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Clin Med- Heme/Oncol > gastrointestinal cancers > Flashcards

gastrointestinal cancers Flashcards

1
Q

Random facts about GI Cancers

A

Most Arise from the Epithelial Layer of the Mucosa
Most are Adenocarcinomas
Many Start Off from Dysplastic Epithelium
Some Start from Polyps
Endoscopic Screening of the Upper and Lower GI Tracks has Improved Mortality

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2
Q

What is the Most Common Esophageal Cancer in the US today is

A

Adenocarcinoma of the Distal Esophagus or Gastro-esophageal Junction

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3
Q

Upper and Mid Esophageal Cancers are mostly what?

A

Mostly Squamous Cell Cancers

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4
Q

What is the presentation of esophageal cancer?

A

Dysphagia
Involuntary Weight Loss & Cachexia
More Frequent in Smokers & Drinkers (Squamous Cell Ca)
More Frequent in Men than Women
More Frequent in Obese Individuals with Reflux

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5
Q

How to diagnose esophageal cancer

A

Barium Swallow with Classic Picture of an “Esophageal Shelf”

Suspicious Hx or Ba Swallow should Prompt Esophago-gastric duodenoscopy (EGD) with Biopsy

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6
Q

What needs to be done if an esophageal cancer is found?

A

Endoscopic Ultra Sound (EUS) to Stage Depth of Invasion is needed. ( >90% Accurate)

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7
Q

Treatment For Tis or High Grade Dysplasia or T1 Adeno Ca

A

Endoscopic Ablation

Esophageal Resection

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8
Q

Treatment for Most Cancers of the Esophagus Present at Higher Stages

A

Squamous Cell Ca of the Upper Esophagus Rx’d with RT or Chemo-RT
AdenoCa of the Esophagus or GE Junction Rx’d with Pre-Op RT or Chemo or Chemo-RT +/- resection
For Stage IV Disease: Palliative RT or Chemo

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9
Q

Prognosis of esophageal cancer?

A

stage I= 98% at 5 years

stage IV= 9 months

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10
Q

2 main presentations of gastric cancer?

A

Diffuse Infiltration of the Stomach (Linitus plastica)

Polypoid or Ulcerative Masses (Intestinal Type)

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11
Q

2 types of rare gastric cancer?

A

Lymphomas

Gastrointestinal Stromal Cell Tumors

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12
Q

Presentation of gastric cancer?

A

GI Bleeding & Hematemesis
Pain, anorexia, and dyspepsia
Clinical Signs include Ascites of Unclear Etiology & + Virchow’s Node

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13
Q

How to diagnose gastric cancers

A

Endoscopic Biopsy is Needed for Dx

Staging Requires CT & PET Scans

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14
Q

Stage I-III treatment of gastric cancers?

A

Rx of Stage I –III is surgical resection.

Adjuvant Chemo-Radiation Therapy is the Standard in the United States for Stage I -III

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15
Q

Gastric Lymphoma cause?

A

Submucosal or Ulcerated Mass.
Histologically most are MALT Lymphomas (Mucosally Associated Lymphoid Tissue)
H. pylori infection seems to be Etiologic in Causing these Malignancies

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16
Q

Presentation of gastric lymphomas?

A

Abdominal Pain, Dyspepsia, Early Satiety
Like AdenoCa, presents in 6th decade.
Relatively Rare

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17
Q

Treatment of gastric lymphomas?

A

Frequently Eradication of H. pylori can  Complete Remission (CR) of these Lymphomas.
75% will Respond to Antibiotic Rx CR.
Responses may be slow to develop and Serial Endoscopies are Needed.
High Grade Lymphomas are Treated with Multi-agent Chemotherapy

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18
Q

Cancers of the Small Bowel

A

Relatively Rare
Most are Adenocarcinomas
Some Adenocarcinomas Arise in Polyps

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19
Q

2 Polyp Forming Inherited Syndromes: Autosomal Dominant

A

Gardeners Syndrome: Multiple Hamartomas, Soft Tissue Tumors & Desmoids as well as Boney Exostoses
Peutz-Jeghers Syndrome: Aberrant Melanin Deposits in the GI Track, Cancers of Ovary, Breast & Pancreas, as well as Multiple Hamartomas

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20
Q

Lymphomas of the Small Bowel are?

A

of the Small Bowel May Be Primary or Secondary

Most are B Cell Lymphomas and Most of those are MALT Lymphomas

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21
Q

Carcinoid Tumors of the Small Bowel

A

Cancers of the Neuro-endocrine Cells and Mostly Arise in the Distal Ileum or Appendix
If Localized, They are Treated by Resection
If Metastatic, Rx is Directed at Controlling the Endocrine

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22
Q

What is the mainstay treatment for metastatic carcinoid cancers?

