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House AMP > Gasrict Tumor > Flashcards

Gasrict Tumor Flashcards

1
Q

Benign gastric tumours-mesenchymal

List 5

A

Fibroma
Lipoma
Neurofibroma
Leiomyoma
Gastrointestinal stromal tumour (GIST)

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2
Q

Benign gastric tumours-epithelial

List 3

A

Adenomas

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3
Q

Malignant Gastric Tumours: epithelial

Mainly _______

 Represents _____-___% of all malignant gastric tumours

A

adenocarcinoma

90-95

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4
Q

Malignant Gastric Tumours: mesenchymal

__________ or ________

A

Malignant GIST
Leiomyosarcoma et

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5
Q

Gastric Cancer- Epidemiology

Gastric cancer is the ____ most common malignancy worldwide accounting for 5.6% of total the _____ leading cause of cancer death (7.7%) in both sexes worldwide

A

5th ; 4th

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6
Q

Gastric Cancer- Epidemiology

 The highest occurs in _____ while the lowest incidences are found in ——— and _______
 Over ____% occurs of the world total occurs in Asia

A

Asia

Africa and Northern America

75

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7
Q

Age and Gender prevalence

In Nigeria:
 Peak age prevalence- _____-______yrs-

M:F ratio is ___:____

 81% of our cases occur above ____yrs

A

55-65

2:1

45

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8
Q

Risk factor-Helicobacter pylori

 Hp has been categorized as a class- ___ carcinogen.

A

A

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9
Q

H.pylori

is a _______ shaped ,

Oxygen: _________

gram- _____ bacterium discovered in 1983.

A

spiral

microaerophilic

negative

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10
Q

African Enigma

 The prevalence of Hp in Africa is ____ (about ____%)and infection occurs (early or late?) in childhood

 Despite this, gastric cancer incidence is (low or high?) with ASR of less than 4.5 compared to 12 per 100,000 in South-East Asia

A

High; 90; early ;low

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11
Q

most strains of Hp are positive for the virulent factors, and there is a consistent association with GC

T/F

A

F

Although most strains of Hp are positive for the virulent factors, there is no consistent association with GC

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12
Q

African Enigma

This phenomenon of _____________________ in spite of _______ prevalence of Hp infection is what is referred to as African Enigma

A

low prevalence of GC

high

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13
Q

EBV associated Gastric Cancer

Accounts for ____% of gastric carcinoma worldwide

A

10

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14
Q

EBV associated Gastric Cancer

Distinct characteristics

(Male or Female?) predominance,
 (Proximal or Distal ?) stomach,
 Most often _______-type gastric carcinomas.

A

Male

Proximal

diffuse

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15
Q

Dietary Risk factors for gastric cancer

High _____ diet
Nitrate, nitrite and N-nitroso compounds, and benzopyerene
Lack of _________ and _______

A

salt

fresh fruit and leafy vegetables

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16
Q

Dietary Risk factors for gastric cancer

Lack of _______
Lack of _________- Vitamin C, E , A, selenium, etc
_______ and ______ foods

A

refrigeration

antioxidants

Smoked and salted

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17
Q

↑Salt in diet→ ———- of _________

A

destruction of mucosa barrier

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18
Q

Environmental & occupational Risk factors

alcohol,
 Cigarette smoking.
 iodizing radiation
 coal,
 tin mining,
 steel, iron and rubber manufacturing industries increase risk

A

Okay?🌚🌚

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19
Q

Genetic syndromes associated with Gastric cancer

 _______________________ cancer
 ______________________
 ___________ and ___________ of the stomach

A

Hereditary nonpolyposis colorectal

Familial adenomatous polyposis(MLH1, MSH2,MSH6)

Gastric adenocarcinoma and proximal polyposis

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20
Q

Genetic syndromes associated with Gastric cancer

_________-associated polyposis
_____________ syndrome
_______-_______ syndrome
__________ syndrome

A

MUTYH

Juvenile polyposis

Peutz–Jegher

Li–Fraumeni

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21
Q

Host factors that predispose to gastric cancer

 Chronic ___________,
 __________ —————-
__________ anemia
 _________ oesophagus.

A

atrophic gastritis

Autoimmune gastritis

Pernicious

Barrett’s

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22
Q

Host factors that predispose to gastric cancer

 Gastric ________
 ______ ________ – [reflux]
 Peptic!______ <1%

A

adenomas

Partial gastrectomy

ulcer

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23
Q

Gastric cancer is one of the most common causes of cancer mortality worldwide.

