GI malignancy

Question 1

esophageal cancer risk factors include:

Answer 1

achalasia
atrophic gastritis
prior gastrectromy
GERD

Question 2

gastric cancer risk factors:

Answer 2

atrophic gastritis
H pylori infection
gastric surgery
gastric ulcers
pernicious anemia

Question 3

colon cancer risk factors

Answer 3

ulcerative colitis and crohn’s dx
Peutz Jegher’s syndrome
Acromegaly
Primary Biliary Cirrhosis.

Question 4

how does achalasia lead to squamous cell carcinoma of the esophagus?

Answer 4

dysphagia with solid foods and liquids and see this from stasis and fermentation that can cause mucosal inflammation and epithelial hyperplasia and focal hypoplasia

Question 5

GIST or high grade gastrointestinal stromal tumor

Answer 5

appears as submucousal masses and are often seen in teh stomach.

diagnosed on EGD and EUS.

Stain positive for CD117

Question 6

treatment of GIST

Answer 6

tyrosine kinase inhibitors imatinib (Gleevec)

targets cKIT and BCR-ABL

DO NOT USE rituximab or monoclonal antibody against CD20 for RA or hodgkin lymphoma. or infliximab (remicade - used in psoriatic arthritis)

Question 7

hereditary diffuse gastric cancer should be expected in:

Answer 7

family members with two or more documented cases of gastric cancer in 1st or second degree relatives and at least one diffuse gastric cancer diagnosed before age of 50

-family with multiple lobular breast cancer with or without diffuse gastric cancer in 1st or 2nd degree relatives

Question 8

FAP or familial adenomatous polyposis will have these extra colonic manifestations:

Answer 8

desmoid tumors, congential hypertrophy or retinal pigment epithelium
epidermaoid cysts, osteoomas, thyroid cancer

FAP is characterized by multiple colorectal adenomatous polyps (>100)

Question 9

Classic FAP is inhereted from

Answer 9

autosomal dominant pattern
from a germline cell mutation in APC gene
not associated with BRCA1/2

Question 10

Treatment of FAB is

Answer 10

prophylactic colectomy

usually all pts will have colon cancer by age 40 years old

Question 11

autoimmune atrophic gastritis

Answer 11

autoimmune common in women
develops pernicious anemia

also seen with Hashimotos thyroiditis and carcinoid tumors

also see increased risk for gastric adenocarcinoma and esophageal squamous cell carcinoma

Question 12

how to diagnosis autoimmune atrophic gastritis?

Answer 12

EGD - see flattened rugae in gastric body and see intestinal metaplasia with presence of goblet cells in gastric fundus biopsy.

see serum gastrin levels >1000 pg/ml and can be seen in both atrophic gastritis and Zollinger Ellison syndrome but ZES will have gastric pH <5

Question 13

management of atrophic gastritis:

Answer 13

treatment of complications
anemia
H pylori
gastric cancer screening with EGD in pts who have family history or certain ethnic backgrounds (Asians)

Question 14

high grade gastrointestinal stromal tumor (GIST) are treated with

Answer 14

surgical resection

but if there is metastatic dx treat with chemotherapy:

imatinib (Gleevec)

Question 15

GISTS vary histologically but they have

Answer 15

spindle cell with pale eosinophilic and indistinct cytoplasm

Stain positive for CD117 (c-KIT) in 95% of cases

Question 16

GIST on EGD

Answer 16

they look like a tonsil sticking out of the stomach or a pedunculated lob on EGD

Question 17

imatinib (Gleevec) targets

Answer 17

this tyrosine kinase inhibitor targets BCR-Abl (seen with CML)

Question 18

H pylori causes:

Answer 18

MALT (gastric marginal zone lymphoma)

Question 19

how to treat MALT

Answer 19

treat the H pylori

but still need an EGD to get biopsy to prove that there is no remaining MALT cancer

12% of pts need radiation therapy despite treatment of H pylori.