GI malignancy Flashcards
List 4 phases of gastric cancer progression
Chronic gastritis -> intestinal metaplasia –> dysplasia –> gastric cancer
4 risk factors for gastric cancer
1) High nitrate foods, high salt intake, low fruits/veg
2) Obesity
3) smoking
4) prior gastric sx
what is an important precursor to esophageal adenocarcinoma
barrett’s dysplasia
Clinical features of squamous cell carcinoma of the esophagus
- Locally invasive -
- ## upper 2/3 of esophagus
Clinical features of adenocarcinoma of the esophagus
lower 1/3
- nodes and liver mets
how do we diagnose eesophageal cancer
Endoscopy and biopsy
when is esophageal cancer resectable
- no mets
- no nodes
- no invasion to adjacent organs
2 types of gastric adenocarcinoma
- Intestinal
- diffuse
types of gastric cancer
- adenocarcioma
- lymphoid
- carcinoid
- GIST
- Young - age of onset 39
- Family Hx
- mutation in E cadherin sometimes
type of cancer?
gastric
- diffuse
histological features of intestinal type gastric adenocarcinoma
- elevated mass
- heaped up border
- central ulcer
what is Linnitis plastica
- thickened gastric wall, loss of rugal folds
What characterizes diffuse gastric cancer histologically
- signet ring cells
Diffuse/signet ring gastric cancer defaults to which grading
G3 poorly differentiated
staging is based on 3 things
1- depth of infiltration
2- nodal met
3- distant met
Cancer that gives you
- Fe def anemia
- nausea
- early satiety
- achalasia-type picture
- virchow’s node in metastatic spread
Gastric cancer
Early gastric cancer may present
as an ulcer
majority of cases of gastric cancer present
at a metastatic stage
man presents with 48 hours of melena
Blood work would include
- CBC
- lytes
- urea
- Ferritin
- Creatinine
man presents with 48 hours of melena
3 imaging modalities to use
Gastroscopy
Colonoscopy
CT CAP
how would you treat a gastric carcinoma
- chemo preop
- gastrectomy and esophagojejunostomy
Risk factors for pancreatic cancer
- hereditary component
- smoking/obesity
- chronic pancreatitis
- Diabetes
Most pancreatic carcinomas are of what origins
ductal origins
classic histological features of pancreatic cancer
- infiltrative ductal glands, and a desmoplastic response - reactive soft tissue PERINEURAL invasion
Stage 3 pancreatic cancer has
invaded to adjacent organs
Stage 4 pancreatic cancer has
involved the SMA or celiac axis
If pancreatic cancer is restricted to the head of the pancreas, first clinical symptom might be
Jaundice
If pancreatic cancer is restricted to the tail of the pancreas, first clinical symptom might be
- none, advanced - silent
when does pain occur in pancreatic cancer
- metastatic spread
- celiac axis invasion
what is a marker that can be used in pancreatic cancer
CA 19-9 - more sensitive than specific
would you biopsy a pancreatic cancer
- usually no, to avoid needle track invasion
instead FNA using ultrasound
what type of Sx performed for pancreatic cancer in head of pancreas
Whipple’s
If someone presents with painless jaundice, pruritis, pale stool, dark urine what are your investigations?
- ERCP
- Endo U/S
- biopsy?
- CT CAP
what is indicative of pancreatic ductal carcinoma histologically
- ducts near vessels
- light pink color indicating reactive soft tissue
Ddx for BRBPR
hemorrhoids
proctitis
polyps
Col ca
3 types of colorectal cancer
adenocarcinoma
lymphoma
sarcoma
what workup do you need if someone presents with colorectal adenocarcinoma
1) microcytic anemia
2) Colonoscopy
3) Biopsy
Most cases of CRC are
sporadic
Biggest risk factor for CRC
- AGE
- history of polyps
- Family Hx
- IBD
- diet/obesity/sedentary
Classic histologic features of tubular adenoma Vs Villous adenoma
Dysplastic epithelium, less mucin, nuclei piling up
- Projections, nuclei piling up
High grade Colonic dysplasia is characterized by
- Nuclear atypia
- Architectural complexity, disorganized
Metastasis and the use of the term carcinoma is restricted to tumors that have
invaded the muscularis mucosae into the Submucosa
what % of colorectal carcinomas are adenocarcinomas
90%
The colonic signet ring cell is associated with
HNPCC
How are colorectal adenocarcinomas graded?
- based on number of glands - low grade, lots of glands!
Margins used in staging colorectal cancer
proximal
distal and RADIAL - mesorectum
If the tumor is < 1mm from radial margin
similar prognosis to being at the margin itself
what % of adenomatous polyps will turn into cancer
25% in 7-10 years
what is the method of screening for HNPCC
3,2,1 rule
3 relatives
Span 2 generations
1 is a first degree relative
HNPCC commonly presents with compared with sporadic cases of CRC
right sided colonic involvement
vs left sided in sporadic
attenuated FAP spares
rectum
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
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
Screening for HNPCC is
q 2 years at 20-25
yearly after 40
Screening in case of IBD
q 1-2 years, after 8 years colitis
biopsy throughout
what is the strongest predictor of survival in colorectal cancer
Nodal status
Negative nodes in CRC means c/w positive nodes
80% survival c/w 55%
what is used to determine the depth of invasion of the primary tumor
MRI
If a lesion goes through lamina propria and muscularis mucosa but not THROUGH submucosa - what stage is it at
T1
If a lesion goes through submucosa to muscularis propria- what stage is it at
T2
If a lesion goes through muscularis propria- what stage is it at
T3
what is the work up for blood work for CRC
- CEA
- CBC
- Cr
- Ferritin
what is the work up for imaging for CRC
CT CAP
Colonoscopy
MRI
Adjuvant chemo after tumor is resected is used for..?
decrease risk of future mets
what is a curable surgically resectable negative margin disease
- 5 cm margins around tumor
Radiation BEFORE surgery in advanced disease decreases
risk of local recurrence
- DOES NOT improve survival
Chemotherapy before/after surgery is to
prevent distant mets
follow up for CRC
CT CAP q6 months yearly
CEA q6 months
Colonoscopy 1,3,5 years
