GI Neoplasms Flashcards
epidemiology of esophageal cancer overall (adenocarcinoma vs. squamous cell carcinoma of the esophagus)
*increase in incidence of ADENOCARCINOMA of the esophagus over the past 20 years; most commonly seen in white males
*decrease in incidence of squamous cell carcinoma of the esophagus over the past 20 years
compare the locations of the 2 main esophageal cancers (squamous cell carcinoma vs. adenocarcinoma of the esophagus)
- squamous cell carcinoma of the esophagus: upper & middle sections of the esophagus
- adenocarcinoma of the esophagus: lower section of the esophagus; often caused by Barrett’s esophagus
risk factors for squamous cell carcinoma of the esophagus
*smoking
*alcohol ingestion
risk factors for adenocarcinoma of the esophagus
*Barrett’s esophagus (from uncontrolled GERD); high-grade dysplasia especially
*smoking
*more commonly seen in white males
clinical presentation of esophageal cancer
*dysphagia, odynophagia, anorexia, weight loss
*SCC is aggressive so additional signs may include vocal cord paralysis, hoarseness, cough, aspiration pneumonia, tracheo-esophageal fistula
*hematemesis from tumor ulceration, anemia
*advanced disease upon presentation with spread to lymphatics (lack of serosal lining in esophagus allows spread before symptoms)
*even early stage disease will often have nodal metastasis
gastric cancer - epidemiology
*association between geographic distribution of gastric cancer and geographic distribution of H. pylori (central and south America and Asia have highest rates)
H. pylori and gastric cancer
*increased risk of gastric adenocarcinoma
*associated with gastric MALT lymphoma
*bacteria possesses virulence factors involved in carcinogenesis
*treat someone if they test positive for H. pylori
gastric cancer - risk factors
infection with H. pylori!!!
gastric cancer - presenting symptoms
*varies: weight loss, abdominal pain, nausea or vomiting, anorexia, dysphagia, GI blood loss, early satiety, peptic ulcer symptoms
gastric MALT
*H. pylori associated!!!
*endoscopic ultrasound can assess for depth of invasion and likelihood of response to antibiotics
gastrointestinal stromal tumor (GIST)
*mesenchymal tumors in the GI tract
*70% of GI GIST occur in the stomach
*indolent, slow-growing tumors that are usually asymptomatic until very large
*sx: GI bleeding, dyspepsia, or obstruction
*most have gain of function C-KIT MUTATIONS
*malignant if spread into regional lymph nodes
*dx: EGD, EUS+FNA
*tx: surgery
genetic mutation associated with gastrointestinal stroma tumors (GIST)
*gain of function C-KIT MUTATION (a proto-oncogene growth factor receptor)
tumors of the small bowel
*mostly asymptomatic
*if symptomatic: abdominal pain, nausea/vomiting, obstruction, GI bleeding
*types:
-malignant: adenocarcinoma, neuroendocrine (carcinoid), primary GI lymphoma, sarcoma
-benign: adenoma, leiomyoma, lipoma, etc
carcinoid - definition
*a small, slow-growing, benign or malignant tumor, usually in the GI tract, that is composed of islands of rounded cells with small vesicular nuclei and secretes serotonin
*derived from enterochromaffin cells (ECL cells)
which carcinoid tumors are malignant most often: foregut, midgut, or hindgut?
MIDGUT carcinoid tumors are the ones that are malignant most commonly (ileal/jejunal)
