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GI_EB > Esophageal, gastric, pancreatic cancers > Flashcards

Esophageal, gastric, pancreatic cancers Flashcards

1
Q

The highest rates of esophageal cancer are in

A

East Asia, East Africa

Primarily squamous cell carcinoma in this area

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2
Q

Over the last several decades there has been a shift from mostly _____ esophageal cancer to mostly ______ esophageal cancer in the US

A

squamous cell carcinoma—-> adenocarcinoma

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3
Q

List risk factors for squamous cell esophageal cancer

A 
Male gender
age
African American
smoking
lye
pickled foods
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4
Q

Explain the field cancerization effect

A

Higher rates of squamous cell carcinoma when tobacco and alcohol are used together

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5
Q

Explain risk factors for esophageal adenocarcinoma

A

Arises from Barrett’s esophagus, associated with GERD and obesity

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6
Q

______ has been shown to be a risk factor for esophageal adenocarcinoma independent of Barrett’s esophagus

A

obesity

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7
Q

Describe the approach to a patient with Barrett’s esophagus to prevent cancer

A

Acid suppression
weight loss
frequent follow up

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8
Q

What are presenting symptoms of esophageal cancer?

A

dysphagia
weight loss
bleeding, melenic stools

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9
Q

Describe the diagnostic workup of esophageal cancer

A

Endoscope exam with dilation of strictures, biopsy
endoscopic ultrasound
CT/PET to look for metastasis

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10
Q

Describe the management of localized esophageal cancer

A
  1. neoadjuvant chemotherapy and radiation
  2. surgery- esophagectomy with gastric pull up
    - patients can never lie flat again
    - will experience weight loss, early satiety
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11
Q

Describe management of metastatic esophageal cancer

A

chemotherapy prolongs life (from 4 to 10 months)

palliative radiotherapy for persistent dysphagia- improves symptoms but not survival

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12
Q

Most gastric cancers are ______ (histologic type)

A

adenocarcinoma

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13
Q

In what geographic area is the prevalence of gastric cancer greatest?

A

East Asia

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14
Q

What factors are associated with the lower incidence of gastric cancer in the US?

A

Changes in dietary habits, recognition and treatment of H. Pylori, and better food preparation/preservation

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15
Q

What are risk factors for gastric cancer

A

H pylori
Diet high in nitrates, salt
inadequately preserved foods

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16
Q

Describe the two types of gastric cancer

A

Intestinal: More mass-like, intraluminal, prone to bleeding; Higher association with H.pylori

Diffuse: Often submucosal; Presenting complaint of early satiety; More often presenting in late stage; Thought to be more aggressive

17
Q

_______ arises from a mutation in CDH1 which inactivates e-cadherin

A

hereditary diffuse gastric cancer

18
Q

Describe the presentation of gastric cancer

A

Long asymptomatic period

nausea, bloating, unexplained weight loss, early satiety

19
Q

_______ is the gold standard for diagnosis of gastric cancer

A

upper endoscopy (EGD) with tissue biopsy

20
Q

Staging is critical in gastric cancer, because it frequently presents with ______ early in its course

A

metastasis

CT/PET analysis

21
Q

Describe management of localized gastric cancer

A
  • surgery: partial gastrectomy or total gastrectomy including D1 or D2 node harvest
  • neo-adjuvant chemotherapy then post-op adjuvant chemotherapy or radiation
22
Q

Describe the management of metastatic gastric cancer

A

palliative chemotherapy

mOS measured in months

23
Q

Describe the benefits of pre-operative chemotherapy

A
  • provides some degree of tumor shrinkage

- test of time for metastases to develop to avoid futile surgery

24
Q

List chemotherapeutic agents used in metastatic gastric or esophageal cancers

A

5-FU, taxanes, platinums, irinotecan

targeted therapy: Her-2, ramucirumab (anti-VEGF)

25
Q

List risk factors for pancreatic cancer

A

smoking

obesity and diabetes (but pancreatic cancer often presents with new onset glucose intolerance)

26
Q

List familial syndromes associated with pancreatic cancer

A

(HNPCC and FAP, BRCA2, cystic fibrosis, familial atypical mole-melanoma syndrome

27
Q

List presenting signs and symptoms of pancreatic cancer

A 
jaundice
epigastric pain radiating to the back
new onset diabetes
weight loss, nausea, vomiting
palpable gallbladder
acholic (clay colored) stool 
cola colored urine
28
Q

Describe the diagnostic work up of pancreatic cancer

A

ERCP (Endoscopic Retrograde CholangioPancreatography) is used for diagnosis and can also directly sample epithelium
Endoscopic ultrasound: assesses local lymph nodes and tissue invasion

29
Q

The most common pancreatic cancer is ________

A

adenocarcinoma

30
Q

In order to be considered resectable, the tumor must not invade or abut the _________. If it does, then a margin negative resection (so-called R0 resection) cannot be performed

A

mesenteric arterial supply

31
Q

85% of patients with pancreatic cancer present with ______ disease

A

advanced, non-resectable cancers due to local invasion or metastatic disease

32
Q

What are the components of a Whipple procedure?

A

Pancreaticoduodenectomy
Gastrojejunostomy
Pancreaticojejunostomy
Choledochojejuonstomy

resection of the head of the pancreas, connecting the stomach to the jejunum, connecting the bile ducts to the small intestine, and reapproximating any remaining pancreatic tissue to the small intestine

33
Q

Pre-operative radiotherapy may be helpful in ______-resectable pancreatic cancers

A

borderline

34
Q

Neoadjuvant therapy in pancreatic cancer is used to:

A
  • make operation easier and improve chances of R0 resection

- avoid potentially futile surgeries

35
Q

What are chemotherapy options for metastatic pancreatic cancer?

A
  • gemcitabine, with possible improvement when gemcitabine + abraxane
  • FOLFIRINOX: 5-FU, oxaliplatin, irinotecan
36
Q

Patients with any GI cancer are at increased risk of thrombotic complications including ___________

A

pulmonary embolism and DVT

37
Q

What is Trousseau’s syndrome

A

Migratory thrombophlebitis which can progress to DVT/PE

GI_EB (39 decks)

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