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GI > Gastric Cancers and Gastrinomas > Flashcards

Gastric Cancers and Gastrinomas Flashcards

1
Q

Key features of general gastrointestinal neuroendocrine tumors types

A

well differentiated-solid, trabecular, gyriform or glandular pattern, salt and pepper chromatin, granular cytoplasm
poorly differentiated-resembled small or large cell neuroendocrine lung carcinoma

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2
Q

What is a marker for GI neuroendocrine tumors?

A

Ki67-large protein involved in cell cycle regulation and/or organization of the nucleolus
increased staining-worse prognosis

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3
Q

Type 1 GI neuroendocrine tumor features

A 
derived from ECL cells
associated w/chronic atrophic gastritis and pernicious anemia
women
old
small and multiple
high gastrin, turns to carcinoid tumors
usually indolent and benign
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4
Q

Type 1 GI neuroendocrine tumor tx

A

endoscopic resection 2cm

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5
Q

What is another name for GI neuroendocrine tumors?

A

Carcinoid tumors

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6
Q

Type 2 GI neuroendocrine tumor features

A

associated w/gastrinomas/MEN1
high gastrin levels
typically indolent

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7
Q

What is MEN1?

A

AD predisposition to tumors of the parathyroid, pituitary and enteropancreatic cells

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8
Q

Type 2 GI neuroendocrine tumor tx

A

endoscopic resection <2cm

address gastrinoma

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9
Q

Type 3 GI neuroendocrine tumor features

A

sporadic, most aggressive
hepatic or local meastases
normal serum gastrin

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10
Q

Type 3 GI neuroendocrine tumor tx

A

partial or total gastrectomy w/local lymph node resection

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11
Q

What is a gastrinoma? Alias?

A

Zollinger-Ellison syndrome
hypersecretion of gastric acid due to ecess gastrin
derived from ECL cells, a neuroendocrine tumor
designated by clinical production of gastrin, NOT morphologic appearance/gastrin staining

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12
Q

Gastrinoma features

A

sporadic
men
assoc w/MEN1 (parathyroid and pituitary adenomas)
20-50 yos

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13
Q

Where do gastrinomas usually arise from?

A

duodenum

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14
Q

What are the differences between duodenal and pancreatic gastrinomas?

A

D-small, often multiple

P-solitary, more malignant potential

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15
Q

Presentation for gastrinoma?

A

PUD
acid reflux
prominent gastric folds
diarrhea

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16
Q

How do you diagnose gastrinoma?

A 
fasting serum gastrin
secretin stimulation test
calcium infusion study:arterial calcium gluconate infusion
CT
MRI
Octreoscan
US (most sensitive imaging modality)
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17
Q

What is the secretin stimulation test?

A

secretin stimulates the release of gastrin by gastrinoma cells, inhibits gastrin release by normal gastric G cells

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18
Q

What is the calcium infusion study: arterial calcium gluconate infusion?

A

positive study-increased serum gastrin and calcium levels

to dx gastrinoma

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19
Q

Tx for gastrinoma?

A

high dose acid suppression
surgery
metastatic disease-somastostatin analogs, liver directed therapy, chemo

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20
Q

Do gastrinoma patients with MEN1 have a better or worse prognosis?

A

lower rate of metastasis and higher survival

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21
Q

What is associated with gastrinoma that confers a worse prognosis?

A

higher fasting gastrin level

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22
Q

Where is gastric adenocarcinoma more common?

A

developing countries

higher geographic latitudes

23
Q

What is happening to the frequency of gastric adenocarcinoma?

A

rapid decline overall
increased incidence of proximal gastric cancers that are more aggressive and not associated w/atrophy and intestinal metaplasia

24
Q

What are the 2 subtypes of adenocarcinoma?

A

Intestinal-sporadic, env. factors, males, older

Diffuse-no sex predominance, younger, wrose prognosis

25
Q

What are some environmental risk factors for gastric adenocarcinoma?

A

salt, nitroso compounds, obesity, smoking, Hpylori, EPV, type A blood

26
Q

What physical risk factors for gastric adenocarcinoma?

A 
gastric ulcers
gastric surgery (billroth II> billroth I)
27
Q

What are other risk factors for gastric adenocarcinoma?

