Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ClinMed II Exam #4 GI > GI Cancer > Flashcards

GI Cancer Flashcards

1
Q

2 main histological types of esophageal cancer?

A

Adenocarcinoma, Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common type of esophageal cancer in the US?

A

Adenocarcinoma (>60%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Most common type of esophageal cancer worldwide?

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What area is known as the esophageal cancer belt?

A

Northern Iran through Central Asia to North China

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Worldwide risk factors of Squamous cell carcinoma?

A

Poor nutritional status, low fruits and veggies, drinking hot beverages, HPV infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Peak age of diagnosis for esophageal cancer?

A

50-70 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Is esophageal cancer more common in males or females?

A

Males>Females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which type of esophageal cancer is more common in African American males?

A

Squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which type of esophageal cancer is more common in Caucasian males?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Location of Squamous cell carcinoma esophageal cancer?

A

Upper 2/3 of esophagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Location of Adenocarcinoma esophageal cancer?

A

Lower 1/3 of esophagus near EGJ (esophagogastric junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Major risk factors for Squamous cell carcinoma esophageal cancer?

A

*Smoking, *alcohol, hot substances, caustic strictures (ex. ingestion of bleach), low fruit/veggie diet, achalasia, HPV infection (types 16&18)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Major risk factors for Adenocarcinoma esophageal cancer?

A

**Barrett’s esophagus, *GERD, obesity, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Possible protective benefit of what meds in Adenocarcinoma esophageal cancer, particularly in those with Barrett’s?

A

ASA and NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pathophys of Adenocarcinoma esophageal cancer?

A

Gastroesophageal reflux –>Metaplasia –> Low-grade dysplasia –> High-grade dysplasia –> Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Early on, patients with esophageal carcinoma have what symptoms?

A

Usually asymptomatic early on

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most common Hallmark symptom of esophageal carcinoma?

A

Progressive dysphagia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Other signs & symptoms of esophageal carcinoma?

A

Odynophagia*, anorexia/weight loss, iron deficiency anemia secondary to blood loss, epigastric/retrosternal pain, heartburn, trahceal-esophageal fistula, hoarseness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Hoarseness with esophageal carcinoma is d/t what?

A

Recurrent laryngeal nerve compression/damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can tacheal-esophageal fistulas cause in esophageal carcinoma?

A

Aspiration of food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

With iron deficiency anemia secondary to blood loss in esophageal carcinoma, where is blood loss most common?

A

EGJ (esophagogastric junction)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Best initial test/gold standard for dx of esophageal cancer?

A

EGD (upper endoscopy) w/ biopsy and brush cytology yield >90% for tissue dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Other diagnostic imaging for esophageal cancer that can be done to assess mobility abnormalities/identify masses?

A

Barium contrast radiography
*can also be useful if entire esophagus unable to be visualized on upper endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is still necessary with barium contrast radiography testing for esophageal cancer?

A

Biopsy to confirm dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the most accurate test for locoregional staging of esophageal cancer?

A

EUS (endoscopic ultrasound) - assesses depth of primary tumor penetration and metastatic nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Common areas for metastasis in esophageal cancer?

A

Spine, Lungs, Liver, Adrenal glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What tests can be used for staging of distant metastatic spread of esophageal cancer?

A

CT of the abdomen/pelvis/chest or PET scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cornerstone of treatment for esophageal cancer?

A

Surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment of esophageal cancer varies depending on what?

A

Disease stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Stage 1-3 esophageal cancer treatment?

A

Endoscopic therapies (mucosal resection/ablation), Esophagectomy, chemo/radiation pre- or post- resection, immunotherapy if residual disease after resection/initial chemo/radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Chemo/raditation pre surgical resection for esophageal cancer AKA?

A

Neoadjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Chemo/raditation post surgical resection for esophageal cancer AKA?

A

Adjuvant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Immunotherapy med for residual esophageal cancer?

A

Nivolumab (Opdivo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Stage 4 esophageal cancer includes invasion of what?

A

Other solid organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Treatment for stage 4 esophageal cancer?

