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T2 - Phase 2 - Systems Modules (III) > GI - GI Tract Tumors > Flashcards

GI - GI Tract Tumors Flashcards

1
Q

Describe the epithelium of the esophagus.

A

Non-keratinized stratified squamous epithelium

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2
Q

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

A

The submucosa

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3
Q

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

A

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

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4
Q

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

A
  1. Adenocarcinoma
  2. Squamous cell carcinoma
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5
Q

Which esophageal malignancy shows an increased prevalence associated with HPV?

A

Squamous cell carcinoma

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6
Q

Which esophageal malignancy shows an increased prevalence associated with obesity?

A

Adenocarcinoma

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7
Q

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

A

Polypoid/exophytic;

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

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8
Q

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

A

Ulcerated;

flat / diffuse

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9
Q

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

A

Flat/diffuse;

insidious, with unnoticed spread

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10
Q

Barrett’s esophagus is associated with what malignancy?

A

Adenocarcinoma

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11
Q

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

A

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

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12
Q

What are the three main patterns of esophageal malignancy invasion?

A
  1. Intra-esophageal
  2. Direct invasion of surrounding structures
  3. Lymphatic spread
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13
Q

________ esophageal malignancies may spread towards the head and neck.

A

Cervical esophageal malignancies may spread towards the head and neck.

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14
Q

________ esophageal malignancies may spread towards the chest.

A

Upper/mid esophageal malignancies may spread towards the chest.

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15
Q

________ esophageal malignancies may spread towards the abdomen.

A

Lower esophageal malignancies may spread towards the abdomen.

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16
Q

Esophageal cancers most commonly spread to which lymph nodes?

A

Retroperitoneal; celiac

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17
Q

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

A

Liver;

lungs

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18
Q

Name a few general risk factors for esophageal malignancies.

A

Alcohol, smoking;

obesity;

HPV

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19
Q

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

A

Lower socioeconomic status

African-Americans

Smoking, alcohol

Nitrous compounds

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20
Q

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

A

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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21
Q

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

A

No epithelial involvement

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22
Q

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

A

A fibrovascular polyp

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23
Q

True/False.

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

A

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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24
Q

Name the four main types of gastric malignancy.

A
  1. Carcinoma
  2. Lymphoma
  3. Carcinoid
  4. Malignant Stromal Tumor
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25
Q

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

A

The pyloric region

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26
Q

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

A

The lesser curvature

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27
Q

Describe the histology of an intestinal-type gastric adenocarcinoma.

A

Polypoid/elevated;

well-differentiated;

expansile growth

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28
Q

Describe the histology of a diffuse-type gastric adenocarcinoma.

A

(Linitis plastica - poor prognosis)

Ulcerated, fungating;

poorly differentiated, infiltrative growth;

signet ring cells (characteristic mucin vacuoles that displace the nucleus to the side)

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29
Q

True/False.

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

A

True.

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30
Q

Describe the histology of a neuroendocrine-type gastric tumor.

A

Organoid arrangement;

relatively uniform nuclei;

“Salt and pepper chromatin pattern”

31
Q

What are the divisions of neuroendocrine tumor?

A

Type I;

Type II;

Type III

32
Q

Of the three types of neuroendocrine tumor, which is most common by far?

Which is associated with pernicious anemia and gastrinemia?

A

Type I;

type I

33
Q

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

A

Type II

34
Q

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

A

Carcinomas

35
Q

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

A

Type I, II, and III

36
Q

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

A

Gastrin- or somatostatin-producing NETs

37
Q

Carcinoid syndrome arises from what type of tumor?

A

Neuroendocrine

38
Q

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

A

Large

39
Q

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

A

Adenomas,

leiomyomas

40
Q

How do colonic adenomas become adenocarcinomas?

A

Stepwise, multi-hit process

(chromosome 5

Ras

loss at 18q

loss at 17p)

41
Q

What is the most common type of colonic adenoma?

A

Tubular

(villous and tubulovillous are much more rare and aggressive)

42
Q

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

A

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

43
Q

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

A

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

44
Q

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

A

Serrated adenomas represent the primary colonic pathway to malignancies that develop due to microsatellite instability.

45
Q

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

A

Look at the base — dilation and branching; more disorganized

46
Q

A polyp with a stalk is known as __________.

A polyp with no stalk is known as __________.

A

A polyp with a stalk is known as pedunculated.

A polyp with no stalk is known as sessile.

47
Q

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

A

African-Americans, smoking, obesity

48
Q

Name a few protective factors against colorectal cancer.

A

High-fiber diet,

whole grains,

fruits and veggies,

dairy products and Ca2+

49
Q

When should colorectal cancer screening begin?

A

50 years of age,

maybe 45 for African-Americans;

OR

10 years before close relative’s age at their diagnosis

50
Q

What does the fecal immunohistochemical test (FIT) assess?

A

Anti-hemoglobin antibodies in the stool

51
Q

The stool guaic test has a _____ sensitivity and specificity.

A

The stool guaic test has a low sensitivity and specificity.

52
Q

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

A

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

53
Q

‘Apple core lesions’ are especially associated with ____-sided colon cancer.

A

‘Apple core lesions’ are especially associated with left-sided colon cancer.

54
Q

Right colon cancers often exhibit what form of morphology?

A

Polypoid, exophytic fungating mass;

centrally ulcerated with raise everted edge

55
Q

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

A

Left-sided

56
Q

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

A

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

57
Q

Name two colonic cancer syndromes.

A

Lynch Syndrome (HNPCC);

familial adenomatous polyposis

58
Q

Lynch Syndrome (HNPCC) follows what inheritance pattern?

A

Autosomal dominant

59
Q

Epidemiology: Lynch Syndrome (HNPCC) causes 2% of all colon cancers.

Individual: Affected individuals have a(n) ____% lifetime risk of colon cancer.

A

Epidemiology: Lynch Syndrome (HNPCC) causes 2% of colon all cancers.

Individual: Affected individuals have an 80% lifetime risk of colon cancer.

60
Q

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

A

The mismatch repair system

61
Q

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

A

MSH2; MLH1

62
Q

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

A

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

63
Q

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

A

Between 20 and 25; then, annually

(or 10 years earlier than age of diagnosis of the youngest case in the family)

64
Q

What is the inheritance pattern for familial adenomatous polyposis?

A

Autosomal dominant

65
Q

True/False.

Familial adenomatous polyposis is associated with a variety of tumors besides colonic.

A

True.

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

66
Q

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

A

Familial adenomatous polyposis is associated with mutation in the APC gene on chromosome 5.

67
Q

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

A

Annual colonoscopies starting at age 10

68
Q

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

A

MYH-associated polyposis

69
Q

What disorder is described below?

A patient presents with pigmented spots on lips and buccal mucosa

+

hamartomatous polyps in GI tract.

A

Peutz-Jeghers

70
Q

Peutz-Jeghers syndrome follows what inheritance pattern?

A

Autosomal dominant

71
Q

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.

A

True.

72
Q

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

A

Juvenile polyposis syndrome

73
Q

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

A

Carcinoid

T2 - Phase 2 - Systems Modules (III) (14 decks)

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