GI Cancer Flashcards
1
Q
2 main histological types of esophageal cancer?
A
Adenocarcinoma, Squamous cell carcinoma
2
Q
Most common type of esophageal cancer in the US?
A
Adenocarcinoma (>60%)
3
Q
Most common type of esophageal cancer worldwide?
A
Squamous cell carcinoma
4
Q
What area is known as the esophageal cancer belt?
A
Northern Iran through Central Asia to North China
5
Q
Worldwide risk factors of Squamous cell carcinoma?
A
Poor nutritional status, low fruits and veggies, drinking hot beverages, HPV infection
6
Q
Peak age of diagnosis for esophageal cancer?
A
50-70 y/o
7
Q
Is esophageal cancer more common in males or females?
A
Males>Females
8
Q
Which type of esophageal cancer is more common in African American males?
A
Squamous cell carcinoma
9
Q
Which type of esophageal cancer is more common in Caucasian males?
A
Adenocarcinoma
10
Q
Location of Squamous cell carcinoma esophageal cancer?
A
Upper 2/3 of esophagus
11
Q
Location of Adenocarcinoma esophageal cancer?
A
Lower 1/3 of esophagus near EGJ (esophagogastric junction)
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)
13
Q
Major risk factors for Adenocarcinoma esophageal cancer?
A
**Barrett’s esophagus, *GERD, obesity, smoking
14
Q
Possible protective benefit of what meds in Adenocarcinoma esophageal cancer, particularly in those with Barrett’s?
A
ASA and NSAIDs
15
Q
Pathophys of Adenocarcinoma esophageal cancer?
A
Gastroesophageal reflux –>Metaplasia –> Low-grade dysplasia –> High-grade dysplasia –> Adenocarcinoma
16
Q
Early on, patients with esophageal carcinoma have what symptoms?
A
Usually asymptomatic early on
17
Q
Most common Hallmark symptom of esophageal carcinoma?
A
Progressive dysphagia
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
19
Q
Hoarseness with esophageal carcinoma is d/t what?
A
Recurrent laryngeal nerve compression/damage
20
Q
What can tacheal-esophageal fistulas cause in esophageal carcinoma?
A
Aspiration of food
21
Q
With iron deficiency anemia secondary to blood loss in esophageal carcinoma, where is blood loss most common?
A
EGJ (esophagogastric junction)
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
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
24
Q
What is still necessary with barium contrast radiography testing for esophageal cancer?
A
Biopsy to confirm dx
25
What is the most accurate test for locoregional staging of esophageal cancer?
EUS (endoscopic ultrasound) - assesses depth of primary tumor penetration and metastatic nodes
26
Common areas for metastasis in esophageal cancer?
Spine, Lungs, Liver, Adrenal glands
27
What tests can be used for staging of distant metastatic spread of esophageal cancer?
CT of the abdomen/pelvis/chest or PET scan
28
Cornerstone of treatment for esophageal cancer?
Surgery
29
Treatment of esophageal cancer varies depending on what?
Disease stage
30
Stage 1-3 esophageal cancer treatment?
Endoscopic therapies (mucosal resection/ablation), Esophagectomy, chemo/radiation pre- or post- resection, immunotherapy if residual disease after resection/initial chemo/radiation
31
Chemo/raditation pre surgical resection for esophageal cancer AKA?
Neoadjuvant
32
Chemo/raditation post surgical resection for esophageal cancer AKA?
Adjuvant
33
Immunotherapy med for residual esophageal cancer?
Nivolumab (Opdivo)
34
Stage 4 esophageal cancer includes invasion of what?
Other solid organs
35
Treatment for stage 4 esophageal cancer?
Chemo +/- radiation w/ palliative support, Opdivo + chemo (FDA approved as of 2022 for unresectable cancer), palliative surgery/stenting
36
5-year survival rate for those with esophageal cancer of all stages?
20%
37
Has treatment of esophageal cancer improved?
Yes, has slowly improved (in 1960's/70's 5-year survival rate only 5%)
38
Recommended screening for esophageal cancer in the general population?
