GI Neoplasia I

Question 1

Risk factors associated with squamous cell carcinoma?

Answer 1

• 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)

Question 2

Risk factors associated with adenocarcinoma?

Answer 2

• Barrett’s Esophagus
• GERD
• Truncal Obesity

Question 3

Symptoms of esophageal carcinoma

Answer 3

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

Question 4

Dysphagia in pt over the age of 50

Answer 4

think about cancer

Question 5

Dx of esophageal cancer

Answer 5

barium x ray

- endoscopy allows biopsy

Question 6

Staging of esophageal cancer

Answer 6

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

Question 7

Curative treatment?

Answer 7

Surgery if they qualify (many do not)

Question 8

Hyperplastic gastric polyps

Answer 8

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

Question 9

Most common type of gastric polyp?

Answer 9

Hyperplastic gastric polyp

Question 10

Fundic fastric polyps most often associated with what?

Answer 10

Chronic PPI use, though they may be sporadic

Remove if over 1 cm….rarely predispose to cancer

Question 11

Adenomatous gastric polyps most commonly where?

Answer 11

Antrum

Question 12

Adenomatous gastric polyps are precursos lesions to

Answer 12

some gastric cancers….risk of cancer increases with size, villous lesions, high grade dysplasia

Question 13

What causes chronic atrophic gastritis?

Answer 13

H. Pylori

Question 14

Risk factors for gastric cancer?

Answer 14

• Chronic atrophic Gastritis
• Pernicious Anemia
• Prior Gastric Surgery
• High dietary nitrates
• Adenomatous gastric polyps
• H. Pylori (inc risk 3-6 times)

Question 15

Explain how an H. Pylori infxn may lead to cancer

Answer 15

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

Question 16

25% of gastric neoplasms are

Answer 16

Gastric Lymphoma

Question 17

Most common symptoms in gastric cancer?

Answer 17

Weight loss
Abdominal Pain
Nausea

Question 18

Where might gastric cancer metastasize to?

Answer 18

Liver, peritoneum, distal lymph node

Question 19

Virchow’s node is what?

Answer 19

Left- supraclavicular node…metastatic gastric cancer

Question 20

Sister Mary Joseph Node is what>

Answer 20

Periumbilical node…metastatic gastric cancer

Question 21

Linitis Plastica

Answer 21

• Aggressive diffuse gastric cancer
• 5% of gastric cancers
• Gastric wall is infiltrated by malignancy
• Results in rigid thickened stomach
• Bad

Question 22

Gastric cancer tx

Answer 22

Surgery is the only potential cure and it rarely works

Question 23

What makes a malignant tumor malignant

Answer 23

Invasion or Metastasis

Question 24

What point mutation is common in squamous cell carcinoma of the esophagus?

Answer 24

p53

Question 25

What mutation is present early in adenocarcinoma of the esophagus?

Answer 25

p53

Question 26

What other genetic mutations occur in adenocarcinoma of the esophagus>

Answer 26

• allelic loss or hypermethylation of P16/INK4a
• Mutation of retinoblastoma tumor suppressor
• Amplification of cERB-B2, cyclin D1, Cyclin E

Question 27

Intestinal type gastric adenocarcinoma characterized by what type of appearance?

Answer 27

Large irregular ulcer with heaped up margins and commonly involves the lesser curvature of teh stomach

Question 28

Diffuse type gastric adenocarcinoma commonly appears like what?

Answer 28

Thickening of the stomach wall, linitis plastica

Question 29

Signet ring cells seen in what type

Answer 29

Diffuse

Question 30

Alcohol and tobacco lead to what type of cancer of the esophagus

Answer 30

squamous cell