GI - GI Tract Tumors Flashcards by Jason Worley

Describe the epithelium of the esophagus.

Non-keratinized stratified squamous epithelium

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Which layer of the esophagus is the first to contain lymphatic vessels?

The submucosa

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Unlike abdominal organs, the esophagus lacks a ________, meaning it is easier for malignancies to invade surrounding structures.

Unlike abdominal organs, the esophagus lacks a serosa, meaning it is easier for malignancies to invade surrounding structures.

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Which two cancer types make up 99% of all esophageal malignancies?

Adenocarcinoma
Squamous cell carcinoma

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Which esophageal malignancy shows an increased prevalence associated with HPV?

Squamous cell carcinoma

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Which esophageal malignancy shows an increased prevalence associated with obesity?

Adenocarcinoma

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What is the most common morphology of esophageal malignancies (60%)?

Polypoid/exophytic;

a “protruding” type that grows into the lumen → can present as esophageal obstruction

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After polyploid/exophytic (60%), what are the two most common morphologies of esophageal malignancies (25% and 15%, respectively)?

Ulcerated;

flat / diffuse

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Which is the most dangerous morphology of esophageal malignancies (polyploid/exophytic, ulcerated, or flat/diffuse)?

Flat/diffuse;

insidious, with unnoticed spread

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Barrett’s esophagus is associated with what malignancy?

Adenocarcinoma

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In cases of Barrett’s esophagus, a higher degree of _____plasia leads to a higher risk of adenocarcinoma development.

In cases of Barrett’s esophagus, a higher degree of dysplasia leads to a higher risk of adenocarcinoma development.

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What are the three main patterns of esophageal malignancy invasion?

Intra-esophageal
Direct invasion of surrounding structures
Lymphatic spread

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________ esophageal malignancies may spread towards the head and neck.

Cervical esophageal malignancies may spread towards the head and neck.

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________ esophageal malignancies may spread towards the chest.

Upper/mid esophageal malignancies may spread towards the chest.

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________ esophageal malignancies may spread towards the abdomen.

Lower esophageal malignancies may spread towards the abdomen.

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Esophageal cancers most commonly spread to which lymph nodes?

Retroperitoneal; celiac

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Esophageal cancers most commonly spread to which non-lymphatic organs?

Liver;

lungs

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Name a few general risk factors for esophageal malignancies.

Alcohol, smoking;

obesity;

HPV

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Name a few risk factors (especially demographic) for squamous cell malignancies of the esophagus.

Lower socioeconomic status

African-Americans

Smoking, alcohol

Nitrous compounds

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Name a few risk factors (especially demographic) for adenocarcinomas of the esophagus.

Whites (5x higher incidence than African-Americans)

Men (8x higher incidence than women)

Age 45-65

GERD, Barrett’s esophagitis

Smoking, alcohol

H. pylori

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How can a leiomyoma of the esophagus be differentiated from an esophageal malignancy?

No epithelial involvement

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A benign esophageal tumor that presents as a “floppy ball” that can block the airway might be a what?

A fibrovascular polyp

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True/False.

Gastric cancer incidence is increasing due to an increase in the most common causes; e,g., H. pylori, gastric ulcers, etc.

False.

Gastric cancer incidence is decreasing due to a decrease in the most common causes; e,g., H. pylori, gastric ulcers, etc.

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Name the four main types of gastric malignancy.

Carcinoma
Lymphoma
Carcinoid
Malignant Stromal Tumor

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Half of gastric malignancies arise in what portion of the stomach?

The pyloric region

A quarter of gastric malignancies arise in what portion of the stomach?

The lesser curvature

Describe the histology of an intestinal-type gastric adenocarcinoma.

Polypoid/elevated; well-differentiated; expansile growth

Describe the histology of a diffuse-type gastric adenocarcinoma.

(**Linitis plastica** - poor prognosis) Ulcerated, fungating; poorly differentiated, infiltrative growth; **signet ring cells** (characteristic mucin vacuoles that displace the nucleus to the side)

**True/False**. Diffuse-type gastric adenocarcinomas (linitis plastica) are responsible for less than 5% of gastric adenocarcinomas.

True.

Describe the histology of a neuroendocrine-type gastric tumor.

Organoid arrangement; relatively uniform nuclei; “Salt and pepper chromatin pattern”

What are the divisions of neuroendocrine tumor?

Type I; Type II; Type III

Of the three types of neuroendocrine tumor, which is most common by far? Which is associated with pernicious anemia and gastrinemia?

Type I; type I

Of the three types of neuroendocrine tumor, which is associated with MEN-1 and Zollinger-Ellison syndrome?

Type II

Neuroendocrine tumors of the esophagus are usually what type(s)?

Carcinomas

Neuroendocrine tumors of the stomach are usually what type(s)?

Type I, II, and III

Neuroendocrine tumors of the duodenum are usually what type(s)?

**Gastrin**- or **somatostatin**-producing NETs

Carcinoid syndrome arises from what type of tumor?

Neuroendocrine

Which is more common, tumors of the small or large intestines?

Large

What are the most common benign tumors of the small intestine?

**Adenomas**, leiomyomas

How do colonic adenomas become adenocarcinomas?

Stepwise, multi-hit process (chromosome **5** ***Ras*** loss at ***18q*** loss at ***17p***)

What is the most common type of colonic adenoma?

**Tubular** (villous and tubulovillous are much more rare and aggressive)

Serrated colonic polyps are polyps showing _________ and epithelial _________ in a traditional adenoma.

Serrated colonic polyps are polyps showing **_hyperplasia_** and epithelial **_dysplasia_** in a traditional adenoma.

Serrated adenomas are more concerning for high grade dysplasia and cancer with spontaneous __________ (bleeding).

Serrated adenomas are more concerning for high grade dysplasia and cancer with spontaneous **_friability_** (bleeding).

Serrated adenomas represent the primary colonic pathway to malignancies that develop due to _____________ \_\_\_\_\_\_\_\_\_\_\_\_.

Serrated adenomas represent the primary colonic pathway to malignancies that develop due to **_microsatellite_** **_instability_**.

How can serrated colonic adenomas be differentiated from non-serrated?

Look at the base --- dilation and branching; more disorganized

A polyp with a stalk is known as \_\_\_\_\_\_\_\_\_\_. A polyp with no stalk is known as \_\_\_\_\_\_\_\_\_\_.

A polyp with a stalk is known as **_pedunculated_**. A polyp with no stalk is known as **_sessile_**.

Name a few risk factors (including demographic) for colonic adenocarcinoma.

African-Americans, smoking, obesity

Name a few protective factors against colorectal cancer.

High-fiber diet, whole grains, fruits and veggies, dairy products and Ca²⁺

When should colorectal cancer screening begin?

**50 years of age**, maybe 45 for African-Americans; OR 10 years before close relative's age at their diagnosis

What does the fecal immunohistochemical test (FIT) assess?

**Anti-hemoglobin antibodies** in the stool

The stool guaic test has a _____ sensitivity and specificity.

The stool guaic test has a **_low_** sensitivity and specificity.

Iron-deficiency anemia is especially associated with \_\_\_\_-sided colon cancer.

Iron-deficiency anemia is especially associated with **_left_**-sided colon cancer.

'Apple core lesions' are especially associated with \_\_\_\_-sided colon cancer.

'Apple core lesions' are especially associated with **_left_**-sided colon cancer.

Right colon cancers often exhibit what form of morphology?

Polypoid, exophytic fungating mass; centrally ulcerated with raise everted edge

Which typically has more symptoms, right- or left-sided colon cancer?

Left-sided

\_\_\_\_-sided colon cancer is often annular sclerosing and associated with bleeding.

**_Left_**-sided colon cancer is often annular sclerosing and associated with bleeding.

Name two colonic cancer syndromes.

Lynch Syndrome (HNPCC); familial adenomatous polyposis

Lynch Syndrome (HNPCC) follows what inheritance pattern?

Autosomal dominant

**Epidemiology**: Lynch Syndrome (HNPCC) causes 2% of all colon cancers. **Individual**: Affected individuals have a(n) \_\_\_\_% lifetime risk of colon cancer.

**Epidemiology**: Lynch Syndrome (HNPCC) causes 2% of colon all cancers. **Individual**: Affected individuals have an **_80_**% lifetime risk of colon cancer.

Lynch Syndrome (HNPCC) is associated with mutations in genes responsible for what?

The **mismatch repair system**

Lynch Syndrome (HNPCC) is associated with mutations in what specific gene(s)?

*MSH2*; *MLH1*

Lynch Syndrome (HNPCC) is associated with high rates of __________ instability.

Lynch Syndrome (HNPCC) is associated with high rates of **_microsatellite_** instability.

How is colon cancer screened for in patients with Lynch Syndrome (HNPCC)?

**Between 20 and 25; then, annually** *(or 10 years earlier than age of diagnosis of the youngest case in the family)*

What is the inheritance pattern for familial adenomatous polyposis?

Autosomal dominant

**True/False**. Familial adenomatous polyposis is associated with a variety of tumors besides colonic.

**True**. E.g. gastric polyps, thyroid cancer, congenital hypertrophy of the retinal pigmented epithelium, desmoid tumors, osteomas, etc.

Familial adenomatous polyposis is associated with mutation in the ____ gene on chromosome \_\_\_\_.

Familial adenomatous polyposis is associated with mutation in the ***_APC_*** gene on chromosome **_5_**.

How is colon cancer screened for in patients with familial adenomatous polyposis?

Annual colonoscopies starting at age 10

Name a syndrome very similar to familial adenomatous polyposis but that is autosomal recessive.

*MYH*-associated polyposis

What disorder is described below? A patient presents with **pigmented spots on lips and buccal mucosa** **+** **hamartomatous polyps in GI tract**.

Peutz-Jeghers

Peutz-Jeghers syndrome follows what inheritance pattern?

Autosomal dominant

**True/False**. Although Peutz-Jeghers syndrome is characterized by hamartomas of the GI tract, it can also present malignancies of the breast, colon, pancreas, and stomach.

True.

What syndrome is an autosomal dominant condition seen in children that increases their risk of colon cancer?

Juvenile polyposis syndrome

Over 50% of appendiceal tumors are what type of tumor?

Carcinoid