A

Chemo +/- radiation w/ palliative support, Opdivo + chemo (FDA approved as of 2022 for unresectable cancer), palliative surgery/stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

5-year survival rate for those with esophageal cancer of all stages?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Has treatment of esophageal cancer improved?

A

Yes, has slowly improved (in 1960’s/70’s 5-year survival rate only 5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Recommended screening for esophageal cancer in the general population?

A

None recommended

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Recommended screening for esophageal cancer in high risk patients with known Barrett’s esophagus?

A

Current recommendation: surveillance EGD w/ biopsy every 3-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How many new cases of gastric cancer diagnosed annually in the US?

A

26,500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Annual deaths resulting from gastric cancer in the US?

A

11,130

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

In which parts of the world is gastric cancer more common?

A

Korea, Japan, Chile, Venezuela

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Median age at gastric cancer diagnosis?

A

64 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Is gastric cancer more common in males or females?

A

Twice as common in males than females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

> 90% of gastric cancers are what type?

A

Adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Other 2% of gastric cancers are what type?

A

Gastric lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Risk factor for gastric cancer?

A

***Chronic H. pylori infection causing chronic inflammation (highest risk), family hx, older age/male, smoking, diet high in salt, smoked/cured meat, pickled veggies, pre-existing conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Pre-existing conditions that are risk factors for gastric cancer?

A

Hx of gastric ulcers, pernicious anemia (autoimmune attack on parietal cells), chronic atrophic gastritis, Hx of gastric polyps-adenoma, Hx of gastric surgery (can disrupt pH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Signs and symptoms of early gastric cancer?

A

Usually no associated sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Signs and symptoms as gastric cancer progresses?

A

Weight loss (62%), epigastric/persistent Abdominal pain (52%) , Dysphagia (if located in proximal stomach/EGJ), Melena/Hematemesis/Pallor (anemia - occult GI bleeding), Early satiety, Nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Physical exam findings of gastric cancer?

A

Weight loss, palpable enlarged stomach mass, melena or pallor from anemia/iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Most physical findings of gastric cancer are indicative of what?

A

Advanced metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Common sites of metastasis with gastric cancer?

A

Liver, lungs, bones, ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Hepatomegaly is indicative of metastasis of gastric cancer to what organ?

A

Mets in liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Krukenberg tumor is indicative of metastasis of gastric cancer to what organ?

A

Mets in ovaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Blumer shelf tumor is indicative of metastasis of gastric cancer to what organ?

A

Mets to caudal portion to the peritoneal cavity or pouch of douglas (area between rectum and uterus)
*palpable on exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is adenopathy?

A

lymphatic metastatic spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Where is Virchow’s node (adenopathy in gastric cancer)?

A

Left supraclavicular region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Where is the Irish node (adenopathy in gastric cancer)?

A

Left axillary region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Where is Sister Mary Joseph’s node (adenopathy in gastric cancer)?

A

Umbilical region

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Best initial test for gastric cancer diagnosis?

A

EGD (upper endoscopy)
Direct visualization w/ 95% accuracy for definitive dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is helpful in gastric cancer diagnosis if unable to pass endoscopy due to obstruction at proximal end?

A

Barium swallow (upper GI series)
*still need biopsy for dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What imaging modality can be used to assess tumor depth and local node involvement in gastric cancer?

A

EUS (endoscopic ultrasound)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What imaging modality can be used to assess metastatic spread in gastric cancer?

A

CT of chest/abdomen/pelvis or PET scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Principal therapy for gastric cancer?

A

Surgical resection
**ONLY POTENTIAL FOR CURE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Early-stage (Stage 1) gastric cancer treatment?

A

Endoscopic mucosal resection or surgery are standard options

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Stage 2 & 3 gastric cancer treatment?

A

Surgery followed by post-chemoradiation
OR
Preoperative chemo w/ surgery followed by postop chemo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Stage 4 gastric cancer or surgically non-resectable disease treatment?

A

Chemoradiation, chemotherapy, palliative management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

5-year survival rate for those with stomach cancer?

