GI Neoplasia I

Question 1

What are factors associated with squamous cell carcinoma?

Answer 1

alcohol, smoking, urban and lower SEC pop, dietary and environmental factors that cause chronic esophageal irritation, hpv, achalasia, high red meat consumption

Question 2

What are risk factors associated with adenocarcinoma of esophagus?

Answer 2

barrett’s esophagus
GERD
Truncal obesity

Question 3

What is the stereotypical squamous esophageal cancer patient?

Answer 3

60-70 black male smoking alcoholic in the midesophagus

Question 4

What the steroetypical pt with adenocarcinoma of esophagus

Answer 4

white male with barrett’s esophagus in 50s or 60s in the distal esophagus

Question 5

What are symptoms of esophageal carcinoma?

Answer 5

dysphagia, weight loss, odynophagia, aspiration anemia

largely due to narrowing or olceration of esophagus

Question 6

when do you see hyperplastic gastric polyps?

Answer 6

chronic inflammation, h pylori, atrophic gastritis, usually asx (75% of gastric polyps)

Question 7

What are fundic gland gastric polyps associated with?

Answer 7

PPI use or FAP

Question 8

What are adenomatous gastric polyps?

Answer 8

10% of gastric polyps
most are in antrum associated with atrophic gastritis
may be sessile or pendunculated
precursor lesion of some cancers

Question 9

What is the epidemiology of gastric cancer?

Answer 9

lower sec and in developing countries, males more than females, 70s

Question 10

what are risk factors for gastic cancers?

Answer 10

chronic atrophic gastritis
pernicious anemia
prior gastric surgery
high dietary nitrates
adenomatous gastric polyps
h pylori infxn (increases risk 3-6 times)

Question 11

What are the two most common types of gastric neoplasia?

Answer 11

adenocarcinoma and lymphoma

Question 12

What are symptoms of gastric cancer?

Answer 12

early perineural invasion - pain
diaphragmatic invasion leading to hiccoughs
Infiltration - decreased compliance and early satiety with weight loss

Question 13

What are additional symptoms of gastric cancer in order of frequency?

Answer 13

weight loss, abd pain, nausea, dysphagia, melena, early satiety, ulcer-type pain

Question 14

What are two common physical findings in gastric cancer?

Answer 14

virchow’s node - left supraclavicular node

sister mary joseph node - periumbilical nodule

Question 15

What is linitis plastica?

Answer 15

an aggressive diffused gastric cancer that infiltrates the gastric wall with a rigid thickened stomach

Question 16

what is the waterbottle stoamch associated with?

Answer 16

linitis plastica

Question 17

What type of gastric cancer doesn’t require surgery?

Answer 17

lymphoma

Question 18

What mutuation is present in sqcca of esophagus?

Not present

Answer 18

p53 is commonly present

KRAS and APC gene are not present in sqcca of esophagus

Question 19

What are the gross appearance of sqcca of esophagus?

Answer 19

small gray-white plaque-like thickenings

become protruding flat or excavated

Question 20

What is the molecular pathogenesis of esophageal adenocarcinoma? important question

Answer 20

early: p53 mutation or overexpression in barrett’s
allelic loss of silencing by hypermethylation of p16/ink4 cyclin-dependent kinase inhibitor
amplification of HER2 (cERBB2), cyclin D1 or cyclin E

Question 21

Are cellular bridges present in progressed barrett’s esophagus?

Answer 21

yes

Question 22

Why is it hard to determine that esophageal cancer was adenocarcinoma from barrett’s as opposed to mets?

Answer 22

Barrett’s causes intestinal epi. So once goblet cells decrease (with increasing malignancy), less signs that it was stoamch-induced metaplasia initially.

Question 23

On histo, what do you see with hyperplastic gastric polyp?

Answer 23

hyperplastic mucosal epi

inflamed edematous stroma

Question 24

What are the two types of gastric carcinoma?

Answer 24

intestinal type and diffuse type

Question 25

What is the intestinal type of gastric carcinoma?

Answer 25

typically masses, with intestinal metaplasia as precursor

Question 26

What is the diffuse type of gastric carcinoma?

Answer 26

typically linitis plastic, infiltration by single cells resembling signet rings

Question 27

Where is linits plastica typically seen?

Answer 27

lesser curve of stomach

Question 28

T or F: h pylori causes chronic gastritis which causes gastric adenocarcinoma

Answer 28

true

Question 29

linitis plastic has no discrete masses: t or f

Answer 29

true