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Gen Med: GI > Gastric Neoplasms > Flashcards

Gastric Neoplasms Flashcards

1
Q

What are the gastric neoplasms?

A
  1. Zollinger-Ellison Syndrome (ZES)
  2. Gastric Adenocarcinoma
  3. Gastric Lymphoma
  4. Gastric Carcinoid Tumor
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2
Q

What is zollinger-ellison syndrome?

A
  1. GASTRIN-SECRETING TUMOR (GASTRINOMA) OF PANCREAS THAT STIMULATES ACID-SECRETING PAREITAL CELLS OF STOMACH → ULCER
  2. RARE

3.. ~ 20% OF GASTRINOMAS ARE PART OF SYNDROME CALLED MULTIPLE ENDOCRINE NEOPLASIA TYPE I (MEN I)

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3
Q

What age of ppl are commonly dxed with Z-E syndrome?

A

MOST PTS DIAGNOSED BETWEEN 20-50 YR

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4
Q

Where are most Z-E tumors found?

A

MOST FOUND IN PANCREAS OR DUODENUM

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5
Q

What is characterisitc of Z-E syndrome?

A

STEATORRHEA & EXCESS BILE SALTS IN FECES

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6
Q

What are the dx studies for Z-E syndrome?

A
  1. Fasting gastrin level > 150 pg/ml
    A. stop H2 blockers for 24 hrs before & PPIs 6 days prior to test
  2. (+) secretin stimulation test
    A. Confirms dx
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7
Q

What is a secretin stimulation test?

A
  1. IV secretin -> gastrin level increases by > 200 pg/ml w/in 2-30 mins in 85% of pts
  2. secretin stimulates release of gastrin by gastrinoma cells
  3. normal gastrin cells are inhibited by secretin
  4. gastrin only rises in pts w/ gastrinomas
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8
Q

What is the rx for Z-E syndrome?

A
  1. Oral PPIs
    A. Control gastrin secretion
  2. Surgical resection of gastrinoma cures if done before hepatic mets
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9
Q

What % of Z-E gastrinomas are malignant?

A

2/3 gastrinomas are malignant

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10
Q

What are gastrinomas?

A

Gastrinomas are SLOW growing tumors

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11
Q

What is the prognosis of ppl with Z-E syndrome?

A

15-yr survival of pts w/o liver mets at initial presentation is >95%

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12
Q

What iare the general characteristics of gastric adenocarcinoma?

A
  1. M > F
  2. Age > 40 yr
  3. Strong association with H. pylori
  4. 2nd most common cause of cancer death worldwide
  5. Incidence has declined rapidly over the past 70 yrs
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13
Q

What is the cure rate for gastric adenocarcinoma?

A
  1. early dX & Tx = 80% cure rate
  2. If muscularis propria involved, cure rate 50%
  3. If lymphatic spread, cure rate 10%
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14
Q

What are the risk factors for gastric adenocarcinoma?

A 
1. Chronic H. pylori gastritis
A. #1 risk factor
2. Smoking
3. Diet high in nitrates or salt
4. Diet low in Vit C
5. Genetics
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15
Q

What are the sxs of early gastric adenocarcinma?

A
  1. IN GENERAL, ASYMPTOMATIC UNTIL DISEASE IS ADVANCED

2. SX’S TEND TO BE NONSPECIFIC

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16
Q

What are the sxs of later gastric adenocarcinoma?

A
  1. DYSPEPSIA / VAGUE EPIGASTRIC PAIN
  2. ANOREXIA / EARLY SATIETY
  3. WEIGHT LOSS
  4. ANEMIA
  5. OCCULT GI BLEEDING
  6. PROGRESSIVE DYSPHAGIA
    A. NEOPLASM IMPINGING. ESOPHAGUS
  7. LEFT SUPRACLAVICULAR NODE (VIRCHOW’S NODE) & UMBILICAL NODULE (SISTER MARY JOSEPH NODULE/NODE)
    A. METASTATIC SPREAD
17
Q

What is Virchow’s node?

A

LEFT SUPRACLAVICULAR NODE

18
Q

What is Sister Mary Joseph nodule?

A

UMBILICAL NODULE

19
Q

What are the dx studies for gastric adenocarcinoma?

A
  1. IRON DEF ANEMIA
  2. MAY HAVE GUAIAC + STOOLS
  3. ELEVATED LFT’S
    A. LIVER METS
  4. ENDOSCOPY
    A. CONFIRMS DX
  5. ONCE DIAGNOSED, CT ABD/PELVIS/CHEST & PET SCAN FOR PRE-OP EVAL
    A. STAGE DISEASE (ASSESS FOR METS)
20
Q

What is the confirmatory test for gastric adenocarcinoma?

A

endoscopy

21
Q

What are the curative treatment options for gastric adenocarcinoma?