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

5-year survival rate for gastric cancer reflects what?

A

Most stomach cancers are diagnosed after cancer has already metastasized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is a result of gastric cancer having no early signs?

A

Often very late diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

At diagnosis of gastric cancer 60% of cancers have already reached an advanced stage that does not allow for what?

A

Curative treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What type of gastric cancer has the best prognosis?

A

Early gastric cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

How many new cases of Hepatocellular carcinoma diagnosed in the US in 2023?

A

41,210

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

How many deaths from hepatocellular carcinoma in the US in 2023?

A

29,380

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Is hepatocellular carcinoma more common in men or women?

A

Men>women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

80% of hepatocellular carcinoma cases are associated with what?

A

Underlying liver disease (HBV, HCV, chronic ETOH use, NASH - Nonalcoholic associated steatohepatitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

HBV accounts for what % of hepatocellular carcinoma worldwide?

A

~55%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

HCV accounts for what % of hepatocellular carcinoma worldwide?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Mean age at dx for hepatocellular carcinoma?

A

Peaks at 70-75
However younger 50-60 y/o rising due to HBV & HCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Main risk factor of hepatocellular carcinoma?

A

Cirrhosis (RF in 80% of cases)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Largest risk factor of hepatocellular carcinoma worldwide?

A

Chronic HBV and HCV infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Other risk factors for hepatocellular carcinoma?

A

Alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD, particularly NASH), Hereditary hemochromatosis, Aflatoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What is Aflatoxin?

A

Carcinogen produced by Aspergillus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Do patients with hepatocellular carcinoma usually have symptoms?

A

No, other than those related to their chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

High suspicion of hepatocellular carcinoma in patients with known liver disease if what occurs?

A

Acute decompensation of their known liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Advanced disease hepatocellular carcinoma symptoms?

A

Upper abdominal pain, hepatomegaly, anorexia, weight loss, jaundice, ascites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

High risk populations for hepatocellular carcinoma?

A

Chronic HBV/HCV, Cirrhosis, Fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Screening for hepatocellular carcinoma in high risk populations?

A

Ultrasound every 6 months
+/- AFP levels (alpha fetoprotein) every 6 months in addition to ultrasound

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Do normal AFP levels exclude hepatocellular carcinoma in high risk screening?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Cancer-marker labs for hepatocellular carcinoma?

A

AFP (alpha-fetoprotein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which lab values for AFP should trigger workup for hepatocellular carcinoma?

A

> 20ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Which lab values for AFP are nearly diagnostic for hepatocellular carcinoma in high risk patients?

A

> 400-500ng/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Best initial diagnostic imaging for hepatocellular carcinoma?

A

Ultrasound (RUQ)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Confirmatory testing if radiological hallmarks of hepatocellular carcinoma are seen in high-risk patients?

A

Multiphase contrast MRI or Abdominal CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What does multiphase contrast MRI/abdominal CT capture in hepatocellular carcinoma?

A

Hypervascular nature of the nodule/mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What can a liver biopsy provide for hepatocellular carcinoma?

A

Definitive diagnosis (but not always needed for dx)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Liver biopsy carries the risk for what?

A

Bleeding and hepatocellular carcinoma tumor spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

When is liver biopsy recommended in hepatocellular carcinoma?

A

Only when imaging studies are inconclusive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

In general all treatment for HCC is based on what two factors?

A

Tumor extent/stage, Severity of underlying liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Surgical resection of HCC is the best choice in which cases?

A

Tumors generally <5cm & localized disease, absence of cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Surgical resection of liver tumors up to what amount can be tolerated?

A

up to 50% of total liver volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Operative mortality of HCC in experienced centers?

A

less than 2%

104
Q

Long-term relapse free survival rate after HCC resection?

A

Approximately 40%

105
Q

Why is liver transplant limited in HCC?

A

Limited donors w/ healthy organs, only 5% of recipients appropriate for transplant at time of dx

106
Q

5-year survival rate after liver transplant for HCC?

A

> 75%

107
Q

Recurrence rates after liver transplant for HCC?