A

The Somatostatin Analog, Octreotide, is the Mainstay of Rx of the Metastatic Carcinoid Cancers

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23
Q

Colorectal Cancer: Epidemiology

A

Third Most Common Cancer in the US and Third Most Lethal
142,000 New Cases Each Year; 49,000 Colorectal Cancer Deaths Each Year
More Common in Western Countries with High Fat, Low Fiber Diets
NSAID may be Protective Against the Development

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24
Q

Colon & Rectal Ca Etiology

A

genetic

environmental

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25
Q

2 Well Defined Inherited Genetic Syndromes that Predispose to the Development of Colorectal Cancer

A

Familial Adenomatous Polyposis Syndrome (FAP)

Hereditary Non-polyposis Colorectal Syndrome

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26
Q

Familial Adenomatous Polyposis Epidemiology

A

Relatively Rare Autosomal Dominant Condition ~ 1:7,000  1:22,000
It is Characterized by the Development of Hundreds to Thousands of Adenomatous Polyps in the Colon
Caused by a Mutation in the Tumor Suppressor Gene APC

27
Q

When do polyps show up if you have Familial Adenomatous Polyposis?

A

Polyps show up at Puberty; Almost All Patients are Symptomatic by Age 25.

28
Q

Treatment for Familial Adenomatous Polyposis?

A

Total Colectomy.

NSAIDs & Omega Fatty Acids Can Attenuate Polyp Formation

29
Q

Lynch Syndrome (LS) or Hereditary Non-Polyposis Colon Cancer Syndrome

A

autosomal dominant
Bethesda Criteria
colon cancers are common

30
Q

What is Bethesda Criteria?

A

Three or more Members of a Family with Colon Ca, two of whom Must Be 1st Degree Relatives &
Family Members in 2 Successive Generations with Colon Ca &
One family member had Colon Ca Age < 50 y.o. &
No FAP &
One family member with one of the Extra-colonic Cancers

31
Q

Primary prevention of colorectal cancer

A

NSAIDs (ASA) Risk of Adenomas, AdenoCa, & Death d/t Colon Ca
Ca++ p.o., Folic Acid p.o. & ? Vit. D p.o.
High Fiber Low Fat Diets
Exercise ?
HRT ?

32
Q

Approved Screening Procedures for CRC*

A

Screening to Start @ 50 y.o. or 10 Years < Age 1st Degree Relative Dx’d with CRC
Annual Digital Rectal Exam (DRE) with Fecal Occult Blood (FOB) Testing or
Flexible Sigmoidoscopy Every 5 Years or
Colonoscopy Every 10 years or
Double Contrast Barium Enema (BaE) Every 5 Years or
CT Colonography Every 5 Years

33
Q

Issues with a colonoscopy?

A

Colonoscopy Has the Obvious Advantage of Being a Complete Colon Exam and allowing the Operator to Bx Suspicious Lesions &/or Remove Polyps
Colonoscopy Is Expensive, Uncomfortable, & May Be Dangerous
FOBT Misses 50% of Colon Ca (False Negative)
FOBT has a ~4% False Positive Rate  Other Studies
Flexible Sigmoidoscopy Can Check the Bowel to ~60 cm. but 50% of Colon Cancers are Right Sided and Cannot Be Reached by Flex Sig.

34
Q

2 reasons you made need Earlier and More Frequent Screening May Be Needed

A

For Individuals with a Personal Hx of Inflammatory Bowel Disease or Colonic Polyps
For Individuals with a Family Hx of CRC, Particularly if Dx’d < Age 50

35
Q

Presenting symptoms of colorectal cancer?

A

Fe Deficiency Anemia in Men or Post Menopausal Women
Stools Positive for Occult Blood (OB)
Hematochezia
Change in Bowel Habit of Sx of Bowel Obstruction (Unexplained Abdominal Pain & N&V)
Narrowing of Caliber of Stool
Tenesmus

36
Q

Labs and imaging that is needed for patient with colorectal cancer?

A

CBC, Chemistry Profile & Carcinoembryonic Antigen (CEA)
Endo-rectal Ultrasound (EUS) for Rectal Cancers
CXR & EKG
Contrast CT Chest & Abdomen for Colon Cancers
Contrast CT Chest, Abdomen & Pelvis if Rectal Cancer Suspected

37
Q

4 Principles of Curative Rx of Colorectal Cancer

A

Complete Resection of All of the Cancer and Regional Lymph Nodes is Essential for a Curative Outcome.
For Rectal Cancers Total Meso-rectal Excision (TME) is Important for a Curative Result in T2 & T3 Cancers.
Pre-operative Chemo-RT ( Neoadjuvant Chemo & RT) is an Important Component of Rx of Stage II & III Rectal Cancers
5FU (5 Fluorouracil) is the Backbone of Rx of Almost All GI Cancers.

38
Q

Palliative Rx of Metastatic CRC

A

If Mets to Bone  Pain, Rx RT.
If Bowel Obstruction d/t Discrete Colon Lesion, Rx Diverting Colostomy
If Peritoneal Carcinomatosis or Mets to Organs, Rx 5FU based Chemotherapy
If Brain Mets Rx RT +/- Surgical Excision if Possible

39
Q

Cancer of the anus?

A

Primarily a Human Papilloma Virus (HPV) Related Disease.
Associated with Genital Warts & Condyloma
More common in AIDS Population

40
Q

symptoms of cancers of the anus?

