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Gen Med: GI > Gastric Neoplasms > Flashcards

Gastric Neoplasms Flashcards

1
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. MOST FOUND IN PANCREAS OR DUODENUM
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2
Q

Diagnostic Studies for Zollinger-Ellison 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
    IV secretin  gastrin level increases by > 200 pg/ml w/in 2-30 mins in 85% of pts
    - Secretin stimulates release of gastrin by gastrinoma cells
    - Normal gastrin cells are inhibited by secretin
    - Gastrin only rises in pts w/ gastrinomas
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3
Q

Treatment for Zollinger-Ellison Syndrome?

A

1, Oral PPIs
A. Control gastrin secretion
2. Surgical resection of gastrinoma cures if done before hepatic mets
3. 2/3 gatrinomas are malignant

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4
Q

Gastric adenocarcinoma characteristics

A
  • M > F
  • Age > 40 yr
  • Strong association with H. pylori
  • Early dX & Tx = 80% cure rate
  • If muscularis propria involved, cure rate 50%
  • If lymphatic spread, cure rate 10%
  • 2nd most common cause of cancer death worldwide
  • Incidence has declined rapidly over the past 70 yrs
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5
Q

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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6
Q

Sxs of Gastric adenocarcinoma

A
  1. IN GENERAL, ASYMPTOMATIC UNTIL DISEASE IS ADVANCED
  2. SX’S TEND TO BE NONSPECIFIC
  3. DYSPEPSIA/VAGUE EPIGASTRIC PAIN
  4. ANOREXIA/EARLY SATIETY
    WEIGHT LOSS
  5. ANEMIA
  6. OCCULT GI BLEEDING
  7. PROGRESSIVE DYSPHAGIA
    (NEOPLASM IMPINGING ESOPHAGUS)
  8. LEFT SUPRACLAVICULAR NODE (VIRCHOW’S NODE) & UMBILICAL NODULE (SISTER MARY JOSEPH NODULE/NODULE)
    A. METASTATIC SPREAD
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7
Q

Diagnostic Studies: 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)
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8
Q

Treatment: Gastric adenocarcinoma

A 
1. CURATIVE
A. SURGICAL RESECTION IN STAGES I – III
-SUBTOTAL OR TOTAL GASTRECTOMY 
-ADJUNCTIVE CHEMO IF (+) LYMPH NODES
2. PALLIATIVE
A. PERITONEAL AND/OR DISTANT METS
B. PALLIATIVE RESECTION MAY BE INDICATED TO RELIEVE PAIN, BLEEDING, OR OBSTRUCTION
C. CHEMOTHERAPY
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9
Q

Prognosis: 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
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10
Q

General characteristics of 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 (+) H pylori
    A. HIV
    B. Long-term immunosuppressant tx
  4. ↑ > 60 yr
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11
Q

Signs & Symptoms of gastric lymphoma

A
  • Dyspepsia
  • Weight loss
  • Anemia
  • Occult GI bleeding
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12
Q

Diagnostic Studies for gastric lymphoma

A
  1. IRON DEF ANEMIA
  2. ELEVATED LFT’S
    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
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13
Q

Treatment: gastric lymphoma

A

Depends on tumor histology, grade & stage

Pts should be tested for H pylori & treated if (+)
-Complete lymphoma regression after H. pylori eradication occurs in 75% of cases w/ low grade lymphoma

Radiation & Chemotherapy
-chemotherapy w/ or w/out rituximab

Surgical resection not recommended

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14
Q

Characteristics: 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
  5. REMEMBER, “CARCINOID” MEANS WELL-DIFFERENTIATED NEUROENDOCRINE TUMOR ORIGINATING IN GI TRACT, LUNGS, APPENDIX, RARE PRIMARY SITES SUCH AS KIDNEY OR OVARIES
  6. Type I, II, III
  7. Type I most common
  8. Carcinoid tumors, in general, have a strong propensity for liver mets
  9. Assoc w/ MEN Type I
  10. Can occur in association w/ pernicious anemia & ZES
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15
Q

Risks: GASTRIC CARCINOID TUMOR

A

CAN LEAD TO TWO CONDITIONS:

SECRETE HORMONES THAT CAUSE SX’S OF FLUSHING, STOMACH CRAMPS/PAIN, DIARRHEA, SOB, PALPS (AKA CARCINOID SYNDROME)

CUSHING’S SYNDROME

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16
Q

Signs & symptoms : GASTRIC CARCINOID TUMOR

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
17
Q

DIAGNOSTIC TESTING : GASTRIC CARCINOID TUMOR

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 (9 decks)

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