A

As low as 15% at 5 years

108
Q

HCC non-surgical treatment options?

A

Loco-regional therapy (Radiofrequency ablation, Transcatheter arterial chemoembolization), Systemic therapy, Supportive care

109
Q

What is radiofrequency ablation for HCC?

A

Local application of radiofrequency thermal energy to HCC lesion (more often w/ smaller tumors < 3cm)

110
Q

What is transcatheter arterial chemoembolization (TACE) for HCC?

A

Chemo and an embolic agent directly through artery feeding the tumor (more often w/ large unresectable HCC)

111
Q

Systemic therapy for HCC?

A

Sorafenib: molecular targeted therapy
Atezolizumab + bevacizumab: immunotherapy

112
Q

When is supportive care for HCC indicated?

A

Poor functional status patients who are not candidates for surgical/local tx

113
Q

Prognosis of HCC is based on what?

A

Stage at time of dx and if patient is eligible for resection or transplant

114
Q

How many HCC patients are surgical candidates at time of diagnosis?

A

~5%

115
Q

General 5-year survival rate of HCC in the US?

A

18%

116
Q

Median survival time after diagnosis of HCC?

A

Generally 6-20 months

117
Q

What are the two types of biliary tract carcinomas?

A

Gallbladder cancer and cholangiocarcinoma (bile duct cancer)

118
Q

Incidence of gallbladder cancer (GBC) in the US annually?

A

~4,000 cases

119
Q

Is GBC more common in males or females?

A

Females (>65 y/o, caucasian)

120
Q

Mean age at onset of GBC?

A

70 y/o

121
Q

Prognosis of GBC?

A

Highly fatal (only 1/5 cases found early)

122
Q

How many cases of bile duct cancer in the US annually?

A

~8,000 cases (rare)

123
Q

Is bile duct cancer more common in males or females?

A

Males

124
Q

Bile duct cancer usual age of diagnosis?

A

50-70 y/o

125
Q

Bile duct cancer can be seen in younger patients with a history of what?

A

Primary sclerosing cholangitis or choledochal cysts

126
Q

Prognosis of bile duct cancer?

A

Highly fatal (usually diagnosed late)

127
Q

What is a common cause of chronic gallbladder inflammation?

A

Gallstones (MC risk factor of GBC)

128
Q

GBC risk factors?

A

Gallstones, porcelain gallbladder, chronic infection, gallbladder polyps

129
Q

What is porcelain gallbladder?

A

Chronic cholecystitis (chronic inflammation) leading to calcification of the GB wall
*rare

130
Q

Porcelain gallbladder increases risk of GBC by what percentage?

A

50%

131
Q

Which chronic infections increase the risk of GBC?

A

Chronic cholecystitis, chronic cholangitis

132
Q

Gallbladder polyps of what size have the highest risk of GBC?

A

> 1cm

133
Q

Risk factors for bile duct cancer?

A

Inflammatory conditions, bile duct abnormalities, parasitic infestations (liver flukes)

134
Q

Parasitic inflammation/liver flukes are a major risk factor of bile duct cancer in what global area?

A

Southeast Asia (from undercooked fish)

135
Q

What bile duct abnormalities are risk factors for bile duct cancer?

A

Bile duct adenoma, bile duct stones

136
Q

What is Primary sclerosing cholangitis (PSC)?
(risk factor for bile duct cancer)

A

Inflammatory disorder of biliary tree leading to fibrosis & stricture of bile ducts

137
Q

PSC has a strong association with what condition?

A

IBD (ex. ulcerative colitis)

138
Q

What are congenital choledochal cysts?
(risk factor for bile duct cancer)

A

Dilation of ducts leading to chronic inflammation

139
Q

Many of the signs and symptoms of GBC and bile duct cancer ________?

A

overlap

140
Q

Do early stage biliary tract cancer patients often have symptoms?

A

No, usually asymptomatic

141
Q

Signs and symptoms of biliary tract carcinomas?

A

RUQ/epigastric pain (MC in GBC), painless jaundice (MC in bile duct cancer), N/V, anorexia, abdominal bloating, weight loss

142
Q

Appearance of urine/stool with bile duct cancer?

