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Gastroenterology yr 2 > GI malignancy > Flashcards

GI malignancy Flashcards

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1
Q

List 4 phases of gastric cancer progression

A

Chronic gastritis -> intestinal metaplasia –> dysplasia –> gastric cancer

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2
Q

4 risk factors for gastric cancer

A

1) High nitrate foods, high salt intake, low fruits/veg
2) Obesity
3) smoking
4) prior gastric sx

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3
Q

what is an important precursor to esophageal adenocarcinoma

A

barrett’s dysplasia

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4
Q

Clinical features of squamous cell carcinoma of the esophagus

A
  • Locally invasive -
  • ## upper 2/3 of esophagus
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5
Q

Clinical features of adenocarcinoma of the esophagus

A

lower 1/3

- nodes and liver mets

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6
Q

how do we diagnose eesophageal cancer

A

Endoscopy and biopsy

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7
Q

when is esophageal cancer resectable

A
  • no mets
  • no nodes
  • no invasion to adjacent organs
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8
Q

2 types of gastric adenocarcinoma

A
  • Intestinal

- diffuse

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9
Q

types of gastric cancer

A
  • adenocarcioma
  • lymphoid
  • carcinoid
  • GIST
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10
Q
  • Young - age of onset 39
  • Family Hx
  • mutation in E cadherin sometimes
    type of cancer?
A

gastric

- diffuse

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11
Q

histological features of intestinal type gastric adenocarcinoma

A
  • elevated mass
  • heaped up border
  • central ulcer
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12
Q

what is Linnitis plastica

A
  • thickened gastric wall, loss of rugal folds
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13
Q

What characterizes diffuse gastric cancer histologically

A
  • signet ring cells
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14
Q

Diffuse/signet ring gastric cancer defaults to which grading

A

G3 poorly differentiated

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15
Q

staging is based on 3 things

A

1- depth of infiltration
2- nodal met
3- distant met

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16
Q

Cancer that gives you

  • Fe def anemia
  • nausea
  • early satiety
  • achalasia-type picture
  • virchow’s node in metastatic spread
A

Gastric cancer

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17
Q

Early gastric cancer may present

A

as an ulcer

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18
Q

majority of cases of gastric cancer present

A

at a metastatic stage

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19
Q

man presents with 48 hours of melena

Blood work would include

A
  • CBC
  • lytes
  • urea
  • Ferritin
  • Creatinine
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20
Q

man presents with 48 hours of melena

3 imaging modalities to use

A

Gastroscopy
Colonoscopy
CT CAP

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21
Q

how would you treat a gastric carcinoma

A
  • chemo preop

- gastrectomy and esophagojejunostomy

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22
Q

Risk factors for pancreatic cancer

A
  • hereditary component
  • smoking/obesity
  • chronic pancreatitis
  • Diabetes
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23
Q

Most pancreatic carcinomas are of what origins

A

ductal origins

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24
Q

classic histological features of pancreatic cancer

A
  • infiltrative ductal glands, and a desmoplastic response - reactive soft tissue PERINEURAL invasion
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25
Stage 3 pancreatic cancer has
invaded to adjacent organs
26
Stage 4 pancreatic cancer has
involved the SMA or celiac axis
27
If pancreatic cancer is restricted to the head of the pancreas, first clinical symptom might be
Jaundice
28
If pancreatic cancer is restricted to the tail of the pancreas, first clinical symptom might be
- none, advanced - silent
29
when does pain occur in pancreatic cancer
- metastatic spread | - celiac axis invasion
30
what is a marker that can be used in pancreatic cancer
CA 19-9 - more sensitive than specific
31
would you biopsy a pancreatic cancer
- usually no, to avoid needle track invasion | instead FNA using ultrasound
32
what type of Sx performed for pancreatic cancer in head of pancreas
Whipple's
33
If someone presents with painless jaundice, pruritis, pale stool, dark urine what are your investigations?
- ERCP - Endo U/S - biopsy? - CT CAP
34
what is indicative of pancreatic ductal carcinoma histologically
- ducts near vessels | - light pink color indicating reactive soft tissue
35
Ddx for BRBPR
hemorrhoids proctitis polyps Col ca
36
3 types of colorectal cancer
adenocarcinoma lymphoma sarcoma
37
what workup do you need if someone presents with colorectal adenocarcinoma
1) microcytic anemia 2) Colonoscopy 3) Biopsy
38
Most cases of CRC are
sporadic
39
Biggest risk factor for CRC
- AGE - history of polyps - Family Hx - IBD - diet/obesity/sedentary
40
Classic histologic features of tubular adenoma Vs Villous adenoma
Dysplastic epithelium, less mucin, nuclei piling up | - Projections, nuclei piling up
41
High grade Colonic dysplasia is characterized by
- Nuclear atypia | - Architectural complexity, disorganized
42
Metastasis and the use of the term carcinoma is restricted to tumors that have
invaded the muscularis mucosae into the Submucosa
43
what % of colorectal carcinomas are adenocarcinomas
90%
44
The colonic signet ring cell is associated with
HNPCC
45
How are colorectal adenocarcinomas graded?
- based on number of glands - low grade, lots of glands!
46
Margins used in staging colorectal cancer
proximal | distal and RADIAL - mesorectum
47
If the tumor is < 1mm from radial margin
similar prognosis to being at the margin itself
48
what % of adenomatous polyps will turn into cancer
25% in 7-10 years
49
what is the method of screening for HNPCC
3,2,1 rule 3 relatives Span 2 generations 1 is a first degree relative
50
HNPCC commonly presents with compared with sporadic cases of CRC
right sided colonic involvement | vs left sided in sporadic
51
attenuated FAP spares
rectum
52
If you have no Fam Hx | 60 at diagnosis you are
Average risk = screen at 50 or 45 african descent - screen colonoscopy q 10 years - sigmoidoscopy q5-10 years - annual FOBT
53
If you have a Family Hx 1st degree relative < 60 at diagnosis or 2 first degree relatives
Screen 10 years younger than relative or at 40 | - Colonoscopy q 5 years
54
Screening for HNPCC is
q 2 years at 20-25 | yearly after 40
55
Screening in case of IBD
q 1-2 years, after 8 years colitis | biopsy throughout
56
what is the strongest predictor of survival in colorectal cancer
Nodal status
57
Negative nodes in CRC means c/w positive nodes
80% survival c/w 55%
58
what is used to determine the depth of invasion of the primary tumor
MRI
59
If a lesion goes through lamina propria and muscularis mucosa but not THROUGH submucosa - what stage is it at
T1
60
If a lesion goes through submucosa to muscularis propria- what stage is it at
T2
61
If a lesion goes through muscularis propria- what stage is it at
T3
62
what is the work up for blood work for CRC
- CEA - CBC - Cr - Ferritin
63
what is the work up for imaging for CRC
CT CAP Colonoscopy MRI
64
Adjuvant chemo after tumor is resected is used for..?
decrease risk of future mets
65
what is a curable surgically resectable negative margin disease
- 5 cm margins around tumor
66
Radiation BEFORE surgery in advanced disease decreases
risk of local recurrence | - DOES NOT improve survival
67
Chemotherapy before/after surgery is to
prevent distant mets
68
follow up for CRC
CT CAP q6 months yearly CEA q6 months Colonoscopy 1,3,5 years

Gastroenterology yr 2 (10 decks)

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