tissues, such as the liver and small intestine.

80
Q

What are some side effects of radiation therapy for pancreatic cancer?

A

Side effects of radiation therapy for pancreatic cancer include nausea, vomiting, esophagitis, and long-term effects like renal failure.

81
Q

How does chemoradiation assist in managing borderline resectable pancreatic cancer?

A

Chemoradiation can shrink the tumor, making surgery possible and improving local control, while also addressing systemic disease.

82
Q

Why is the liver considered the most common site of metastasis for rectal, pancreatic, and esophageal cancers?

A

These cancers often metastasize to the liver due to its role in filtering blood from the digestive organs, making it a common site for metastatic disease.

F24 103 Intro to Oncology & W&L (13 decks)

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