Esophagus, Gastric, and Colon Cancer Lecture Powerpoint

Question 1

Unlike the stomach, the esophagus is not surrounded by a ___, leading to some differences in the cancers

Answer 1

double layered serosa

Question 2

3 constrictures of the esophagus

Answer 2

Cricoid cartilage level, aortic arch level, and esophageal hiatus

Question 3

Vascular supply to the esophagus

Answer 3

3 different arteries, branches of inferior thyroid, thoracic aortic branches, and phrenic

Question 4

Lymph nodes of the esophagus

Answer 4

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

Question 5

Histology of the esophagus

Answer 5

Inner circular layer of muscle, outer longitudinal layer of muscle, mucosa composed of stratified squamous epithelium with transition to columnar epithelium lower down

Question 6

Leiomyoma

Answer 6

Esophageal benign tumor of smooth muscle that occurs in the lower portion of the esophagus causing dysphagia, retrosternal distress, and pain

Question 7

Esophageal polyps

Answer 7

Benign tumor 80% cervical with regurgitation into mouth being the common presenting symptom, can be surgically excised

Question 8

Overwhelming majority of neoplasms in the esophagus are (benign or malignant)

Answer 8

malignant

Question 9

Achalasia

Answer 9

Esophageal dismotility syndrome due to lack of parasympathetic ganglia in the GI system resulting in a lack of peristalsis

Question 10

Barrett’s esophagus

Answer 10

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

Question 11

EGD (esophagogastroduodenoscopy)

Answer 11

Endoscopic procedure to visualize the esophagus to the duodenum

Question 12

Dysphagia is ___ until proven otherwise

Answer 12

esophageal cancer

Question 13

Esophageal cancer staging

Answer 13

CT scan

Question 14

Esophageal cancer should indicate need for MRI for bronchoscopy. This is because…

Answer 14

…the esophagus doesn’t have a serosa so it can directly transmit to adjacent tissue

Question 15

Esophageal cancer treatment (2) and prognosis

Answer 15

• palliation thru resection or stents
• neoadjuvant chemo therapy in case they become candidates for resection
• 5 year survival <10-15%

Question 16

Blood supply to stomach (4)

Answer 16

right and left hepatic arteries, and left and right gastroepiploic arteries

Question 17

Gastric cancer prevalence and prognosis

Answer 17

Decreased in the US, most occur in the antral area, prognosis is terrible

Question 18

Risk factors for gastric cancer (2)

Answer 18

• familial adenomatous polyposis (anywhere from colon deep)

- chronic atrophic gastritis

Question 19

Most common tissue type of stomach/esophagus cancer

Answer 19

Adenocarcinoma

Question 20

Gastric cancer ways of spreading

Answer 20

• lymphatics
• blood stream
• peritoneal seeding
• direct extension

Question 21

Bloomer’s shelf

Answer 21

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

Question 22

Gastric cancer symptoms (6)

Answer 22

• anorexia and weight loss
• dysphagia
• early satiety
• virchow’s node (left supraclavicular)
• sister mary josephs node (periumbilical area)
• massive hematemesis

Question 23

Gastric cancer diagnosis (2)

Answer 23

EGD

Upper GI series

Question 24

Gastric carcinoma therapy (1)

Answer 24

• surgery (subtotal or total gastrectomy) with 6cm distal and 3cm proximal margins
• radiation and chemo little benefit

Question 25

Gastrointestinal stromal tumor (GIST)

Answer 25

submucosal tumors that protrude into the lumen of the stomach that present with pain, dyspepsia, and GI bleeding

Question 26

GIST diagnosis, prognosis, treatment (2)

Answer 26

• kit protein, CD34+
• low mitosis likely benign, high mitosis likely malignant
• surgical removal with clear margins and gleevec (chemo adjuvant)

Question 27

colon layers

Answer 27

3 layers of smooth muscle at the rectum, 2 deep to that in the colon, one is referred to as the tenae coli

Question 28

Largest risk factor for colon cancer and some others

Answer 28

• family history in a 1st degree relative
• serrated polyposis syndrome
• ulcerative colitis

Question 29

Colon cancer symptoms (3)

Answer 29

• nonspecific
• change in bowel habits (alternating constipation and diarrhea)
• bright red blood per rectum/hematochezia

Question 30

Intussusception

Answer 30

Bowel teloscoping in on itself

Question 31

Rectal bleeding always requires a…

Answer 31

…digital rectal exam

Question 32

Colon cancer imaging (1)

Answer 32

-colonoscopy

Question 33

What type of cancer is most common histologically in the colon?

Answer 33

Adenocarcinoma

Question 34

Carcinoembryonic antigen (CEA) levels

Answer 34

Elevation of the CEA is consistent with more frequent liver metastasis of the colon cancer in some cases

Question 35

colon cancer treatment (2)

Answer 35

• resection

- chemotherapy in stage 3 or 4 depending on microsatellite instability

Question 36

Microsatellite instability

Answer 36

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

Question 37

2 chemo agents used for rectal cancer

Answer 37

• 5 fu

- cyclophosphamide

Question 38

incisors to EG junction distance

Answer 38

35-40cm

Question 39

Most stomach cancers are found in what part?

Answer 39

Antrum

Question 40

4 common types of gastric cancer

Answer 40

• polypoid
• ulcerative
• superficiaal spreading
• schirrhous linitis plastica

Question 41

Gastric carcinoma staging

Answer 41

Endoscopic inspection or CT

Question 42

2 most common locations for tumor distribution of colon cancers

Answer 42

• cecum

- distal left or sigmoid