A

Tea colored urine, clay colored stool

143
Q

Why does pruritis occur with bile duct cancer?

A

Buildup of bile salts and bilirubin in the body which collects in the skin

144
Q

Physical exam characteristics that may be present with biliary tract carcinomas?

A

+/- jaundice, abdominal mass, palpable gallbladder in setting of painless jaundice (Courvoisier sign)

145
Q

Non-diagnostic/non-specific lab studies for biliary tract carcinomas?

A

Elevated transaminases (ALT & AST), ALP elevated in cholestatic picture (obstruction d/t tumor), elevated bilirubin

146
Q

Tumor markers for bile duct carcinoma?

A

CA 19-9 (carbohydrate antigen) elevated in up to 85% of cases, possible CEA elevation

*Levels can be utilized to monitor therapy

147
Q

If tumor markers are elevated in bile duct carcinoma, what does this usually mean for prognosis?

A

Poor overall prognosis

148
Q

Best initial test for biliary tract carcinoma dx?

A

RUQ US

149
Q

What can RUQ US detect in biliary carcinomas?

A

Obstruction (tumor pathology or stones), Dilitation (biliary tree and/or gallbladder), Masses (may miss small lesions w/in ducts)

150
Q

What test is recommended to assist with diagnosis, extent of tumor, and plan management of biliary tract cancers?

A

MRCP (Magnetic resonance choliangiopancreatography) or MDCT (Multidector computed tomography)

151
Q

Which test can be used for staging of biliary tract carcinomas?

A

CT of chest & abdomen or PET scan

152
Q

Common sites of metastasis of biliary tract cancer?

A

Lungs, pleura, liver

153
Q

Is biopsy usually necessary in GBC?

A

No, typically will proceed directly to surgical removal

154
Q

What can ERCP (Endoscopic retrograde cholangiography) be used for with biliary tract carcinoma?

A

Stent placement if obstruction of tumor is present, biopsy can be done (extrahepatic bx easier than intrahepaic & perihilar region)

155
Q

What is the only potential curative option for GBC?

A

Surgical resection

156
Q

Resectable disease is present in about what percentage of bile duct tract cancers?

A

<10% (other 90% non-resectable)

157
Q

Treatment of resectable bile duct cancer with margins (+) positive nodes?

A

Resection and post chemoradiation or clinical trial

158
Q

Treatment of resectable bile duct cancer with margins (-) ?

A

Adjuvant chemotherapy (Xeloda)

159
Q

Treatment for unresectable bile duct cancer?

A

Palliative: Chemo, Stenting, TACE (transarterial chemoembolization), Clinical trial

160
Q

Prognosis/5-year survival rate for extrahepatic bile duct cancer?

A

10%
(9% in the US)

161
Q

Prognosis/5-year survival rate for perihilar region bile duct cancer?

A

10-30%

162
Q

What % of patients with Stage 1 and 2 GBC have symptoms?

A

<10%

163
Q

What % of patients are diagnosed incidentally with cholecystectomy & have early-stage GBC?

A

20%

164
Q

Treatment for Stage 1&2 GBC?

A

Surgical resection

165
Q

Treatment for Stage 3&4 GBC?

A

Clinical trials, chemo+radiation, palliative chemotherapy alone

166
Q

Prognosis/5-year survival rate of GBC?

A

19%

167
Q

Most common GI cancer?

A

Colorectal cancer

168
Q

How many people will be diagnosed w/ colorectal cancer in their lifetime?

A

1 in 20

169
Q

What is the 3rd most common cancer in females and males in the US?

A

Colorectal cancer

170
Q

What is the second leading cause of cancer deaths in the US?

A

Colorectal cancer

171
Q

How many new cases of colorectal cancer diagnosed in 2023?

A

106,970 colon only
46,050 rectal

172
Q

Combined deaths from colorectal cancer in 2023?

A

52,550

173
Q

Colorectal cancer mean age of diagnosis?