T/F

A

T

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24
Q

Gastric cancer

Risk factors can be _______ and ________

A

modifiable and nonmodifiable

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25
Q

Gastric cancer

___________,_________, and ________ are important modifiable risk factors.

A

H. Pylori, diet, and smoking

26
Q

Pathology: Classification of gastric cancer

Can be classified based on:

 Anatomic- _______,________, and _____

 Clinical- ______ and ______

 Histologic-90% are _________

A

proximal cardia, fundic and antral

early and advanced

adenocarcinoma

27
Q

Pathology: Classification of gastric cancer
Can be classified based on:
 Anatomic, clinical, histological and molecular subtypes

Histologic-
 Lauren’s criteria – _______,_______, and _________
 WHO(2010): _______,_________,__________, and ____________ types, uncommon variants

A

intestinal, diffuse and indeterminate

tubular, papillary, mucinous and signet ring

28
Q

Early Gastric cancer; Advanced Gastric Cancer

Extent:
Size:
Location

A

Confined to mucosa and /submucosa ± lymph node metastasis or size; Beyond submucosa

Small 2-5cm; >5cm

Lesser curvature; Any

29
Q

Early Gastric cancer; Advanced Gastric Cancer

Gross appearance

Histologic

Prognosis

A

Polypoid, flat, excavating, diffusely infiltrating

Exophytic, Fungating Ulcerating, diffusely infiltrative (linitis plastica)

Well differentiated tubular and papillary; Mixed patterns

Excellent -5yrs SR-90%; 60% or less

30
Q

Histologic classification: Lauren’s

 Intestinal-____%
 Diffuse-___%
 Indeterminate-____%

A

54

32

15

31
Q

Diffuse-type tumors were associated with a significantly (better or worse?) prognosis than were intestinal- type tumors (P = .______)

A

Worse

018

32
Q

Differences btw intestinal and diffuse types of gastric cancer

Age

Gender

Race

Incidence

A

Older. ; Younger

Male>female ; M=F

Black; nil

Decreasing; increasing

33
Q

Differences btw intestinal and diffuse types of gastric cancer

By Association

A

Corpus-dominant gastritis with gastric atrophy and intestinal metaplasia
H.Pylori

Pangastritis without atrophy

34
Q

Well-differentiated Papillary adenocarcinoma- (intestinal)

Papillary-

(common or rare?) , seen also in _____.

 In (younger or older?) patients
 (Proximal or distal?) stomach

 Frequently associated with ____ metastasis and (lower or higher?) rate of lymph node invasion

A

Common; EGC

Older

Proximal

liver; higher

35
Q

Mucinous carcinoma

 Mucinous-____%

 Extracellular mucin pools in _____% of
tumour volume

A

10

50

36
Q

Regional Lymph Nodes (pN) 35

 pNx:__________

 pN0:_____ regional lymph node metastasis

 pN1: Metastasis in ______ perigastric nodes

 pN2: Metastasis in _______ perigastric nodes

 pN3: Metastasis in _______ perigastric lymph nodes

 pN3a: Metastasis in _______ perigastric lymph nodes

 pN3b: Metastasis in ________ perigastric lymph nodes

A

Cannot be assessed

No

1 to 2; 3 to 6

7 or more

7 to 15

16 or more

37
Q

Histologic Grading-gastric

 Grade x-__________

 Grade 1-_____ differentiated (_____% of tumor are glands)

 Grade 2 - _______ differentiated ( ______% )

 Grade 3 - _______ differentiated (______
% or)

 Signet ring are ____ grade (grade__)while small cell carcinoma are
classified as grade ____

A

Cannot be assessed

Well; >95

Moderately; 50- 95

Poorly; </=49

High; 3; 4

38
Q

Tumour Spread

Local spread →involve the ____ → ______,_____,_______and
retroperitoneum

Regional lymph node spread.

Distant lymph node-________ node– [_______ node] or and _____ node (anterior axillary) can be 1st clinical sign of ________

Distant spread by blood → _____,_____, _____,______ .etc.