None recommended
39
Recommended screening for esophageal cancer in high risk patients with known Barrett's esophagus?
Current recommendation: surveillance EGD w/ biopsy every 3-5 years
40
How many new cases of gastric cancer diagnosed annually in the US?
26,500
41
Annual deaths resulting from gastric cancer in the US?
11,130
42
In which parts of the world is gastric cancer more common?
Korea, Japan, Chile, Venezuela
43
Median age at gastric cancer diagnosis?
64 y/o
44
Is gastric cancer more common in males or females?
Twice as common in males than females
45
>90% of gastric cancers are what type?
Adenocarcinoma
46
Other 2% of gastric cancers are what type?
Gastric lymphoma
47
Risk factor for gastric cancer?
***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
48
Pre-existing conditions that are risk factors for gastric cancer?
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)
49
Signs and symptoms of early gastric cancer?
Usually no associated sx
50
Signs and symptoms as gastric cancer progresses?
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
51
Physical exam findings of gastric cancer?
Weight loss, palpable enlarged stomach mass, melena or pallor from anemia/iron deficiency anemia
52
Most physical findings of gastric cancer are indicative of what?
Advanced metastatic disease
53
Common sites of metastasis with gastric cancer?
Liver, lungs, bones, ovaries
54
Hepatomegaly is indicative of metastasis of gastric cancer to what organ?
Mets in liver
55
Krukenberg tumor is indicative of metastasis of gastric cancer to what organ?
Mets in ovaries
56
Blumer shelf tumor is indicative of metastasis of gastric cancer to what organ?
Mets to caudal portion to the peritoneal cavity or pouch of douglas (area between rectum and uterus)
*palpable on exam
57
What is adenopathy?
lymphatic metastatic spread
58
Where is Virchow's node (adenopathy in gastric cancer)?
Left supraclavicular region
59
Where is the Irish node (adenopathy in gastric cancer)?
Left axillary region
60
Where is Sister Mary Joseph's node (adenopathy in gastric cancer)?
Umbilical region
61
Best initial test for gastric cancer diagnosis?
EGD (upper endoscopy)
Direct visualization w/ 95% accuracy for definitive dx
62
What is helpful in gastric cancer diagnosis if unable to pass endoscopy due to obstruction at proximal end?
Barium swallow (upper GI series)
*still need biopsy for dx
63
What imaging modality can be used to assess tumor depth and local node involvement in gastric cancer?
EUS (endoscopic ultrasound)
64
What imaging modality can be used to assess metastatic spread in gastric cancer?
CT of chest/abdomen/pelvis or PET scan
65
Principal therapy for gastric cancer?
Surgical resection
**ONLY POTENTIAL FOR CURE
66
Early-stage (Stage 1) gastric cancer treatment?
Endoscopic mucosal resection or surgery are standard options
67
Stage 2 & 3 gastric cancer treatment?
Surgery followed by post-chemoradiation
OR
Preoperative chemo w/ surgery followed by postop chemo
68
Stage 4 gastric cancer or surgically non-resectable disease treatment?
Chemoradiation, chemotherapy, palliative management
69
5-year survival rate for those with stomach cancer?
33%
70
5-year survival rate for gastric cancer reflects what?
Most stomach cancers are diagnosed after cancer has already metastasized
71
What is a result of gastric cancer having no early signs?
Often very late diagnosis
72
At diagnosis of gastric cancer 60% of cancers have already reached an advanced stage that does not allow for what?
Curative treatment
73
What type of gastric cancer has the best prognosis?
Early gastric cancer
74
How many new cases of Hepatocellular carcinoma diagnosed in the US in 2023?
41,210
75
How many deaths from hepatocellular carcinoma in the US in 2023?
29,380
76
Is hepatocellular carcinoma more common in men or women?
Men>women
77
80% of hepatocellular carcinoma cases are associated with what?
Underlying liver disease (HBV, HCV, chronic ETOH use, NASH - Nonalcoholic associated steatohepatitis)
78
HBV accounts for what % of hepatocellular carcinoma worldwide?
~55%
79
HCV accounts for what % of hepatocellular carcinoma worldwide?