A

68 y/o
*risk increases with age

174
Q

Rise of colorectal cancers are being seen at what age?

A

Younger patients <50y/o
(decline in past few years in patients >50)

175
Q

Is colorectal cancer more common in males or females?

A

males

176
Q

Overall, >95% of colorectal cancers are what type?

A

Adenocarcinomas that arise from adenomatous polyps

177
Q

Risk factors for colorectal cancer?

A

Increasing age >40, african american race, smoking, obesity, diets rich in red meat/low in fiber, hx of IBD (UC or Chrons), hx of colorectal adenomas, family hx of colorectal cancer in 1st degree relative

178
Q

Hereditary conditions that increase the risk of colorectal cancer?

A

Familial adenomatous polyposis (FAP), Lynch syndrome (aka hereditary nonpolyposis colorectal cancer)

179
Q

Protective factors against colorectal cancer?

A

Physical activity, regular NSAID/ASA use

180
Q

What type of condition is FAP?

A

Relatively rare autosomal dominant condition causing hundreds to thousands of adenomatous polyps in the colon & rectum

181
Q

FAP accounts for what % of colorectal cancer?

A

<1%

182
Q

When do polyps show up in FAP?

A

Show up at puberty, almost always symptomatic at 16 y/o

183
Q

Cause of FAP?

A

Mutation in the tumor suppression gene APC (Adenomatous polyposis coli)

184
Q

Screening for colorectal cancer w/ FAP dx per ASCO (American Society of Clinical Oncology)?

A

Colonoscopy/sigmoidoscopy at 10-12 y/o every 1-2 years
*once polyps are found: yearly colonoscopy until resection

185
Q

If FAP remains untreated by age 40-45, what is the risk of developing colon cancer?

A

100%

186
Q

Treatment for FAP?

A

Prophylactic colectomy

187
Q

What is the most common form of hereditary colorectal cancer?

A

Lynch Syndrome (HNPCC) - 75,000 new cases annually

188
Q

Lynch Syndrome (HNPCC) accounts for what % of cases of all colorectal cancer?

A

3%

189
Q

Lynch Syndrome (HNPCC) accounts for what % colorectal cancer diagnoses each year in patients <50 y/o?

A

~8%

190
Q

What is Lynch Syndrome (HNPCC)?

A

Inherited autosomal dominant disease caused by mutation in the DNA mismatch repair gene

191
Q

Lynch Syndrome (HNPCC) increases the lifetime risk of developing colon cancer by how much?

A

up to 40%

192
Q

Average age of colorectal cancer onset in those with Lynch Syndrome (HNPCC)?

A

48

193
Q

ASCO screening recommendations for colorectal cancer in those with Lynch Syndrome (HNPCC)?

A

Colonoscopy q1-2 years beginning at 25-25 y/o or 5 years prior to earliest age of colorectal cancer dx in the family

194
Q

Clinical presentation of colorectal cancer will present in 1 of 3 ways:

A
  1. asymptomatic found on routine screening
  2. suspicious symptoms/signs
  3. emergency admission due to obstruction, peritonitis, or lower GI bleed
195
Q

Suspicious signs/symptoms for colorectal cancer?

A

Change in character of stool/bowel habits, hematochezia/melena, iron deficiency anemia, abd. tenderness, palpable abdominal/rectal mass

196
Q

Proximal/Right side colorectal cancer symptoms?

A

Chronic bleeding: iron deficiency anemia, melena

197
Q

Distal/Left side colorectal cancer symptoms?

A

Change in bowel habits: thiner caliber/constipation, intestinal obstruction/perf, colicky abdominal pain d/t obstruction, circumferential lesions w/ “apple core” appearance

198
Q

Colorectal cancer is the most common cause of what condition in adults?

A

Large bowel obstruction

199
Q

Symptoms of rectal cancer?

A

Rectal pain, hematochezia, tenesmus, decrease caliber of stools (“pencil shaped”)

200
Q

Is iron deficiency anemia more common in L or R sided colorectal cancer?

A

Right sided

201
Q

Labs for colorectal cancer?