Peritoneal seedling, one or both ____ (Krukenberg’s tumor –ref.
breast, pancreas and bladder)

A

wall; serosa, duodenum, pancreas

supraclavicular; Virchow’s

Irish; occult Ca

Liver, lung, bone, brain

ovaries

39
Q

Clinical presentation
Non-specific
 Indigestion
 Nausea or vomiting
 Dysphagia
________ fullness
 Loss of appetite
______ or _____ from
anemia
 _________
 Abdominal pain
 Weight loss
__________ stomach with _______
 Enlarged lymph nodes such as _______ node or _____ node

A

Postprandial

Melena or pallor

Hematemesis

Palpable enlarged ; succussion
splash

Virchow; Irish

40
Q

Diagnosis of gastric cancer
 Clinical-symptoms and signs
 Lab test
 LFT
 Tumour markers-
 elevated CEA in ______% of cases
 elevated CA 19-9 in about _____% of cases
 Imaging-CTScan, etc
 Endoscopic Biopsy to confirm, type and stage the tumour

A

45-50

20

41
Q

 Tumour markers-
 elevated ____ in 45-50% of cases
 elevated _____ in about 20% of cases

A

CEA

CA 19-9

42
Q

Management

Multidisciplinary team with combination of Surgery and chemotherapy or targeted immunotherapy

T/F

A

T

43
Q

Prognosis

Prognosis depends on –
 ________ of invasion
 extent of _______ and ________

A

depth

nodal and distant
metastases

44
Q

5yr Survival rate after surgical resection for EGCa is ______%, for advance GCa is ____%

A

90-95

15

45
Q

Intestinal Type

Grossly appears as (small or large?) ulcer with (regular or irregular?) margins

Similar to _________________

A

Large ; irregular

colonic adenocarcinoma

46
Q

Intestinal Type

Results from intestinal metaplasia
•__________;_________

Common in ________ (where ulcers form!)

A

H. pylori; autoimmune gastritis

lesser curvature

47
Q

Intestinal Type

Risk Factors

More common among (younger or older?) men

Other risk factors
Smoking
______ consumption
______________
Type ____ blood

A

Older

Alcohol

Nitrosamines

A

48
Q

Diffuse Type

(More or Less?) common form

(Plenty of Few?) established risk factors

Made up of _________ cells, _______ cells

A

Less

Few

gastric mucosa

Signet ring

49
Q

Diffuse Type is Not associated with metaplasia, H. pylori

T/F

A

T

50
Q

Diffuse Type

Stomach diffusely thickened
• __________ is a common symptom
•Linitis plastica: stomach thickened like ________

A

Early satiety

leather

51
Q

Diffuse Type

Signet ring cells
•_______ forms → _______ pushed to periphery

A

Mucin

nucleus

52
Q

Metastasis of gastric cancer

Most common site is ______

A

liver

53
Q

Clinical Features

Early curable gastric cancer: It may present with ________ features.

Advanced cancer: It presents with early satiety, bloating, distension and vomiting. The tumor frequently ———-  causing _______________

Tumor in the pyloric region may present with _______________

A

nonspecific

bleeds; iron-deficiency anemia.

gastric outlet obstruction.

54
Q

Gastric Carcinoma
Special Clinical Findings

Acanthosis Nigricans

•_______________ on skin
•__________ sites (folds)
•Classically ______ and ______

A

Hyperpigmented plaques

Intertriginous

neck and axillae

55
Q

Gastric Carcinoma
Special Clinical Findings

Associated with _________ ———-

(Frequently or Rarely?) associated with malignancy

_______________ is the most common

A

insulin resistance

Rarely

Gastric adenocarcinoma

56
Q

Gastric Carcinoma
Special Clinical Findings

Leser-Trelat sign
•“________ onset” of multiple _____________

•Probably caused by _________

Associated with (No or Many?) malignancies

A

Explosive; itchy seborrheic keratosis

cytokines

many

57
Q

Gastric Carcinoma
Special Clinical Findings

Virchow’s node (_____ sign)
•(right or left?) ___________ node (drains stomach)

Sister Mary Joseph nodule
•Metastasis to _____________
•________ on exam

A

Troiser’s; Left supraclavicular

periumbilical region

Palpable

58
Q

Gastric Carcinoma
Special Clinical Findings

Trousseau’s sign:

(Metastatic or Non-metastatic?) effects may be in the form of ______________ (Trousseau’s sign) and __________ thrombosis.

These are due to the effects of the tumor on _______ and ———— mechanisms.

A

Non-metastatic

migrating thrombophlebitis

deep venous

thrombotic and hemostatic

59
Q

Gastric Carcinoma
Special Clinical Findings

Krukenberg tumor
•_______ tumor secondary to metastasis from another site
•Most common from gastric adenocarcinoma
•___lateral _______ metastasis
•________ cells often seen on pathology

A

Ovarian

Bi

ovarian

Signet

60
Q

Gastric Carcinoma
Special Clinical Findings

_________ tumor
_______ node (______ sign)
______________ nodule
____________ sign
___________ sign
___________________

A

Krukenberg

Virchow’s; Troiser’s

Sister Mary Joseph

Trousseau’s

Leser-Trelat

Acanthosis Nigricans

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