A 
pernicious anemia
gastric adenomatous polyps
immunodeficiency syndromes
menetrier's disease
genetic causes (HDGC, FAP, HNPCC, Peutz-Jegher's, Li-Fraumeni)
28
Q

What are gastric adenocarcinoma protective factors?

A

fruits/veggies, fiber
NSAIDs???
Female reproductive hormones

29
Q

Key features of intestinal gastric adenocarcinoma

A

related to h. pylori–>reactive nitric oxides induce DNA abnormalities, ie on bet-catenin–>Wnt pathway activation–>activation of bet catinin/Tcell factor complex–>genes that stimulate proliferation, angiogenesis, tumor invasion and metastasis

30
Q

List the ways that NO can lead to cancer

A 
causes oxidative DNA damage
angiogenesis
inhibition of DNA repair enzymes
Dysregulation of apoptosis
oncogene expression 
modulation of transcription factors
31
Q

What genes are invovled in intestinal gastric adenocarcinoma?

A

alterations in tumor suppressor genes

32
Q

What additional site can cells leading to intestinal gastric adenocarcinoma arise from?

A

bone marrow

33
Q

What is the sequence leading to gastric adenocarcinoma?

A

non-atrophic gastritis-> atrophic gastritis->intestinal metaplasia->dysplasia->maligancy

34
Q

List the variants of intestinal gastric adenocarcinoma

A

mucinous, tubular, papillary, adenosquamous histologic variants

35
Q

Where is intestinal gastric adenocarcinoma usually located?

A

incisura, antrum or body

36
Q

What genetic markers are common in diffuse gastric adenocarcinoma?

A 
E cadherin (CDH1 gene, 16q22.1) defective
loss of expression leads to defective intercellular adhesions
37
Q

What does E cadherin do?

A

cell adhesion, transmitting signals, controlling cell movement, tumor suppressor gene, regulating activity of other genes

38
Q

What histologic finding is seen with diffuse gastric adenocarcinoma?

A

signet ring histology

39
Q

Is H pylori associated with diffuse gastric adenocarcinoma?

A

yes

40
Q

What is the clinical presentation for gastric adenocarcinoma?

A 
wt loss
abd pain
dysphagia
GI bleed
early satiety & nausea w/linitis plastica (aggressive form of diffuse type gastric adenocarcinoma)
ulcer, mass
41
Q

What is the treatment for gastric adenocarcinoma?

A

surgery (curative)
adjuvant/neoadjuvant chemo
radiation for unresectable disease
endoscopic methods

42
Q

What is Hereditary diffuse cancer?

A

AD w/high penetrance
avg age of onset 38
>80% lifetime cumulative risk for advanced gastric cancer by age 80

43
Q

What other cancer is HDGC associated with?

A

breast cancer

44
Q

How do you manage HDGC?

A

prophylactic gastrectomy after age 20
random biopsy surviellance
breast cancer screening

45
Q

What is gastric lymphoma?

A

most common extranodal site of lymphoma
50s-60s
males
non-hodgkin lymphomas most often

46
Q

ARe primary or secondary NHLs/gastric lymphomas more common?

A

secondary, primary is very rare

47
Q

What are risk factors for gastric lymphoma?

A

H pylori infection-MALT lymphoma
Immunodeficiency and immunosuppression
celiac disease-EATL & Bcell lymphoma
autoimmune diseases (linked to immunosuppressive therapy)

48
Q

What are the most common primary gastric lymphoma NHLs?

A

MALT lymphoma

DLBCL

49
Q

What is the clinical presentation for gastric lymphoma?

A 
Epigastric pain
anorexia
wt loss
nausea/vomiting
occult bleeding
B symptoms
50
Q

What is seen on EGD of gastric lympohoma?

A

SUBTLE

erythema, mass, ulcer, nodularity, thickened gastric folds

51
Q

Features of gastric ESCC (extrapulmonary small cell lung cancer)

A 
rare
males
70yo
usually locally advanced/disseminated on rpesentation
8% 2r survival
52
Q

What are the symptoms of gastric ESCC?

A

mass
ulceration
bleeding
invasion into adjacent structures

53
Q

Where is gastric ESCC usually located?

A

upper third of stomach

54
Q

What is the treatment for gastric ESCC?

A

surgery for debulking nd chemo

GI (20 decks)

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