A

Rectal exam FOBT, CBC for iron deficiency anemia

202
Q

If iron deficiency anemia is absent on CBC, does it exclude colon cancer?

A

No

203
Q

Gold standard diagnostic for suspicion of colorectal cancer?

A

Colonoscopy (allows biopsy, removal of polyps)
*requires prep

204
Q

If colonoscopy is incomplete due to poor prep, what diagnostic modality can be used for colorectal cancer?

A

CT colonography
*also requires prep
*does not allow for bx

205
Q

What diagnostic modality is only appropriate if colorectal cancer mass is palpable on DRE?

A

Flex sigmoidoscopy
*may miss R sided lesions

206
Q

If unable to complete colonoscopy (ex. d/t apple core lesions), what test can be used for colorectal cancer?

A

Barium enema
*does not allow for bx

207
Q

Diagnostics for colorectal cancer following biopsy confirmation?

A

Cancer markers and staging

208
Q

Cancer markers for colorectal cancer?

A

CEA (serum carcinoembryonic antigen) levels
Sensitivity only 46% for CRC
(high levels –> more advanced disease, worse prognosis)
*ALWAYS assess level prior to tx to monitor progress

209
Q

What can be used for determining metastasis/staging of colorectal cancer?

A

CT of chest, abdomen, pelvis

210
Q

Most common sites of metastasis for colorectal cancer?

A

Liver** MC followed by lungs

211
Q

Treatment for Stage 1 colorectal cancer?

A

Wide sugical resection

212
Q

Treatment for Stage 2 colorectal cancer?

A

Surgical resection
(post-chemotherapy is controversial)

213
Q

Treatment for Stage 3 colorectal cancer?

A

Wide surgical resection followed by chemotherapy

214
Q

Treatment for Stage 4 colorectal cancer?

A

Chemotherapy combo regimen, immunotherapy agents, clinical trials *palliative tx plan

215
Q

Standard treatment and only curative modality for colorectal cancer?

A

Surgery

216
Q

5-year survival rate of stage 1 colorectal cancer?

A

75-90%

217
Q

5-year survival rate of stage 2 colorectal cancer?

A

45-65%

218
Q

5-year survival rate of stage 3 colorectal cancer?

A

30-70%

219
Q

5-year survival rate of stage 4 colorectal cancer?

A

6-13%

220
Q

Poor prognostic factors of colorectal cancer?

A

Advanced age, bowel obstruction/perf at diagnosis, elevated preoperative CEA levels

221
Q

Colorectal cancer screening guidelines for average risk patients?

A

Starting at age 45 continuing to 75
-colonoscopy q10 years *** GOLD STANDARD

222
Q

Other methods of colorectal cancer screening if colonoscopy not preferred/unable?

A

-Flexbile sigmoidoscopy q5 yrs
-CT colonography q5 yrs
-Flexibile sigmoidoscopy q 10 yrs + FIT every yr
-Yearly guaiac FOBT
-Yearly fecal immunochemical test (FIT)
-Stool DNA test + FIT (cologuard) q1-3 yrs

223
Q

Colorectal preventative screening guidelines for pts with family hx per NCCN as of 2021?

A

If first degree relative diagnosed w CRC, start screening at age 40 or 10 years prior to family member dx (whichever comes first)

224
Q

Recommended screening for CRC per NCCN as of 2021?

A

Colonoscopy repeated every 5 yrs
If declined by patient: annual FIT should be offered

225
Q

How many new cases of pancreatic cancer in the US (2023)?

A

64,050

226
Q

How many deaths from pancreatic cancer in the US (2023)?

A

50,550

227
Q

What is the third leading cause of cancer death in the US?

A

Pancreatic cancer

228
Q

Age of onset for pancreatic cancer?

A

60-80 y/o

229
Q

2 main cell types for pancreatic cancer?

A

Exocrine cells (>95% of PC)
Endocrine cells (Rare, 5% of PC)

230
Q

What type of tumor arises from exocrine pancreatic cells?

A

85% adenocarcinoma **MC PC TUMOR

231
Q

What type of tumor arises from endocrine pancreatic cells?