20%
80
Mean age at dx for hepatocellular carcinoma?
Peaks at 70-75
However younger 50-60 y/o rising due to HBV & HCV
81
Main risk factor of hepatocellular carcinoma?
Cirrhosis (RF in 80% of cases)
82
Largest risk factor of hepatocellular carcinoma worldwide?
Chronic HBV and HCV infections
83
Other risk factors for hepatocellular carcinoma?
Alcoholic liver disease, nonalcoholic fatty liver disease (NAFLD, particularly NASH), Hereditary hemochromatosis, Aflatoxin
84
What is Aflatoxin?
Carcinogen produced by Aspergillus
85
Do patients with hepatocellular carcinoma usually have symptoms?
No, other than those related to their chronic liver disease
86
High suspicion of hepatocellular carcinoma in patients with known liver disease if what occurs?
Acute decompensation of their known liver disease
87
Advanced disease hepatocellular carcinoma symptoms?
Upper abdominal pain, hepatomegaly, anorexia, weight loss, jaundice, ascites
88
High risk populations for hepatocellular carcinoma?
Chronic HBV/HCV, Cirrhosis, Fibrosis
89
Screening for hepatocellular carcinoma in high risk populations?
Ultrasound every 6 months
+/- AFP levels (alpha fetoprotein) every 6 months in addition to ultrasound
90
Do normal AFP levels exclude hepatocellular carcinoma in high risk screening?
No
91
Cancer-marker labs for hepatocellular carcinoma?
AFP (alpha-fetoprotein)
92
Which lab values for AFP should trigger workup for hepatocellular carcinoma?
>20ng/mL
93
Which lab values for AFP are nearly diagnostic for hepatocellular carcinoma in high risk patients?
>400-500ng/mL
94
Best initial diagnostic imaging for hepatocellular carcinoma?
Ultrasound (RUQ)
95
Confirmatory testing if radiological hallmarks of hepatocellular carcinoma are seen in high-risk patients?
Multiphase contrast MRI or Abdominal CT
96
What does multiphase contrast MRI/abdominal CT capture in hepatocellular carcinoma?
Hypervascular nature of the nodule/mass
97
What can a liver biopsy provide for hepatocellular carcinoma?
Definitive diagnosis (but not always needed for dx)
98
Liver biopsy carries the risk for what?
Bleeding and hepatocellular carcinoma tumor spread
99
When is liver biopsy recommended in hepatocellular carcinoma?
Only when imaging studies are inconclusive
100
In general all treatment for HCC is based on what two factors?
Tumor extent/stage, Severity of underlying liver disease
101
Surgical resection of HCC is the best choice in which cases?
Tumors generally <5cm & localized disease, absence of cirrhosis
102
Surgical resection of liver tumors up to what amount can be tolerated?
up to 50% of total liver volume
103
Operative mortality of HCC in experienced centers?
less than 2%
104
Long-term relapse free survival rate after HCC resection?
Approximately 40%
105
Why is liver transplant limited in HCC?
Limited donors w/ healthy organs, only 5% of recipients appropriate for transplant at time of dx
106
5-year survival rate after liver transplant for HCC?
>75%
107
Recurrence rates after liver transplant for HCC?
As low as 15% at 5 years
108
HCC non-surgical treatment options?
Loco-regional therapy (Radiofrequency ablation, Transcatheter arterial chemoembolization), Systemic therapy, Supportive care
109
What is radiofrequency ablation for HCC?
Local application of radiofrequency thermal energy to HCC lesion (more often w/ smaller tumors < 3cm)
110
What is transcatheter arterial chemoembolization (TACE) for HCC?
Chemo and an embolic agent directly through artery feeding the tumor (more often w/ large unresectable HCC)
111
Systemic therapy for HCC?
Sorafenib: molecular targeted therapy
Atezolizumab + bevacizumab: immunotherapy
112
When is supportive care for HCC indicated?
Poor functional status patients who are not candidates for surgical/local tx
113
Prognosis of HCC is based on what?
Stage at time of dx and if patient is eligible for resection or transplant
114
How many HCC patients are surgical candidates at time of diagnosis?