A

Chronic Bright Red Blood Per Rectum Mimicking Hemorrhoidal Bleeding
Tenesmus
Sensation of Anal Fullness
Persistent Anal or Perianal Itching

41
Q

Cancer of the pancreas?

A 
This Remains a Dismal Disease.
90% are Inoperable at the Time of Dx.
The 5 Year Survival is 5% on Average.
Dx’d in Individuals 60 – 80  y.o.
Most People have No Sx until they have Advanced Disease
42
Q

3 presenting symptoms of pancreatic cancer?

A

Painless Jaundice
Back Pain
Unexplained Anorexia, N&V +/or Weight loss

43
Q

What are 4 signs that you might find on physical exam indicating pancreatic cancer

A

Jaundice
Palpable Gallbladder (Courvoisier’s Sign)
Peritoneal Carcinomatosis with Mets to the Umbilicus (Sister Mary Joseph Node)
Mets to the Left SCF (Virchow’s Node)

44
Q

7 ways to help diagnose pancreatic cancer?

A 
CBC, CMP, CA 19-9
CT Scan Chest & Abdomen with Contrast
Upper Abdominal MRI
Endoscopy and Endoscopic Retrograde Cholangiopancreatography (ERCP)
EUS
FDG-PET to look for Distant Mets
45
Q

How are Small Cancers of the Pancreatic Head or Uncinate Process treated?

A

Pylorus Preserving Pancreaticoduodenectomy (Modified Whipple Procedure)

46
Q

how are Unresectable Locally Advanced Pancreatic Ca treated?

A

Chemo & RT

47
Q

Hepatocellular Carcinoma (HCC

A

One of the Most Common Cancers Worldwide with 1,000,000 People Dx’d each Year
The Disease is Most Prevalent in Sub-Saharan Africa, China
The Incidence in the US is ~ 3/105.
HCC is Highly Correlated with Chronic Hepatitis: Hepatitis B, C or ETOHic.

48
Q

Presenting symptoms of HCC?

A

Abdominal Pain
Anorexia & Weight Loss
Routine Lab Tests or Follow-Up of Known Cirrhosis

49
Q

2 Presenting symptoms of HCC?

A

Rapidly increased Hepatomegaly &/or Ascites

Fever of Unknown Origin (FUO)

50
Q

3 ways to diagnose HCC?

A

Chem Profile, CBC & Alpha Feto-protein (AFP)
Abdominal CT Scan &/or MRI.
Liver Biopsy

51
Q

4 treatments that depend on the stage of HCC

A

If Localized Partial Hepatectomy
If More Generalized Throughout the Liver, Liver Transplantation has been Successful
Localized Radiological Ablative Techniques have Also been Used Effectively.
If Metastatic, Newer Agents such as Sorafenib a Multi-Kinase Inhibitor &/or Bevicizumab + Erlotinib.

52
Q

Pancreatic NECs Cancers are Characterized by what?

A 
the Hormones they Secrete
Gastrinomas
Vasoactive Intestinal Peptide Tumors (VIPomas)
Insulinomas
Glucagonomas
53
Q

Multiple Endocrine Neoplasms (MEN) 1 inherited syndromes

A

Pituitary Adenomas, Parathyroid Tumors and Pancreatic NECs (PPP)

54
Q

MEN 2 inherited syndromes

A

Parathyroid Tumors, Pheochromocytomas & Medullary Thyroid Ca.

55
Q

treatment for Pancreatic Neuro-endocrine Cancers

A

Surgical Resection if Possible, Even if Incomplete
Loco-regional Chemoembolization of Hepatic Mets.
Somatostatin Analogue

56
Q

What does GIST stand for?

A

Gastro-Intestinal Stromal Cell Tumors (GIST)

57
Q

Clinical presentation of GIST?

A

Most are Asymptomatic Masses found Incidentally at time of Surgery for Other GI Problems
The Most Common Form of GI Sarcoma
Arise Mostly in the Stomach or Small Intestine
May Be Associated with Obstruction or GI Bleeding

58
Q

Staging of GIST?

A

Low ( < 5 cm; < 5 Mitoses/ 50 HPFs (High Power Fields))
High ( > 10 cm; > 5 Mitoses / HPF)
High: Any Small Bowel GIST
Tumor Invading Peritoneum or Liver

59
Q

Treatment fo GIST

A

Surgical Resection is Most Important
3 Years of Adjuvant P.O. Imatinib  Improves Relapse Free Survival of High Risk Patients
In Metastatic GIST, Imatinib

60
Q

HCC is related to what?

A

Liver Injury particularly Hepatitis B

61
Q

What is the best option for GI Neuroendocrine Cancer treatment?

A

Surgical excision

but if Complete Excision is Not Possible, Controlling the Hormonal Effects of these tumors is the Mainstay of Rx.

62
Q

GI Stromal Cell Tumors are unique Sarcomas of the GI tract. They are caused by what?

A

a mutation that produces an abnormal Tyrosine kinase, c-Kit.

63
Q

GISTs do not respond to what treatment?

A

conventional chemotherapy

Clin Med- Heme/Oncol (10 decks)

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