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Clin Med III - Heme/Onc > GI Cancers > Flashcards

GI Cancers Flashcards

1
Q

How are GI cancers generally staged?

A

Depth of penetration and then degree of spread

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2
Q

What is the globally recognized staging of malignant tumors?

A

T - size of original tumor
N - lymph node invovlement
M - metastasis

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3
Q

Most GI cancers arise from what layer?

A

Epithelial

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4
Q

Most GI cancers are what type?

A

Adenocarcinoma

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5
Q

Upper and mid esophageal cancers are mostly what type?

A

Squamous cell

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6
Q

Risks for esophageal cancer?

A

Tobacco 10x

ETOH 100x

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7
Q

MC type of esophageal cancer in the US?

A

Adenocarcinoma of distal esophagus or GE junction

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8
Q

What is adenocarcinoma of the distal esophagus/GE junction a/w?

A
  • Reflux and dysplastic changes of mucosa

- Barrett Esophagus

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9
Q

Evaluation and staging of esophageal cancer

A
  • Barium swallow showing “esophageal shelf”
  • EGD w/biopsy
  • If cancer found, endoscopic ultrasound to stage depth of invasion
  • CT scan to look for mets
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10
Q

Treatment of T0/high grade dysplasia/T1 adenocarcinoma of esophagus?

A
  • Endoscopic ablation

- Esophageal resection

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11
Q

How do most cancers of the esophagus present?

A

At stages higher than T0/high grade dysplasia/T1 adenocarcinoma

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12
Q

Treatment of higher stages esophageal cancer?

A
  • RT or chemo-RT

- Stage IV: Palliative

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13
Q

Prognosis of T0 and T1 esophageal cancer

A

5 year survival is 98%

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14
Q

Prognosis of stage II and III esophageal cancer

A

Median survival is approx 4 years with tri-modality treatment of chemo-RT and then esophagectomy

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15
Q

Stage IV esophageal cancer prognosis

A

Median survival is approx 9 months

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16
Q

Where is gastric cancer a common problem?

A

Japan and some other areas of Asia

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17
Q

Risks for gastric cancer

A
  • Diets LOW in Vit A and C
  • Consumpton of smoked/cured foods
  • Tobacco
  • Untreated H. pylori
  • Genetic (Type A blood, pernicious anemia, HNPCC)
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18
Q

MC type of gastric cancer?

A

Adenocarcinoma (95% cases)

  • Diffuse infiltration (linitus plastica)
  • Polypoid or ulcerative masses (intestinal)
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19
Q

Clinical presentation of gastric cancer

A
  • Melena
  • Ascites of unclear etiology
  • Virchow’s node
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20
Q

What is needed for diagnosis of gastric cancer?

A

Endoscopic biopsy

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21
Q

What is Virchow’s node and what does it indicate?

A
  • L supraclavicular adenopathy

- Gastric, pancreatic cancer

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22
Q

Prevention of gastric cancer?

A
  • Screening EGD in endemic areas (e.g. Japan)

- Treat H. pylori infections

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23
Q

Treatment of Stage I-III gastric adenocarcinoma

A

Surgical resection

  • D1 in the US (and adjuvant chemo-RT)
  • D2 in Japan
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24
Q

When does gastric cancer typically present?

A

6th decade

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25
Q

Describe gastric lymphoma

A
  • Relatively rare
  • Submucosal or ulcerated mass
  • Histologically most are MALT
  • H. pylori etiology MC
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26
Q

Treatment of gastric lymphoma

A
  • Eradicate H. pylori
  • 75% will achieve CR with abx
  • High grade lymphomas are treated with multi-agent chemo (40-50% 5 yr survival)
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27
Q

MC type of small bowel cancer

A

Adenocarcinoma

28
Q

What types of small bowel cancer arise from polyps?

A

Autosomal dominant:

  • Gardener’s syndrome
  • Peutz-Jeghers syndrome
29
Q

What are carcinoid tumors of the small bowel?

A
  • Uncommon
  • Cancers of neuroendocrine cells
  • Mostly arise in distal ileum or appendix
30
Q

Treatment of carcinoid tumors of small bowel

A
  • Resection if localized

- Control endocrine manifestations if metastatic (octreotide)

31
Q

Where is colorectal cancer MC?

A

Western countries with high fat, low fiber diets

32
Q

NSAIDs and colorectal cancer

A

NSAIDs may be protective against colorectal cancer

33
Q

Genetic risks for colon cancer?

A
  • Familial Adenomatous Polyposis (FAP) syndrome

- HNPCC or Lynch syndromes

34
Q

Describe familial adenomatous polyposis

A
  • Autosomal dominant
  • Development of hundreds to thousands of adenomatous polyps in colon
  • Symptoms usually by 25 yo
  • Increased risk of colon cancer
35
Q

Initial treatment of patients with FAP or other familial syndromes?