~5%
115
General 5-year survival rate of HCC in the US?
18%
116
Median survival time after diagnosis of HCC?
Generally 6-20 months
117
What are the two types of biliary tract carcinomas?
Gallbladder cancer and cholangiocarcinoma (bile duct cancer)
118
Incidence of gallbladder cancer (GBC) in the US annually?
~4,000 cases
119
Is GBC more common in males or females?
Females (>65 y/o, caucasian)
120
Mean age at onset of GBC?
70 y/o
121
Prognosis of GBC?
Highly fatal (only 1/5 cases found early)
122
How many cases of bile duct cancer in the US annually?
~8,000 cases (rare)
123
Is bile duct cancer more common in males or females?
Males
124
Bile duct cancer usual age of diagnosis?
50-70 y/o
125
Bile duct cancer can be seen in younger patients with a history of what?
Primary sclerosing cholangitis or choledochal cysts
126
Prognosis of bile duct cancer?
Highly fatal (usually diagnosed late)
127
What is a common cause of chronic gallbladder inflammation?
Gallstones (MC risk factor of GBC)
128
GBC risk factors?
Gallstones, porcelain gallbladder, chronic infection, gallbladder polyps
129
What is porcelain gallbladder?
Chronic cholecystitis (chronic inflammation) leading to calcification of the GB wall
*rare
130
Porcelain gallbladder increases risk of GBC by what percentage?
50%
131
Which chronic infections increase the risk of GBC?
Chronic cholecystitis, chronic cholangitis
132
Gallbladder polyps of what size have the highest risk of GBC?
>1cm
133
Risk factors for bile duct cancer?
Inflammatory conditions, bile duct abnormalities, parasitic infestations (liver flukes)
134
Parasitic inflammation/liver flukes are a major risk factor of bile duct cancer in what global area?
Southeast Asia (from undercooked fish)
135
What bile duct abnormalities are risk factors for bile duct cancer?
Bile duct adenoma, bile duct stones
136
What is Primary sclerosing cholangitis (PSC)?
(risk factor for bile duct cancer)
Inflammatory disorder of biliary tree leading to fibrosis & stricture of bile ducts
137
PSC has a strong association with what condition?
IBD (ex. ulcerative colitis)
138
What are congenital choledochal cysts?
(risk factor for bile duct cancer)
Dilation of ducts leading to chronic inflammation
139
Many of the signs and symptoms of GBC and bile duct cancer ________?
overlap
140
Do early stage biliary tract cancer patients often have symptoms?
No, usually asymptomatic
141
Signs and symptoms of biliary tract carcinomas?
RUQ/epigastric pain (MC in GBC), painless jaundice (MC in bile duct cancer), N/V, anorexia, abdominal bloating, weight loss
142
Appearance of urine/stool with bile duct cancer?
Tea colored urine, clay colored stool
143
Why does pruritis occur with bile duct cancer?
Buildup of bile salts and bilirubin in the body which collects in the skin
144
Physical exam characteristics that may be present with biliary tract carcinomas?
+/- jaundice, abdominal mass, palpable gallbladder in setting of painless jaundice (Courvoisier sign)
145
Non-diagnostic/non-specific lab studies for biliary tract carcinomas?
Elevated transaminases (ALT & AST), ALP elevated in cholestatic picture (obstruction d/t tumor), elevated bilirubin
146
Tumor markers for bile duct carcinoma?
CA 19-9 (carbohydrate antigen) elevated in up to 85% of cases, possible CEA elevation
*Levels can be utilized to monitor therapy
147
If tumor markers are elevated in bile duct carcinoma, what does this usually mean for prognosis?
Poor overall prognosis
148
Best initial test for biliary tract carcinoma dx?
RUQ US
149
What can RUQ US detect in biliary carcinomas?
Obstruction (tumor pathology or stones), Dilitation (biliary tree and/or gallbladder), Masses (may miss small lesions w/in ducts)
150
What test is recommended to assist with diagnosis, extent of tumor, and plan management of biliary tract cancers?