A

Pancreatic neuroendocrine tumors (PNETs)

232
Q

MC location for Pancreatic adenocarcinoma?

A

Head of pancreas

233
Q

PNETs are characterized by what?

A

Hormones they secrete

234
Q

Types of PNETs?

A

-Gastrinomas: too much gastrin secretion (Zollinger Ellis Syndrome)
-Insulinomas: too much insulin secretion (causes hypoglycemia)

235
Q

Risk factors of pancreatic cancer?

A

Smoking**, Age >55, heavy alcohol use*, chronic pancreatitis, diabetes, obesity/inactivity, male gender, African American race

236
Q

Pancreatic exocrine cancer symptoms?

A

Vague insidious onset of significant weight loss, mid-epigastric pain often w/ radiation to mid-back of flank w/ insidious onset, jaundice, pruritus, tea colored urine, clay colored stool

237
Q

Pancreatic exocrine cancer mid-epigastric pain/radiation to mid-back/flank characteristics?

A

Insidious onset, Night time pain predominant complaint, Worse w/ eating, Improved w/ sitting up or leaning forward if tumor in body or tail

238
Q

Is it common to have early signs/symptoms in pancreatic exocrine cancer?

A

No, rare symptoms

239
Q

Early physical exam findings of pancreatic exocrine cancer?

A

Jaundice, Courvoisier sign (13%), skin excoriation from unrelenting pruritus

240
Q

What is the Courvoiser sign?

A

Palpable/distended/non-tender gallbladder & jaundice

241
Q

Courvoiser sign is more common if pancreatic exocrine tumors are located where?

A

In the head of the pancreas due to location to CBD

242
Q

Physical exam findings for advancing pancreatic exocrine cancer?

A

Ascites, palpable abdominal mass, hepatomegaly, adenopathy

243
Q

Common sites for metastasis for pancreatic exocrine cancer?

A

Liver, peritoneum, lungs, bone

244
Q

Tumor marker lab tests for pancreatic cancer?

A

CA19-9 elevated 70-90%
*for monitoring progression/response to tx, not as a screening tool

245
Q

Best initial imaging for pancreatic cancer if jaundice is the presenting symptom?

A

US
(if positive for mass, proceed to CT)

246
Q

What does CT assess with pancreatic cancer?

A

Tumor extent, respectability, metastatic disease
*CT typical for pancreatic cancer

247
Q

When may a biopsy be unnecessary for pancreatic cancer?

A

If imaging provides enough info regarding respectability and patient is fit for surgical intervention

248
Q

If a CT is negative of inconclusive for pancreatic cancer, what is the next step for imaging?

A

ERCP (Endoscopic retrograde cholangiopancreatography) with stent if indicated for decompression of biliary tree and can biopsy lesion

249
Q

Staging for pancreatic cancer?

A

CT of chest, abdomen, pelvis
*abdomen/pelvis should have already been completed

250
Q

What is the only curative option for pancreatic cancer?

A

Surgery

251
Q

What % of pancreatic cancer is operable at dx?

A

20%

252
Q

Surgery for pancreatic cancer if tumor located in head of pancreas?

A

Pancreaticoduodenectomy (Whipple procedure): resection of pancreatic head, distal stomach, duodenum, gallbladder, common bile duct, and lymph nodes

253
Q

Surgery for pancreatic cancer if tumor located in body or tail of pancreas?

A

Resection of left side of pancreas and the spleen

254
Q

Treatment for stage 1&2 pancreatic cancer?

A

Surgery or clinical trial (post chemotherapy +/- radiation)

255
Q

Treatment for stage 3 pancreatic cancer?

A

Palliative surgical stenting, chemo, radiation

256
Q

Treatment for stage 4 pancreatic cancer?

A

Palliative treatment plan possibly including stenting/any of the following,
Good performance status: clinical trial, chemo/chemoradiation
Poor performance status: Single agent chemo

257
Q

Overall prognosis/5-year survival rate of pancreatic cancer?

A

Poor (10%)

ClinMed II Exam #4 GI (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions