GI Cancers -Rajurkar Flashcards
***What are the common locations and risk factors for Squamous Esophageal Cancer and Adenocarcinoma of the Esophagus?
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
***What is required for definitive diagnosis of esophageal cancer? What is the staging based off of?
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
How does a PET scan find cancer?
cancer consumes more glucose than normal cells
PET scan will light up cancer (and brain –> use MRI for brain cancer)
***What is the prognosis of most esophageal cancer? Treatment?
poor
Tx: Esophagectomy (early tumors); Palliative care w/ chemo (Stage IV)
Where is the highest occurrence of gastric cancer?
Japan =lots of smoked fish
*What is Menetrier disease? What is this a risk for?
- protein-losing hypertrophic gastropathy
- precancerous* for gastric cancer
- protein loss–> hypoalbuminemia
- hypertrophy
- parietal cell atrophy
- inc mucosal epithelial cells
What is the pathophysiology of Menetrier disease?
↑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
What are some paraneoplastic manifestations of Gastric Cancer?
- Acanthosis nigricans
- Leser-Trelat sign: Multiple pigmented skin lesions
- Trousseau’s syndrome
- Hypercoagulable state –> migratory thrombophlebitis
***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?
- Intestinal
- associated with H. pylori
- irregular ulcer with raised margins - Diffuse
- Signet ring cells
- Linitis plastica
***What is a predisposing condition for Gastric Lymphoma?
H. pylori
stomach is most common extranodal site of lymphoma
***How is gastric cancer diagnosed? Staged? Treatment?
- diagnosed by endoscopy with biopsy
- staged with abd CT scan
- Tx: sx resection w/ adjunct chemo
Any pt with iron deficiency has _____ until proven otherwise
colon cancer (or gastric or esophageal)
***How will colon cancer on the left side present? What about the right side?
left=anemia (more common in the ascending colon)
left=obstruction
***What is the most common colon and rectum cancer?
adenocarcinoma
***What is Familial Adenomatous Polyposis (FAP)? What is the mutation? What is recommended?
- 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)
***What is the mutation associated with Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome)? What other malignancies are these patients at increased risk for?
-DNA mismatch repair (MMR) gene mutation
- endometrial cancer*
- ureter cancer
If a pt presents with ureter cancer, what should you suspect?
think Lynch syndrome bcasuse ureter cancer is very uncommon
***What is Peutz-Jeghers Syndrome? What PE finding will be seen?
Multiple nonmalignant hamartomas throughout GI tract
Hyperpigmentation at mouth, lips, hands, genitalia
***What is Gardener’s Syndrome?
- Polyps + osseous and soft tissue tumors
- Osteoma of skull & mandible
***What is Turcot’s Syndrome?
Polyps + CNS tumors (cerebellar medulloblastoma or glioblastoma multiforme)
What is the most sensitive and specific test for colon and rectum cancer?
colonoscopy
***Can CEA tumor marker be a useful diagnostic screening tool?
NO! Not sensitive or specific
goof for treatment assessment and suspicion of reoccurrence
***How should you screen for colon and rectum cancer? What age range should be screened?
- 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
***How often should colonoscopies be performed on a pt who has a history of colon cancer?
Colonoscopy at 1 year after resection, then 3 years, then every 5 years
***At what age should FAP pts be screened for colon cancer?
Sigmoidoscopy or colonoscopy at age 12 every year
What is the only curative modality for treatment of localized colon cancer?
Surgical resection
***What is the most common type of anal cancer (anal canal and anal margin)? Risk factors? How are these treated?
-squamous cell carcinoma
-risk factors: similar to genital malignancies so anal sex, HPV, HIV
-*treated with chemo and radiation
(anal cancer is rare)
***How is adenocarcinoma of the anal canal treated?
Surgery
What are the clinical features of hepatocellular carcinoma? (2nd leading cause of cancer-related death in the world)
- 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)
***What tumor marker will be elevated in HCC?
AFP
***If you have a AFP >500 and a known liver mass, do you need a biopsy to diagnose HCC?
NO!
What is Trousseau’s Syndrome? What can this be a sign of?
- Migratory thrombophlebitis
- Pancreatic cancer (Adenocarcinoma= Most common; most are from endocrine pancreas)
***If pancreatic cancer is suspected, what test should be done first? What does it mean if this is negative?
CA19-9
if negative, does not rule out cancer
check CEA
***What does the prognosis of pancreatic cancer depend on?
the SIZE of the cancer, not the depth
What is the treatment for pancreatic cancer?
Whipple procedure (pancreaticoduodenectomy) -super poor prognosis, most present in stage III or IV
