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GI Final > GI Cancers -Rajurkar > Flashcards

GI Cancers -Rajurkar Flashcards

1
Q

***What are the common locations and risk factors for Squamous Esophageal Cancer and Adenocarcinoma of the Esophagus?

A

Squamous: MIDDLE esophagus.

  • smoking and alcohol
  • HPV
  • poor nutritional status
  • Plummer-Vinson Syndrome
  • Black people

Adenocarcinoma: DISTAL esophagus

  • GERD and Barrett’s
  • high BMI
  • White people
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2
Q

***What is required for definitive diagnosis of esophageal cancer? What is the staging based off of?

A

Endoscopic biopsy (endoscopy often shows stricture but not mass)

staging=TEE =tells you the depth of the cancer (more important than the size) –> determines treatment

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3
Q

How does a PET scan find cancer?

A

cancer consumes more glucose than normal cells

PET scan will light up cancer (and brain –> use MRI for brain cancer)

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4
Q

***What is the prognosis of most esophageal cancer? Treatment?

A

poor

Tx: Esophagectomy (early tumors); Palliative care w/ chemo (Stage IV)

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5
Q

Where is the highest occurrence of gastric cancer?

A

Japan =lots of smoked fish

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6
Q

*What is Menetrier disease? What is this a risk for?

A
  • protein-losing hypertrophic gastropathy
  • precancerous* for gastric cancer
  • protein loss–> hypoalbuminemia
  • hypertrophy
  • parietal cell atrophy
  • inc mucosal epithelial cells
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7
Q

What is the pathophysiology of Menetrier disease?

A

↑TGF-alpha → bind & activate EGFR → ↑EGFR activivty → ↑proliferation of gastric mucosal epithelial cells → giant mucosal folds

TGF-alpha also inhibit parietal cells → parietal atrophy → ↓ gastric secretion

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8
Q

What are some paraneoplastic manifestations of Gastric Cancer?

A
  • Acanthosis nigricans
  • Leser-Trelat sign: Multiple pigmented skin lesions
  • Trousseau’s syndrome
  • Hypercoagulable state –> migratory thrombophlebitis
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9
Q

***What are the 2 types of gastric adenocarcinoma (most common gastric cancer)? What are their key features and which one is associated with H. pylori?

A
  1. Intestinal
    - associated with H. pylori
    - irregular ulcer with raised margins
  2. Diffuse
    - Signet ring cells
    - Linitis plastica
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10
Q

***What is a predisposing condition for Gastric Lymphoma?

A

H. pylori

stomach is most common extranodal site of lymphoma

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11
Q

***How is gastric cancer diagnosed? Staged? Treatment?

A
  • diagnosed by endoscopy with biopsy
  • staged with abd CT scan
  • Tx: sx resection w/ adjunct chemo
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12
Q

Any pt with iron deficiency has _____ until proven otherwise

A

colon cancer (or gastric or esophageal)

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13
Q

***How will colon cancer on the left side present? What about the right side?

A

left=anemia (more common in the ascending colon)

left=obstruction

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14
Q

***What is the most common colon and rectum cancer?

A

adenocarcinoma

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15
Q

***What is Familial Adenomatous Polyposis (FAP)? What is the mutation? What is recommended?

A
  • thousands of polyps at a young age
  • Autosomal dominant mutation of APC gene (Chromosome 5q)–> inc proliferation

-prophylactic colectomy is recommended (100% progress to CRC by age 40)

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16
Q

***What is the mutation associated with Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome)? What other malignancies are these patients at increased risk for?

A

-DNA mismatch repair (MMR) gene mutation

  • endometrial cancer*
  • ureter cancer
17
Q

If a pt presents with ureter cancer, what should you suspect?

A

think Lynch syndrome bcasuse ureter cancer is very uncommon

18
Q

***What is Peutz-Jeghers Syndrome? What PE finding will be seen?

A

Multiple nonmalignant hamartomas throughout GI tract

Hyperpigmentation at mouth, lips, hands, genitalia

19
Q

***What is Gardener’s Syndrome?

A
  • Polyps + osseous and soft tissue tumors

- Osteoma of skull & mandible

20
Q

***What is Turcot’s Syndrome?

A

Polyps + CNS tumors (cerebellar medulloblastoma or glioblastoma multiforme)

21
Q

What is the most sensitive and specific test for colon and rectum cancer?

A

colonoscopy

22
Q

***Can CEA tumor marker be a useful diagnostic screening tool?

A

NO! Not sensitive or specific

goof for treatment assessment and suspicion of reoccurrence

23
Q

***How should you screen for colon and rectum cancer? What age range should be screened?

A
  • adults 50 – 75 year-old. (or 10 years earlier than age of family member’s cancer)
  • Sigmoidoscopy + sensitivity fecal occult blood testing every 5 years

OR

-Colonoscopy at intervals of 10 years.

Recommends against screening for adults > 76 year-old

24
Q

***How often should colonoscopies be performed on a pt who has a history of colon cancer?

A

Colonoscopy at 1 year after resection, then 3 years, then every 5 years

25
Q

***At what age should FAP pts be screened for colon cancer?

A

Sigmoidoscopy or colonoscopy at age 12 every year

26
Q

What is the only curative modality for treatment of localized colon cancer?

A

Surgical resection

27
Q

***What is the most common type of anal cancer (anal canal and anal margin)? Risk factors? How are these treated?

A

-squamous cell carcinoma
-risk factors: similar to genital malignancies so anal sex, HPV, HIV
-*treated with chemo and radiation
(anal cancer is rare)

28
Q

***How is adenocarcinoma of the anal canal treated?

A

Surgery

29
Q

What are the clinical features of hepatocellular carcinoma? (2nd leading cause of cancer-related death in the world)

A
  • Abdominal pain
  • Hepatomegaly
  • Weight loss, anorexia, fatigue
  • Symptoms of chronic liver disease: (Portal HTN, Ascites, Jaundice , Splenomegaly)
  • Paraneoplastic syndrome: (Erythrocytosis, hypercalcemia, hypoglycemia, Severe watery diarrhea)
30
Q

***What tumor marker will be elevated in HCC?

A

AFP

31
Q

***If you have a AFP >500 and a known liver mass, do you need a biopsy to diagnose HCC?

A

NO!

32
Q

What is Trousseau’s Syndrome? What can this be a sign of?

A
  • Migratory thrombophlebitis

- Pancreatic cancer (Adenocarcinoma= Most common; most are from endocrine pancreas)

33
Q

***If pancreatic cancer is suspected, what test should be done first? What does it mean if this is negative?

A

CA19-9

if negative, does not rule out cancer

check CEA

34
Q

***What does the prognosis of pancreatic cancer depend on?

A

the SIZE of the cancer, not the depth

35
Q

What is the treatment for pancreatic cancer?

A 
Whipple procedure (pancreaticoduodenectomy)
-super poor prognosis, most present in stage III or IV

GI Final (18 decks)

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