GI - GI Tract Tumors Flashcards
Describe the epithelium of the esophagus.
Non-keratinized stratified squamous epithelium
Which layer of the esophagus is the first to contain lymphatic vessels?
The submucosa
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.
Which two cancer types make up 99% of all esophageal malignancies?
- Adenocarcinoma
- Squamous cell carcinoma
Which esophageal malignancy shows an increased prevalence associated with HPV?
Squamous cell carcinoma
Which esophageal malignancy shows an increased prevalence associated with obesity?
Adenocarcinoma
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
After polyploid/exophytic (60%), what are the two most common morphologies of esophageal malignancies (25% and 15%, respectively)?
Ulcerated;
flat / diffuse
Which is the most dangerous morphology of esophageal malignancies (polyploid/exophytic, ulcerated, or flat/diffuse)?
Flat/diffuse;
insidious, with unnoticed spread
Barrett’s esophagus is associated with what malignancy?
Adenocarcinoma
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.
What are the three main patterns of esophageal malignancy invasion?
- Intra-esophageal
- Direct invasion of surrounding structures
- Lymphatic spread
________ esophageal malignancies may spread towards the head and neck.
Cervical esophageal malignancies may spread towards the head and neck.
________ esophageal malignancies may spread towards the chest.
Upper/mid esophageal malignancies may spread towards the chest.
________ esophageal malignancies may spread towards the abdomen.
Lower esophageal malignancies may spread towards the abdomen.
Esophageal cancers most commonly spread to which lymph nodes?
Retroperitoneal; celiac
Esophageal cancers most commonly spread to which non-lymphatic organs?
Liver;
lungs
Name a few general risk factors for esophageal malignancies.
Alcohol, smoking;
obesity;
HPV
Name a few risk factors (especially demographic) for squamous cell malignancies of the esophagus.
Lower socioeconomic status
African-Americans
Smoking, alcohol
Nitrous compounds
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
How can a leiomyoma of the esophagus be differentiated from an esophageal malignancy?
No epithelial involvement
A benign esophageal tumor that presents as a “floppy ball” that can block the airway might be a what?
A fibrovascular polyp
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.
Name the four main types of gastric malignancy.
- Carcinoma
- Lymphoma
- Carcinoid
- Malignant Stromal Tumor
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