MRCP (Magnetic resonance choliangiopancreatography) or MDCT (Multidector computed tomography)
151
Which test can be used for staging of biliary tract carcinomas?
CT of chest & abdomen or PET scan
152
Common sites of metastasis of biliary tract cancer?
Lungs, pleura, liver
153
Is biopsy usually necessary in GBC?
No, typically will proceed directly to surgical removal
154
What can ERCP (Endoscopic retrograde cholangiography) be used for with biliary tract carcinoma?
Stent placement if obstruction of tumor is present, biopsy can be done (extrahepatic bx easier than intrahepaic & perihilar region)
155
What is the only potential curative option for GBC?
Surgical resection
156
Resectable disease is present in about what percentage of bile duct tract cancers?
<10% (other 90% non-resectable)
157
Treatment of resectable bile duct cancer with margins (+) positive nodes?
Resection and post chemoradiation or clinical trial
158
Treatment of resectable bile duct cancer with margins (-) ?
Adjuvant chemotherapy (Xeloda)
159
Treatment for unresectable bile duct cancer?
Palliative: Chemo, Stenting, TACE (transarterial chemoembolization), Clinical trial
160
Prognosis/5-year survival rate for extrahepatic bile duct cancer?
10%
(9% in the US)
161
Prognosis/5-year survival rate for perihilar region bile duct cancer?
10-30%
162
What % of patients with Stage 1 and 2 GBC have symptoms?
<10%
163
What % of patients are diagnosed incidentally with cholecystectomy & have early-stage GBC?
20%
164
Treatment for Stage 1&2 GBC?
Surgical resection
165
Treatment for Stage 3&4 GBC?
Clinical trials, chemo+radiation, palliative chemotherapy alone
166
Prognosis/5-year survival rate of GBC?
19%
167
Most common GI cancer?
Colorectal cancer
168
How many people will be diagnosed w/ colorectal cancer in their lifetime?
1 in 20
169
What is the 3rd most common cancer in females and males in the US?
Colorectal cancer
170
What is the second leading cause of cancer deaths in the US?
Colorectal cancer
171
How many new cases of colorectal cancer diagnosed in 2023?
106,970 colon only
46,050 rectal
172
Combined deaths from colorectal cancer in 2023?
52,550
173
Colorectal cancer mean age of diagnosis?
68 y/o
*risk increases with age
174
Rise of colorectal cancers are being seen at what age?
Younger patients <50y/o
(decline in past few years in patients >50)
175
Is colorectal cancer more common in males or females?
males
176
Overall, >95% of colorectal cancers are what type?
Adenocarcinomas that arise from adenomatous polyps
177
Risk factors for colorectal cancer?
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
Hereditary conditions that increase the risk of colorectal cancer?
Familial adenomatous polyposis (FAP), Lynch syndrome (aka hereditary nonpolyposis colorectal cancer)
179
Protective factors against colorectal cancer?
Physical activity, regular NSAID/ASA use
180
What type of condition is FAP?
Relatively rare autosomal dominant condition causing hundreds to thousands of adenomatous polyps in the colon & rectum
181
FAP accounts for what % of colorectal cancer?
<1%
182
When do polyps show up in FAP?
Show up at puberty, almost always symptomatic at 16 y/o
183
Cause of FAP?
Mutation in the tumor suppression gene APC (Adenomatous polyposis coli)
184
Screening for colorectal cancer w/ FAP dx per ASCO (American Society of Clinical Oncology)?
Colonoscopy/sigmoidoscopy at 10-12 y/o every 1-2 years
*once polyps are found: yearly colonoscopy until resection
185
If FAP remains untreated by age 40-45, what is the risk of developing colon cancer?
100%
186
Treatment for FAP?
Prophylactic colectomy
187
What is the most common form of hereditary colorectal cancer?
Lynch Syndrome (HNPCC) - 75,000 new cases annually
188
Lynch Syndrome (HNPCC) accounts for what % of cases of all colorectal cancer?
3%
189
Lynch Syndrome (HNPCC) accounts for what % colorectal cancer diagnoses each year in patients <50 y/o?
~8%
190
What is Lynch Syndrome (HNPCC)?