A
  1. SURGICAL RESECTION IN STAGES I – III
    A. SUBTOTAL OR TOTAL GASTRECTOMY
    B. ADJUNCTIVE CHEMO IF (+) LYMPH NODES
22
Q

What are the palliative treatment options for gastric adenocarcinoma?

A
  1. PERITONEAL AND/OR DISTANT METS
  2. PALLIATIVE RESECTION MAY BE INDICATED TO RELIEVE PAIN, BLEEDING, OR OBSTRUCTION
  3. CHEMOTHERAPY
23
Q

What is the prognosis for gastric adenocarcinoma?

A
  1. Tumors of proximal stomach have far worse prognosis than distal Tumors
  2. 5-yr survival for pts with successful curative resection is > 45%
  3. Survival related to tumor stage, location and histology
24
Q

What are the general characteristics for gastric lymphoma?

A
  1. lymphoma that originates in the stomach itself
    A. common extranodal site for lymphomas - originating somewhere else w/ mets to stomach
  2. < 15% of gastric malignancies & about 2% of all lymphomas
  3. Risk gastric lymphoma ↑ 6-fold if:
    A. (+) H pylori,
    B. HIV
    C. Long-term immunosuppressant tx
  4. ↑ > 60 yr
25
Q

What are the sxs of gastric lymphoma?

A
  1. Dyspepsia
  2. Weight loss
  3. Anemia
  4. Occult GI bleeding
26
Q

What are the dx studies for gastric lymphoma?

A
  1. IRON DEF ANEMIA
  2. elevated LFTs
    A. LIVER METS
  3. ENDOSCOPY
    A. CONFIRMS DX
    B. BX REVEALS LESION W/ LYMPHOCYTIC INFILTRATION (B CELLS) OF STOMACH WALL
  4. CT ABD /PELVIS / CHEST & PET SCAN
    A. STAGE DISEASE
27
Q

What is the rx for gastric lymphoma?

A
  1. Depends on tumor histology, grade & stage
  2. Pts should be tested for H pylori & treated if (+)
    A. Complete lymphoma regression after H. pylori eradication occurs in 75% of cases w/ low grade lymphoma
  3. Radiation & Chemotherapy
    chemotherapy w/ or w/out rituximab
  4. Surgical resection not recommended
28
Q

What are the general characteristics for gastric carcinoid tumor?

A
  1. RARE NEUROENDOCRINE TUMORS OF THE LUMINAL GI TRACT
  2. SLOW-GROWING TYPE OF CANCER
  3. CAN BE CURED IF CAUGHT EARLY
  4. DIFFICULT TO DIAGNOSE
29
Q

What does carcinoid tumor mean?

A

REMEMBER, “CARCINOID” MEANS WELL-DIFFERENTIATED NEUROENDOCRINE TUMOR ORIGINATING IN GI TRACT, LUNGS, APPENDIX, RARE PRIMARY SITES SUCH AS KIDNEY OR OVARIES

30
Q

What are the types of gastric carcinoid tumors?

A

Type I, II, III

Type I most common

31
Q

Where are common met sites for gastric carcinoid tumors?

A

Carcinoid tumors, in general, have a strong propensity for liver mets

32
Q

What are gastric carcinoid tumors asst. with?

A
  1. Assoc w/ MEN Type I

2. Can occur in association w/ pernicious anemia & ZES

33
Q

What are the risks of gastric carcinoid tumors?

A

Leads to:

  1. SECRETE HORMONES THAT CAUSE SX’S OF FLUSHING, STOMACH CRAMPS/PAIN, DIARRHEA, SOB, PALPS (AKA CARCINOID SYNDROME)
  2. CUSHING’S SYNDROME
34
Q

What are the sxs of gastric carcinoid tumors?

A
  1. FLUSHING &/OR DIARRHEA 2°TO SEROTONIN SECRETION
  2. CAN HAVE ABD PAIN OR BOWEL OBSTRUCTION AS RESULT OF TUMOR GROWTH
  3. CAN BE DISCOVERED INCIDENTALLY ON UPPER EGD OR CT SCAN/MRI
35
Q

What are the dx studies for gastric carcinoid tumors?

A
  1. 24-HR EXCRETION OF 5-HIAA (URINE TEST)
    A. 5-HYDROXYINDOLEACETIC ACID URINE TEST
    B. ELEVATED IN CARCINOID SYNDROME
    C. END PRODUCT OF SEROTONIN METABOLISM
  2. CT SCAN ABD/PELVIS
  3. MRI – FOR LIVER METS, MORE SENSITIVE THAN CT SCAN
  4. SOMATOSTATIN-RECEPTOR SCINTIGRAPHY (SRS)- AKA OCTREOSCAN
  5. UEGD W/ BX

Gen Med: GI (16 decks)

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