Esophagus, Gastric, and Colon Cancer Lecture Powerpoint Flashcards
Unlike the stomach, the esophagus is not surrounded by a ___, leading to some differences in the cancers
double layered serosa
3 constrictures of the esophagus
Cricoid cartilage level, aortic arch level, and esophageal hiatus
Vascular supply to the esophagus
3 different arteries, branches of inferior thyroid, thoracic aortic branches, and phrenic
Lymph nodes of the esophagus
Run longitudinally in the wall of the esophagus, with upper ones going to the cervical nodes and the lower going to the gastric or celiac nodes
Histology of the esophagus
Inner circular layer of muscle, outer longitudinal layer of muscle, mucosa composed of stratified squamous epithelium with transition to columnar epithelium lower down
Leiomyoma
Esophageal benign tumor of smooth muscle that occurs in the lower portion of the esophagus causing dysphagia, retrosternal distress, and pain
Esophageal polyps
Benign tumor 80% cervical with regurgitation into mouth being the common presenting symptom, can be surgically excised
Overwhelming majority of neoplasms in the esophagus are (benign or malignant)
malignant
Achalasia
Esophageal dismotility syndrome due to lack of parasympathetic ganglia in the GI system resulting in a lack of peristalsis
Barrett’s esophagus
Precancerous damage to the lower portion of the esophagus (GERD) where squamous cells have undergone metastasis into columnar, a precancerous condition with risk to develop into adenocarcinoma, responsible for the rising cases of adenocarcinoma in the western world opposed to squamous cell which is due to tobacco and alcohol
EGD (esophagogastroduodenoscopy)
Endoscopic procedure to visualize the esophagus to the duodenum
Dysphagia is ___ until proven otherwise
esophageal cancer
Esophageal cancer staging
CT scan
Esophageal cancer should indicate need for MRI for bronchoscopy. This is because…
…the esophagus doesn’t have a serosa so it can directly transmit to adjacent tissue
Esophageal cancer treatment (2) and prognosis
- palliation thru resection or stents
- neoadjuvant chemo therapy in case they become candidates for resection
- 5 year survival <10-15%
Blood supply to stomach (4)
right and left hepatic arteries, and left and right gastroepiploic arteries
Gastric cancer prevalence and prognosis
Decreased in the US, most occur in the antral area, prognosis is terrible
Risk factors for gastric cancer (2)
- familial adenomatous polyposis (anywhere from colon deep)
- chronic atrophic gastritis
Most common tissue type of stomach/esophagus cancer
Adenocarcinoma
Gastric cancer ways of spreading
- lymphatics
- blood stream
- peritoneal seeding
- direct extension
Bloomer’s shelf
finding felt on rectal exam that indicates if a tumor has metastasized to the pouch of douglas, usually metastasis of lung or stomach and sometimes palpable on rectal exam
Gastric cancer symptoms (6)
- anorexia and weight loss
- dysphagia
- early satiety
- virchow’s node (left supraclavicular)
- sister mary josephs node (periumbilical area)
- massive hematemesis
Gastric cancer diagnosis (2)
EGD
Upper GI series
Gastric carcinoma therapy (1)
- surgery (subtotal or total gastrectomy) with 6cm distal and 3cm proximal margins
- radiation and chemo little benefit
Gastrointestinal stromal tumor (GIST)
submucosal tumors that protrude into the lumen of the stomach that present with pain, dyspepsia, and GI bleeding
GIST diagnosis, prognosis, treatment (2)
- kit protein, CD34+
- low mitosis likely benign, high mitosis likely malignant
- surgical removal with clear margins and gleevec (chemo adjuvant)
colon layers
3 layers of smooth muscle at the rectum, 2 deep to that in the colon, one is referred to as the tenae coli
Largest risk factor for colon cancer and some others
- family history in a 1st degree relative
- serrated polyposis syndrome
- ulcerative colitis
Colon cancer symptoms (3)
- nonspecific
- change in bowel habits (alternating constipation and diarrhea)
- bright red blood per rectum/hematochezia
Intussusception
Bowel teloscoping in on itself
Rectal bleeding always requires a…
…digital rectal exam
Colon cancer imaging (1)
-colonoscopy
What type of cancer is most common histologically in the colon?
Adenocarcinoma
Carcinoembryonic antigen (CEA) levels
Elevation of the CEA is consistent with more frequent liver metastasis of the colon cancer in some cases
colon cancer treatment (2)
- resection
- chemotherapy in stage 3 or 4 depending on microsatellite instability
Microsatellite instability
A series of 4 defective DNA mismatch pairs that if present are indicative of lynch syndrome which places at risk for colon cancer stage 3 or 4 and need for chemotherapy
2 chemo agents used for rectal cancer
- 5 fu
- cyclophosphamide
incisors to EG junction distance
35-40cm
Most stomach cancers are found in what part?
Antrum
4 common types of gastric cancer
- polypoid
- ulcerative
- superficiaal spreading
- schirrhous linitis plastica
Gastric carcinoma staging
Endoscopic inspection or CT
2 most common locations for tumor distribution of colon cancers
- cecum
- distal left or sigmoid
