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Gastroenterology yr 2 > GI malignancy > Flashcards

GI malignancy Flashcards

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
Q

Stage 3 pancreatic cancer has

A

invaded to adjacent organs

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26
Q

Stage 4 pancreatic cancer has

A

involved the SMA or celiac axis

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27
Q

If pancreatic cancer is restricted to the head of the pancreas, first clinical symptom might be

A

Jaundice

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28
Q

If pancreatic cancer is restricted to the tail of the pancreas, first clinical symptom might be

A
  • none, advanced - silent
29
Q

when does pain occur in pancreatic cancer

A
  • metastatic spread

- celiac axis invasion

30
Q

what is a marker that can be used in pancreatic cancer

A

CA 19-9 - more sensitive than specific

31
Q

would you biopsy a pancreatic cancer

A
  • usually no, to avoid needle track invasion

instead FNA using ultrasound

32
Q

what type of Sx performed for pancreatic cancer in head of pancreas

A

Whipple’s

33
Q

If someone presents with painless jaundice, pruritis, pale stool, dark urine what are your investigations?

A
  • ERCP
  • Endo U/S
  • biopsy?
  • CT CAP
34
Q

what is indicative of pancreatic ductal carcinoma histologically

A
  • ducts near vessels

- light pink color indicating reactive soft tissue

35
Q

Ddx for BRBPR

A

hemorrhoids
proctitis
polyps
Col ca

36
Q

3 types of colorectal cancer

A

adenocarcinoma
lymphoma
sarcoma

37
Q

what workup do you need if someone presents with colorectal adenocarcinoma

A

1) microcytic anemia
2) Colonoscopy
3) Biopsy

38
Q

Most cases of CRC are

A

sporadic

39
Q

Biggest risk factor for CRC

A
  • AGE
  • history of polyps
  • Family Hx
  • IBD
  • diet/obesity/sedentary
40
Q

Classic histologic features of tubular adenoma Vs Villous adenoma

A

Dysplastic epithelium, less mucin, nuclei piling up

- Projections, nuclei piling up

41
Q

High grade Colonic dysplasia is characterized by

A
  • Nuclear atypia

- Architectural complexity, disorganized

42
Q

Metastasis and the use of the term carcinoma is restricted to tumors that have

A

invaded the muscularis mucosae into the Submucosa

43
Q

what % of colorectal carcinomas are adenocarcinomas

A

90%

44
Q

The colonic signet ring cell is associated with

A

HNPCC

45
Q

How are colorectal adenocarcinomas graded?

A
  • based on number of glands - low grade, lots of glands!
46
Q

Margins used in staging colorectal cancer

A

proximal

distal and RADIAL - mesorectum

47
Q

If the tumor is < 1mm from radial margin

A

similar prognosis to being at the margin itself

48
Q

what % of adenomatous polyps will turn into cancer

A

25% in 7-10 years

49
Q

what is the method of screening for HNPCC

A

3,2,1 rule
3 relatives
Span 2 generations
1 is a first degree relative

50
Q

HNPCC commonly presents with compared with sporadic cases of CRC

A

right sided colonic involvement

vs left sided in sporadic

51
Q

attenuated FAP spares

A

rectum

52
Q

If you have no Fam Hx

60 at diagnosis you are

A

Average risk = screen at 50 or 45 african descent

  • screen colonoscopy q 10 years
  • sigmoidoscopy q5-10 years
  • annual FOBT
53
Q

If you have a Family Hx
1st degree relative < 60 at diagnosis or
2 first degree relatives

A

Screen 10 years younger than relative or at 40

- Colonoscopy q 5 years

54
Q

Screening for HNPCC is

A

q 2 years at 20-25

yearly after 40

55
Q

Screening in case of IBD

A

q 1-2 years, after 8 years colitis

biopsy throughout

56
Q

what is the strongest predictor of survival in colorectal cancer

A

Nodal status

57
Q

Negative nodes in CRC means c/w positive nodes

A

80% survival c/w 55%

58
Q

what is used to determine the depth of invasion of the primary tumor

A

MRI

59
Q

If a lesion goes through lamina propria and muscularis mucosa but not THROUGH submucosa - what stage is it at

A

T1

60
Q

If a lesion goes through submucosa to muscularis propria- what stage is it at

A

T2

61
Q

If a lesion goes through muscularis propria- what stage is it at

A

T3

62
Q

what is the work up for blood work for CRC

A
  • CEA
  • CBC
  • Cr
  • Ferritin
63
Q

what is the work up for imaging for CRC

A

CT CAP
Colonoscopy
MRI

64
Q

Adjuvant chemo after tumor is resected is used for..?

A

decrease risk of future mets

65
Q

what is a curable surgically resectable negative margin disease

A
  • 5 cm margins around tumor
66
Q

Radiation BEFORE surgery in advanced disease decreases

A

risk of local recurrence

- DOES NOT improve survival

67
Q

Chemotherapy before/after surgery is to

A

prevent distant mets

68
Q

follow up for CRC

A

CT CAP q6 months yearly
CEA q6 months
Colonoscopy 1,3,5 years

Gastroenterology yr 2 (10 decks)

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