Inherited autosomal dominant disease caused by mutation in the DNA mismatch repair gene
191
Lynch Syndrome (HNPCC) increases the lifetime risk of developing colon cancer by how much?
up to 40%
192
Average age of colorectal cancer onset in those with Lynch Syndrome (HNPCC)?
48
193
ASCO screening recommendations for colorectal cancer in those with Lynch Syndrome (HNPCC)?
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
Clinical presentation of colorectal cancer will present in 1 of 3 ways:
1. asymptomatic found on routine screening
2. suspicious symptoms/signs
3. emergency admission due to obstruction, peritonitis, or lower GI bleed
195
Suspicious signs/symptoms for colorectal cancer?
Change in character of stool/bowel habits, hematochezia/melena, iron deficiency anemia, abd. tenderness, palpable abdominal/rectal mass
196
Proximal/Right side colorectal cancer symptoms?
Chronic bleeding: iron deficiency anemia, melena
197
Distal/Left side colorectal cancer symptoms?
Change in bowel habits: thiner caliber/constipation, intestinal obstruction/perf, colicky abdominal pain d/t obstruction, circumferential lesions w/ "apple core" appearance
198
Colorectal cancer is the most common cause of what condition in adults?
Large bowel obstruction
199
Symptoms of rectal cancer?
Rectal pain, hematochezia, tenesmus, decrease caliber of stools ("pencil shaped")
200
Is iron deficiency anemia more common in L or R sided colorectal cancer?
Right sided
201
Labs for colorectal cancer?
Rectal exam FOBT, CBC for iron deficiency anemia
202
If iron deficiency anemia is absent on CBC, does it exclude colon cancer?
No
203
Gold standard diagnostic for suspicion of colorectal cancer?
Colonoscopy (allows biopsy, removal of polyps)
*requires prep
204
If colonoscopy is incomplete due to poor prep, what diagnostic modality can be used for colorectal cancer?
CT colonography
*also requires prep
*does not allow for bx
205
What diagnostic modality is only appropriate if colorectal cancer mass is palpable on DRE?
Flex sigmoidoscopy
*may miss R sided lesions
206
If unable to complete colonoscopy (ex. d/t apple core lesions), what test can be used for colorectal cancer?
Barium enema
*does not allow for bx
207
Diagnostics for colorectal cancer following biopsy confirmation?
Cancer markers and staging
208
Cancer markers for colorectal cancer?
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
What can be used for determining metastasis/staging of colorectal cancer?
CT of chest, abdomen, pelvis
210
Most common sites of metastasis for colorectal cancer?
Liver** MC followed by lungs
211
Treatment for Stage 1 colorectal cancer?
Wide sugical resection
212
Treatment for Stage 2 colorectal cancer?
Surgical resection
(post-chemotherapy is controversial)
213
Treatment for Stage 3 colorectal cancer?
Wide surgical resection followed by chemotherapy
214
Treatment for Stage 4 colorectal cancer?
Chemotherapy combo regimen, immunotherapy agents, clinical trials *palliative tx plan
215
Standard treatment and only curative modality for colorectal cancer?
Surgery
216
5-year survival rate of stage 1 colorectal cancer?
75-90%
217
5-year survival rate of stage 2 colorectal cancer?
45-65%
218
5-year survival rate of stage 3 colorectal cancer?
30-70%
219
5-year survival rate of stage 4 colorectal cancer?
6-13%
220
Poor prognostic factors of colorectal cancer?
Advanced age, bowel obstruction/perf at diagnosis, elevated preoperative CEA levels
221
Colorectal cancer screening guidelines for average risk patients?
Starting at age 45 continuing to 75
-colonoscopy q10 years *** GOLD STANDARD
222
Other methods of colorectal cancer screening if colonoscopy not preferred/unable?
-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
Colorectal preventative screening guidelines for pts with family hx per NCCN as of 2021?
If first degree relative diagnosed w CRC, start screening at age 40 or 10 years prior to family member dx (whichever comes first)
224
Recommended screening for CRC per NCCN as of 2021?
