GI Neoplasia I Flashcards
Risk factors associated with squamous cell carcinoma?
- Alcohol
- Smoking
- Urban and lower socioeconomic populations
- other things that cause chronic esophageal irritation
- Rare predisposing conditions such as Tylosis, Plummer-Vinson, HPV infection (rising in frequency)
Risk factors associated with adenocarcinoma?
- Barrett’s Esophagus
- GERD
- Truncal Obesity
Symptoms of esophageal carcinoma
Due to narrowing or ulceration of esophagus
- dysphagia
- wt loss
- odynophagia (painful swallowing)
- Aspiration- food backs up in esophagus…may also cause tracheo-esophageal fistula
- Anemia- blood loss
Dysphagia in pt over the age of 50
think about cancer
Dx of esophageal cancer
barium x ray
- endoscopy allows biopsy
Staging of esophageal cancer
CT of chest
- endoscopic ultrasound can help gauge how far into the wall of the esophagus the cancer has gone
- Decreased survival if lymph node mets are present
Curative treatment?
Surgery if they qualify (many do not)
Hyperplastic gastric polyps
Seen with chronic inflammation, H. Pylori, atrophic gastritis
- usually asx but they may cause microscopic bleeding if they are large
- remove if over 1 cm
Most common type of gastric polyp?
Hyperplastic gastric polyp
Fundic fastric polyps most often associated with what?
Chronic PPI use, though they may be sporadic
Remove if over 1 cm….rarely predispose to cancer
Adenomatous gastric polyps most commonly where?
Antrum
Adenomatous gastric polyps are precursos lesions to
some gastric cancers….risk of cancer increases with size, villous lesions, high grade dysplasia
What causes chronic atrophic gastritis?
H. Pylori
Risk factors for gastric cancer?
- Chronic atrophic Gastritis
- Pernicious Anemia
- Prior Gastric Surgery
- High dietary nitrates
- Adenomatous gastric polyps
- H. Pylori (inc risk 3-6 times)
Explain how an H. Pylori infxn may lead to cancer
H. Pylori infection–> Gastritis –> Atrophic Gastritis (no acid) –> high bacterial growth –> high bacterial enzymes like Nitrate reductase…this can lead to nitrates being turned into nitrites which leads to mutation
25% of gastric neoplasms are
Gastric Lymphoma
Most common symptoms in gastric cancer?
Weight loss
Abdominal Pain
Nausea
Where might gastric cancer metastasize to?
Liver, peritoneum, distal lymph node
Virchow’s node is what?
Left- supraclavicular node…metastatic gastric cancer
Sister Mary Joseph Node is what>
Periumbilical node…metastatic gastric cancer
Linitis Plastica
- Aggressive diffuse gastric cancer
- 5% of gastric cancers
- Gastric wall is infiltrated by malignancy
- Results in rigid thickened stomach
- Bad
Gastric cancer tx
Surgery is the only potential cure and it rarely works
What makes a malignant tumor malignant
Invasion or Metastasis
What point mutation is common in squamous cell carcinoma of the esophagus?
p53
What mutation is present early in adenocarcinoma of the esophagus?
p53
What other genetic mutations occur in adenocarcinoma of the esophagus>
- allelic loss or hypermethylation of P16/INK4a
- Mutation of retinoblastoma tumor suppressor
- Amplification of cERB-B2, cyclin D1, Cyclin E
Intestinal type gastric adenocarcinoma characterized by what type of appearance?
Large irregular ulcer with heaped up margins and commonly involves the lesser curvature of teh stomach
Diffuse type gastric adenocarcinoma commonly appears like what?
Thickening of the stomach wall, linitis plastica
Signet ring cells seen in what type
Diffuse
Alcohol and tobacco lead to what type of cancer of the esophagus
squamous cell