A

Frequent colonoscopies

36
Q

Definitive treatment of FAP/other familial syndromes?

A

Total colectomy

37
Q

What can attenuate polyp formation?

A

NSAIDs and omega fatty acids

38
Q

How is Lynch Syndrome or HNPCC diagnosed?

A

Bethesda Criteria

39
Q

What are the Bethesda criteria?

A

Diagnose LS or HPNCC

  • 3 or more family members w/colon cancer (2 must be 1st degree relatives)
  • 2 successive generations w/colon cancer
  • 1 family member had colon cancer under 50 yo
  • NO FAP
  • 1 family member w/one of the extra-colonic cancers
40
Q

What are LS and HNPCC characterized by?

A

Microsatellite instability on immunohistochemical staining

41
Q

Colon cancers in HNPCC tend to occur:

A

Age 50 or less

42
Q

Primary prevention of colorectal cancer:

A
  • NSAIDs
  • High fiber, low fat diets
  • Ca, folic acid, Vit D?
  • Exercise?
  • HRT?
43
Q

Secondary prevention of colorectal cancer:

A

Screening to start at 50 yo (or 10 years under the age your 1st degree relative was diagnosed)

44
Q

Approved screening for colorectal cancer:

A
  • Annual DRE w/FOB
  • Flexible sigmoidoscopy every 5 yrs
  • Colonoscopy every 10 yrs
  • Double contrast Ba enema every 5 yrs
  • CT colonography every 5 yrs
45
Q

Drawback of flex sigmoidoscopy?

A

Can check bowel to approx 60 cm but 50% of colon cancers are R sided and cannot be reached by flex sig

46
Q

Presenting symptoms of colorectal cancer

A
  • Fe deficiency anemia in men or post-menopausal women
  • Stools positive for occult blood
  • Hematochezia
  • Change in bowel habits
  • Tenesmus
47
Q

What is essential for a curative outcome of colorectal cancer?

A

Complete resection of all cancer and regional lymph nodes

48
Q

What is the backbone of treatment for almost all GI cancers?

A

5-FU

49
Q

What is cancer of the anus associated with?

A
  • HPV
  • Genital warts and condyloma
  • MC in HIV
50
Q

CDC recommendations for HPV vaccination?

A

Males 11-21 yo

Females 11-26 yo

51
Q

Anal cancers are MC what type?

A

Squamous cell

52
Q

How are anal cancers staged?

A

Unlike other GI cancers, it is staged by diameter of tumor (T3 is over 5 cm) and LN involvement

53
Q

Preferred curative treatment for anal cancer?

A

Chemo (mitomycin C and 5FU) + RT

NOT surgery

54
Q

Prognosis of pancreatic cancer

A

90% inoperable at time of diagnosis

55
Q

What is Courvoisier’s sign?

A

Palpable gallbladder (sign of pancreatic cancer)

56
Q

What is Sister Mary Joseph Node?

A

Peritoneal carcinomatosis w/mets to umbilicus (sign of pancreatic cancer)

57
Q

Where does hepatocellular carcinoma MC occur?

A

Sub-Saharan Africa

China and other parts of Asia (western)

58
Q

What is hepatocellular carcinoma highly associated with?

A

Chronic hepatitis (HBV, HCV, ETOH)

59
Q

Etiology of hepatocellular carcinoma in poorer countries

A

Contaminated food (Aflatoxin B1 from Aspergillus)

60
Q

Treatment of hepatocellular carcinoma

A
  • If localized, partial hepatectomy
  • If more generalized, transplant
  • Chemo-RT
61
Q

What are pancreatic neuroendocrine cancers characterized by?

A

The hormones they secrete

  • Gastrinomas
  • VIPomas
  • Insulinomas
  • Glucagonomas
62
Q

Describe MEN1

A
  • Inherited syndrome of multiple endocrine neoplasms

- Pituitary adenomas, Parathyroid tumors, Pancreatic neuroendocrine tumors (PPP)

63
Q

Describe MEN2

A
  • Inherited syndrome

- Parathyroid tumors, Pheochromocytomas, Medullary thyroid cancer

64
Q

Describe gastrointestinal stromal cell tumors (GIST)

A

Unique sarcomas of GI tract

65
Q

MC form of GI sarcoma?

A

GIST

66
Q

GISTs arise mostly in:

A

Stomach or small intestine

67
Q

Treatment of GISTs

A
  • Surgical resection (most important)

- 3 yrs of adjuvant PO Imatinib

Clin Med III - Heme/Onc (8 decks)

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