GI Cancers Flashcards
How are GI cancers generally staged?
Depth of penetration and then degree of spread
What is the globally recognized staging of malignant tumors?
T - size of original tumor
N - lymph node invovlement
M - metastasis
Most GI cancers arise from what layer?
Epithelial
Most GI cancers are what type?
Adenocarcinoma
Upper and mid esophageal cancers are mostly what type?
Squamous cell
Risks for esophageal cancer?
Tobacco 10x
ETOH 100x
MC type of esophageal cancer in the US?
Adenocarcinoma of distal esophagus or GE junction
What is adenocarcinoma of the distal esophagus/GE junction a/w?
- Reflux and dysplastic changes of mucosa
- Barrett Esophagus
Evaluation and staging of esophageal cancer
- Barium swallow showing “esophageal shelf”
- EGD w/biopsy
- If cancer found, endoscopic ultrasound to stage depth of invasion
- CT scan to look for mets
Treatment of T0/high grade dysplasia/T1 adenocarcinoma of esophagus?
- Endoscopic ablation
- Esophageal resection
How do most cancers of the esophagus present?
At stages higher than T0/high grade dysplasia/T1 adenocarcinoma
Treatment of higher stages esophageal cancer?
- RT or chemo-RT
- Stage IV: Palliative
Prognosis of T0 and T1 esophageal cancer
5 year survival is 98%
Prognosis of stage II and III esophageal cancer
Median survival is approx 4 years with tri-modality treatment of chemo-RT and then esophagectomy
Stage IV esophageal cancer prognosis
Median survival is approx 9 months
Where is gastric cancer a common problem?
Japan and some other areas of Asia
Risks for gastric cancer
- Diets LOW in Vit A and C
- Consumpton of smoked/cured foods
- Tobacco
- Untreated H. pylori
- Genetic (Type A blood, pernicious anemia, HNPCC)
MC type of gastric cancer?
Adenocarcinoma (95% cases)
- Diffuse infiltration (linitus plastica)
- Polypoid or ulcerative masses (intestinal)
Clinical presentation of gastric cancer
- Melena
- Ascites of unclear etiology
- Virchow’s node
What is needed for diagnosis of gastric cancer?
Endoscopic biopsy
What is Virchow’s node and what does it indicate?
- L supraclavicular adenopathy
- Gastric, pancreatic cancer
Prevention of gastric cancer?
- Screening EGD in endemic areas (e.g. Japan)
- Treat H. pylori infections
Treatment of Stage I-III gastric adenocarcinoma
Surgical resection
- D1 in the US (and adjuvant chemo-RT)
- D2 in Japan
When does gastric cancer typically present?
6th decade
Describe gastric lymphoma
- Relatively rare
- Submucosal or ulcerated mass
- Histologically most are MALT
- H. pylori etiology MC
Treatment of gastric lymphoma
- Eradicate H. pylori
- 75% will achieve CR with abx
- High grade lymphomas are treated with multi-agent chemo (40-50% 5 yr survival)
MC type of small bowel cancer
Adenocarcinoma
What types of small bowel cancer arise from polyps?
Autosomal dominant:
- Gardener’s syndrome
- Peutz-Jeghers syndrome
What are carcinoid tumors of the small bowel?
- Uncommon
- Cancers of neuroendocrine cells
- Mostly arise in distal ileum or appendix
Treatment of carcinoid tumors of small bowel
- Resection if localized
- Control endocrine manifestations if metastatic (octreotide)
Where is colorectal cancer MC?
Western countries with high fat, low fiber diets
NSAIDs and colorectal cancer
NSAIDs may be protective against colorectal cancer
Genetic risks for colon cancer?
- Familial Adenomatous Polyposis (FAP) syndrome
- HNPCC or Lynch syndromes
Describe familial adenomatous polyposis
- Autosomal dominant
- Development of hundreds to thousands of adenomatous polyps in colon
- Symptoms usually by 25 yo
- Increased risk of colon cancer
Initial treatment of patients with FAP or other familial syndromes?
Frequent colonoscopies
Definitive treatment of FAP/other familial syndromes?
Total colectomy
What can attenuate polyp formation?
NSAIDs and omega fatty acids
How is Lynch Syndrome or HNPCC diagnosed?
Bethesda Criteria
What are the Bethesda criteria?
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
What are LS and HNPCC characterized by?
Microsatellite instability on immunohistochemical staining
Colon cancers in HNPCC tend to occur:
Age 50 or less
Primary prevention of colorectal cancer:
- NSAIDs
- High fiber, low fat diets
- Ca, folic acid, Vit D?
- Exercise?
- HRT?
Secondary prevention of colorectal cancer:
Screening to start at 50 yo (or 10 years under the age your 1st degree relative was diagnosed)
Approved screening for colorectal cancer:
- 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
Drawback of flex sigmoidoscopy?
Can check bowel to approx 60 cm but 50% of colon cancers are R sided and cannot be reached by flex sig
Presenting symptoms of colorectal cancer
- Fe deficiency anemia in men or post-menopausal women
- Stools positive for occult blood
- Hematochezia
- Change in bowel habits
- Tenesmus
What is essential for a curative outcome of colorectal cancer?
Complete resection of all cancer and regional lymph nodes
What is the backbone of treatment for almost all GI cancers?
5-FU
What is cancer of the anus associated with?
- HPV
- Genital warts and condyloma
- MC in HIV
CDC recommendations for HPV vaccination?
Males 11-21 yo
Females 11-26 yo
Anal cancers are MC what type?
Squamous cell
How are anal cancers staged?
Unlike other GI cancers, it is staged by diameter of tumor (T3 is over 5 cm) and LN involvement
Preferred curative treatment for anal cancer?
Chemo (mitomycin C and 5FU) + RT
NOT surgery
Prognosis of pancreatic cancer
90% inoperable at time of diagnosis
What is Courvoisier’s sign?
Palpable gallbladder (sign of pancreatic cancer)
What is Sister Mary Joseph Node?
Peritoneal carcinomatosis w/mets to umbilicus (sign of pancreatic cancer)
Where does hepatocellular carcinoma MC occur?
Sub-Saharan Africa
China and other parts of Asia (western)
What is hepatocellular carcinoma highly associated with?
Chronic hepatitis (HBV, HCV, ETOH)
Etiology of hepatocellular carcinoma in poorer countries
Contaminated food (Aflatoxin B1 from Aspergillus)
Treatment of hepatocellular carcinoma
- If localized, partial hepatectomy
- If more generalized, transplant
- Chemo-RT
What are pancreatic neuroendocrine cancers characterized by?
The hormones they secrete
- Gastrinomas
- VIPomas
- Insulinomas
- Glucagonomas
Describe MEN1
- Inherited syndrome of multiple endocrine neoplasms
- Pituitary adenomas, Parathyroid tumors, Pancreatic neuroendocrine tumors (PPP)
Describe MEN2
- Inherited syndrome
- Parathyroid tumors, Pheochromocytomas, Medullary thyroid cancer
Describe gastrointestinal stromal cell tumors (GIST)
Unique sarcomas of GI tract
MC form of GI sarcoma?
GIST
GISTs arise mostly in:
Stomach or small intestine
Treatment of GISTs
- Surgical resection (most important)
- 3 yrs of adjuvant PO Imatinib
