esophageal and stomach tumors Flashcards
the 2 distinctive histological types of esophageal @ gastric cancer are:
SCC- upper 2/3 of esophagus
Adenoca- lower 1/3 and GEJ
what are the similarities and differences of SCC @ Adenoca?
different etiological factors
similar clinical, endoscopic and radiologic findings.
epidemiology of esophageal SCC?
m:f 3:1 from east asia to west euro and north africa lower socioeconomic status blacks>whites >50's
epidemiology of esophageal Adenoca?
m:f 6:1
white>black
>50’s
risk of esophageal Adenoca?
obesity GERD Barettes esophagus smoking p53 aneuploidity and mutations in dysplastic epithel hereditary mutation in 15%
risk of esophageal SCC?
smoking alcohol ingested carcinogenes achlasia (food remains cause inflammation) congenital head @ neck tumors association
symptoms of esophageal cancer
progressive dysphagia
disproportionate weight loss
iron.d anemia
reflux and regurritation (in Adenoca)
symptoms of complicated esophageal cancer
odynophagia chest/back pain aspiration pneumonia hoarsness metastsis fistula (upper and mid 1/3's) hypercalcemia in SCC
esophageal cancer staging
T depth of tumor
N lymph node involvement (ajacent and supraclavicular)
M metastasis
staging procedures in esophageal cancer:
CT EUS for local staging (T>N) PET (occults mets 15%) laryngo/bronchioscopy in SCC HER2, PD-L1, MSI immuno-staining
what is the 5 year rate survival rate in esophageal cancer?
10%
treatment for stage 1 esophageal cancer?
endoscopic mucosal resection (EMR)
endoscopic submucosal disection (ESD)
surgery- total resection at 45% of cases, 5year survival rate on 20%
chemo+ radio therapy
treatment for stage 2+3 esophageal cancer?
chemo+ RT for shrinking and then surgery
treatment for stage 4 esophageal treatment?
palliative:
+disphagia: endoscopic diatlition, chemo, RT, feeding tube
-disphagia: systemic chemo
chemo: platinum, trastuzumab (+herceptin, HER2)
what is the etiological differance between esophagial adenoca and gastric cance?
esophageal adeno etiology: reaccurent acid irritations
gastric cancer: chronic gastritis with H.pylori establishment
favored location of well differentiated gastric adenocarcinoma
anrtum and lesser curvature
morphology of gastric intestinal (well differrentiated) adenoca
single lesion
ulcerative
patophysiology of diffuse (poorly differentiated) gastric adenoca?
naive cells
E-cahedrin LOF (loss of tight junctions)
linitis plastica (infiltration and thicking of stomach wall)
enviromental risk factors of gastric cancer
H.pylori diet nitrates gastritis @intestinal metaplasia gastric surgery low socioeconomic tendency obisity, smoking, alcohol mentrier's disease
genetic risk factors of gastric cancer
heredetary diffuse gastric cancer HDGC- CDH1 gene
other cancer predisposing syndromes (lynch, brac2, APC)
blood group A»O
heredetary diffuse gastric cancer treatment
prophylactic gastrectomy
refuse/genetic diagnosis wasnt done?
annualy gastric endoscopy with 30 biopsies.
symptoms of early gastric cancer?
80% asymptomatic thus late stage diagnosis and bad prognosis
symptoms of advanced gastric cancer?
50% UAP varying in intensity weight loss 60% nausea vomit anorexia dysphagia early satiety iron.d anemia rare: paraneoplastic syndroms and dermatologic sings.
heredetary gastric cancer cause
germline mutation in CDH1
what is a wirchow tumor?
supraclavicular LN involved in spread of gastric carcinoma
what is a krukenberg tumor?
overy LN involved in spread of gastric cancer
what is a sister mary joseph tumor?
periumbilical LN involved in spread of gastric tumor
what is blummer’s shelf tumor?
peritoneal cul- de-sac (near-rectal) LN involved which can be felt in anal checkup
what is the first site of hemoragical metastasis of gastric carcinoma?
liver
which are the staging procedures of gastric cancer?
CT
EUS (early)
PET (GEJ cancer)
HER2, PD-L1, MSI immuno- stating
gastric cancer stage 1A treatment?
EMR ESD surgery: antrum- sub total gastrectomy proximal- total gastrectomy
gastric cancer stage 1B THROUGH 3C treatment?
surgery + adjovant chemo +-RT
or
the ‘sandwich’: chemo-> surgery->chemo
gastric cancer stage 4 treatment?
systemic chemo
trastuzumab- for Herceptin possitive patients (HER2)
what endoscoping finding differ between primary gastric lymphoma and gastric adenocarcinoma?
none!
biopsies are crutial for diagnosis
what cell does primary gastric lymphoma originate from?
B cells
etiology of primary gastric lymphoma?
most cases are H.pylori related
translocation at (14,18)
t(11,18)
t(1,14)
primary gastric lymphoma associated with H.pylori treatment?
eradication of H.pylori / antibiotics
the 25% that fail treatment due to t(11, 18) will be treated with RT
primary gastric lymphoma advanced stage treatment?
CHAP + rituximab
favored GIST location?
fundus
location of GIST metastates?
liver and lungs (not the adjacent LN and visera)
treat ment for GIST?
local - surgery
spread (c-kat receptor mutation) - imatinib (comertial: gleevec), effictive at 50%