Colonoscopy repeated every 5 yrs
If declined by patient: annual FIT should be offered
225
How many new cases of pancreatic cancer in the US (2023)?
64,050
226
How many deaths from pancreatic cancer in the US (2023)?
50,550
227
What is the third leading cause of cancer death in the US?
Pancreatic cancer
228
Age of onset for pancreatic cancer?
60-80 y/o
229
2 main cell types for pancreatic cancer?
Exocrine cells (>95% of PC)
Endocrine cells (Rare, 5% of PC)
230
What type of tumor arises from exocrine pancreatic cells?
85% adenocarcinoma **MC PC TUMOR
231
What type of tumor arises from endocrine pancreatic cells?
Pancreatic neuroendocrine tumors (PNETs)
232
MC location for Pancreatic adenocarcinoma?
Head of pancreas
233
PNETs are characterized by what?
Hormones they secrete
234
Types of PNETs?
-Gastrinomas: too much gastrin secretion (Zollinger Ellis Syndrome)
-Insulinomas: too much insulin secretion (causes hypoglycemia)
235
Risk factors of pancreatic cancer?
Smoking***, Age >55*, heavy alcohol use*, chronic pancreatitis, diabetes, obesity/inactivity, male gender, African American race
236
Pancreatic exocrine cancer symptoms?
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
Pancreatic exocrine cancer mid-epigastric pain/radiation to mid-back/flank characteristics?
Insidious onset, Night time pain predominant complaint, Worse w/ eating, Improved w/ sitting up or leaning forward if tumor in body or tail
238
Is it common to have early signs/symptoms in pancreatic exocrine cancer?
No, rare symptoms
239
Early physical exam findings of pancreatic exocrine cancer?
Jaundice, Courvoisier sign (13%), skin excoriation from unrelenting pruritus
240
What is the Courvoiser sign?
Palpable/distended/non-tender gallbladder & jaundice
241
Courvoiser sign is more common if pancreatic exocrine tumors are located where?
In the head of the pancreas due to location to CBD
242
Physical exam findings for advancing pancreatic exocrine cancer?
Ascites, palpable abdominal mass, hepatomegaly, adenopathy
243
Common sites for metastasis for pancreatic exocrine cancer?
Liver, peritoneum, lungs, bone
244
Tumor marker lab tests for pancreatic cancer?
CA19-9 elevated 70-90%
*for monitoring progression/response to tx, not as a screening tool
245
Best initial imaging for pancreatic cancer if jaundice is the presenting symptom?
US
(if positive for mass, proceed to CT)
246
What does CT assess with pancreatic cancer?
Tumor extent, respectability, metastatic disease
*CT typical for pancreatic cancer
247
When may a biopsy be unnecessary for pancreatic cancer?
If imaging provides enough info regarding respectability and patient is fit for surgical intervention
248
If a CT is negative of inconclusive for pancreatic cancer, what is the next step for imaging?
ERCP (Endoscopic retrograde cholangiopancreatography) with stent if indicated for decompression of biliary tree and can biopsy lesion
249
Staging for pancreatic cancer?
CT of chest, abdomen, pelvis
*abdomen/pelvis should have already been completed
250
What is the only curative option for pancreatic cancer?
Surgery
251
What % of pancreatic cancer is operable at dx?
20%
252
Surgery for pancreatic cancer if tumor located in head of pancreas?
Pancreaticoduodenectomy (Whipple procedure): resection of pancreatic head, distal stomach, duodenum, gallbladder, common bile duct, and lymph nodes
253
Surgery for pancreatic cancer if tumor located in body or tail of pancreas?
Resection of left side of pancreas and the spleen
254
Treatment for stage 1&2 pancreatic cancer?
Surgery or clinical trial (post chemotherapy +/- radiation)
255
Treatment for stage 3 pancreatic cancer?
Palliative surgical stenting, chemo, radiation
256
Treatment for stage 4 pancreatic cancer?
Palliative treatment plan possibly including stenting/any of the following,
Good performance status: clinical trial, chemo/chemoradiation
Poor performance status: Single agent chemo
257
Overall prognosis/5-year survival rate of pancreatic cancer?
Poor (10%)
