GI Cancers Flashcards
What are the 3 histological types of oral cancers?
Pleiomorphic Adenoma, Mucoepidermoid carcinoma, Warthin tumor.
Which salivary gland has the worst cancer prognosis?
Sublingual gland is 75% malignant tumors vs only 25% of the Parotid and 50% of Submandibular.
What percentage of Warthin tumors are malignant?
Only 10%.
Which nerve runs through the Parotid gland?
CN VII - Facial nerve.
If not resected entirely, what often occurs with a Pleiomorphic Adenoma?
It will often just regenerate from the tissue not resected entirely.
What are the two main types of Esophageal cancer?
Upper 2/3rds and larynx are Squamous Cell Carcinoma. Lower third is Adenocarcinoma, like most of the GIT.
What are Risk Factors for Esophageal cancer?
Achalasia is for both. Alcohol, Smoking, Hot liquids are RFs for SCCa. GERD is naturally the RF for Adenocarcinoma after the metaplasia to glandular mucosal and columnar cells has taken place.
What are the two types of Gastric Adenocarcinoma?
Intestinal is localized and appears as an ulcer with raised margins, usually found at the Lesser curvature of the stomach.
What are the RFs for Gastric Adenocarcinoma?
Nitrosamine ingestion from smoked foods (Scandinavia, Japan, Russia). Group A Blood type (that’s me!), Chronic gastritis with H. Pylori (though not in the diffuse linitis plastica type), and cigarette smoking. Also salty preserved foods diet.
Low socioeconomic status. And males have it at a ratio of 2:1 because they boars who eat anything except my Jeremy. jk.
Describe the Diffuse type of gastric Adenocarcinoma.
Presents with a diffuse leathery bottle thickened rigidity of the stomach. Has mucus-filled signet ring cells in which the nucleus has been pushed to the edge. It is highly aggressive and highly malignant. Not associated with H. Pylori. Most cases due to E-cadherin mutation.
Gastric Adenocarcinoma is 90% of stomach cancers. Which other types are in the 10% minority?
Lymphoma, GI stromal tumor, Carcinoid (especially rare).
Describe the Intestinal type of gastric adenocarcinoma.
Appears like an ulcer but with raised margins. Commonly on the lesser curvature of the stomach and highly associated with H. Pylori and smoked foods.
Name the 4 metastases of gastric cancer.
Virchow’s node is left supraclavicular lymph node from stomach. Umbilicus of Sister Mary Joseph is subcutaneous periumbilical metastasis. Krukenberg tumor is BILATERAL ovaries with abundant mucin secreting signet ring cells.
Then we have Bookshelf - oops, i mean Blumer shelf - a palpable mass on DRE suggesting metastasis to the rectouterine pouch of Douglas.
How does gastric cancer present?
Unfortunately late, like esophageal and pancreatic. Weight loss, abdominal pain, early satiety and in half of patients with acanthosis nigricans or Leser Trelat sign.
Describe Acanthosis Nigricans and what other times will you see it present.
MCC?
Simply hyperpigmented patches on the skin and thickened velvety body creases - under breasts, arms, groin, back and sides of neck.. More common to those of African, Hispanic, and Native American descent, oddly enough.
Discoloration can be light brown to deep gray or black (cow patch colors!). Usually a symmetrical distribution.
Seen in diabetics, hypothyroidism, PCOS, some pituitary disorders, and stomach cancer.
Corticosteroids ad Aripiprazole can cause it by affecting insulin. As can OCPs.
Too much insulin in the body is the MCC.
Not contagious, not harmful.
https://www.youtube.com/watch?v=T-8O1KcRx_k
What is the Leser-Trelat sign?
How are they removed?
Seborrheic Keratosis. Waxy, rough benign growths usually on the head, arm or trunk of the body. Looks stuck on as if you could pull it off.
Cryotherapy with liquid nitrogen is removal technique.
RET proto-oncogene encodes which receptor? Which chromosome is it on?
Which diseases is it implicated in with loss of function? What occurs with gain of function?
Tyrosine Kinase. Chromosome 10.
RET loss of function mutations are associated with the development of Hirschsprung’s disease.
While gain of function mutations are associated with the development of various cancer, including medullary thyroid carcinoma, MEN type 2A and 2B, pheochromocytoma and parathyroid hyperplasia.
What is the third most common cancer to both men and women?
Colon cancer.
What are the 3 shapes of colon polyps?
Pedunculated, Sessile (having no stalk), and Flat.
Mucosal and Submucosal polyps are generally what…
Benign. No threat.
Hamartomatous polyps are shaped how and made up of what?
What two conditions is it associated with?
Benign, pedunculated, disorganized mature cells. Not developmentally abnormal as in the case of cancer.
Peutz-Jeghers and Juvenile Polyposis. Despite the hamartomas being benign, these two do predispose the pt to colorectal cancer.
Inflammatory pseudopolyps are made up of what and associated with which disease?
Scar tissue and edema. IBD - esp UC.
Hyperplastic polyp vs Serrated polyp?
Low to moderate risk of cancer. Serrated polyp is definitely precancerous. Unfortunately both look like sawtooth crypts.
Hyperplastic tend to be tiny and under 5mm and found in the rectosigmoid region. They very rarely are on the right side but these have premalignant potential.
Pedunculated with cellular atypia is high risk and known as what type of polyp?
Adenomatous polyp with the villous type being the most malignant and tubular the third most malignant.
