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GI 2 > GI Neoplasms > Flashcards

GI Neoplasms Flashcards

1
Q

Esophageal tumors:

  • Benign Type
  • Malignant Type
A

Benign: Leiomyoma

malignant: esophageal carcinoma

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2
Q

Esophageal Carcinoma:

  • what are the 2 types? which is MC?
  • mortality rate?
  • Age
  • sx
A

Types:

  • squamous cell carcinoma
  • adenocarcinoma (MC) (distal 1/3 of esophagus, occurs in barretts esophagus)

Moratlity: very high.

Age: 50-80YO

Sx:

  • progressive dysphagia
  • odynophagia (painful swallowing)
  • regurgitation
  • heartburn
  • anorexia
  • vomiting
  • weight loss
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3
Q

Esophageal cancer:

  • dx
  • Tx
A

Dx:

  • UGI/barium swallow
  • endoscopic US
  • EGD (good for getting bx) GOLD STANDARD
  • CT (for staging and r/o mets)
  • esophageal US (often done in combo w/ EGD to help appreciate the extent of tumor invasion of esophageal wall)

Tx:

  • Chemo, radiation, surgery
  • combined modality tx leads to best outcome*
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4
Q

Stomach Cancer:

-what are the benign and malignant types?

A
  • Benign:
  • -polyps
  • -Tumors: Leiomyomas, lipomas
  • Malignant:
  • -Tumors:
  • –Carcinoma (epithelial cell)
  • –Lymphoma (lymphatics); sensitive to radiation
  • –Sarcoma (CT)
  • –Carcinoid (Serotonin secreting) (neuroendocrine tumor)
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5
Q

Gastric Polyps:

  • types
  • macroscopic appearance
  • tx
A

Types: tubular, villous (greater than 2cm & malignant)

Macroscopic appearance:

  • MC in antrum
  • pedunculated (stalk)
  • solitary, large, ulcerated

Tx:
-endoscopic removal if no malignancy identified, then period surveillance.

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6
Q

Gastric Leiomyoma:

  • appearance
  • tx
A

appearance: large protruding lesions with central ulcer, usually presents with bleeding if at all.

Tx: local excision with 2-3cm margin

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7
Q

Adenocarcinoma of Stomach

  • cause
  • histological typing
A

Cause: H. pylori d/t chronic atrophic gastritis

  • low dietary intake of vegetables and fruit, high dietary intake of starches
  • increased incidence with pernicious anemia and blood group A.

Histological typing:
-ulcerated carcinoma: deep penetrated ulcer with shallow edges, usually through all layers of stomach

  • polipoid carcinoma: intraluminal tumors, large size, late mets
  • superficial spreading: confinement to mucosa and sub mucosa, best prognosis*
  • Lintis Plastica: involves all layers of the stomach,, “leather bottle” appearance on xray
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8
Q

Adenocarcinoma of the stomach

  • signs and sx
  • tx
A

vague discomfort difficult to distinguish from dyspepsia

anorexia

  • meat aversion
  • pronounced weight loss

Late stage:

  • epigastric mass
  • hematemesis: coffee grounds

Metastasis: Virchows Node (L supreclavicular)

Tx:

  • surgical resection is the only cure
  • prognosis; 12% 5 year survival
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9
Q

Routes of Gastric Carcinoma spread

A

Local infiltration (through the wall of stomach to peritoneum, pancreas, etc)

  • lymphatic; local and regional LN
  • blood; liver, lungs
  • transcoelomic (across peritoneal cavity; often involves ovaries)
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10
Q

Dx of Gastric Cancer

A 
anemia in 40% 
Elevated CEA 
UGI 
Endoscopy 
CT for mets
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11
Q

Pancreatic Cancer:

  • age and gender affected
  • prognosis
  • cause
  • risk factors
  • pathophysiology
A

Age: 60-70YO, Males

Prognosis: less than 20% live longer than one year.

Cause: unknown

Risk factors:

  • smoking
  • high fat, high protein, high alcohol diets

Pathophys:
-arise from epithelial cells of pancreatic ducts, discovered in late stage so has spread throughout pancreas. MC site is HEAD OF PANCREAS!!!*

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12
Q

Pancreatic Cancer:

  • signs and sx
  • dx
A

Signs and Sx:

  • vague, dull, abd pain
  • painless jaundice
  • weight loss, weakness
  • anorexia, n/v
  • glucose intolerance
  • flatulence
  • GI bleeding
  • ascities
  • leg/calf pain
  • jaundice (if head of pancreas is involved; clay colored stools)

Dx:

  • elevated amylase, lipase, alk phos, bilirubin, CEA C19-9
  • CT US
  • ERCP** most definitive dx test
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13
Q

Pancreatic Cancer:

-clinical management

A
  • chemo or radiation
  • pain control (opiods)
  • distal resection
  • whipple procedure
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14
Q

What is a whipple procedure? when is this used?

A

surgeon removes the head of the pancreas, the gallbladder, part of the duodenum, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.

Only used for CA of the pancreas head.

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15
Q

Zollinger-Ellison Syndrome

  • what is this?
  • pathophys
  • sx
  • MC gender
  • dx
A

WHat; islet cell tumor of pancreas or duodenum, gastrinoma.

Pathophys: hypergastrineimia, gastric acid hypersecretion leading to PUD, GERD.

Sx:
-diarrhea, malabsorption, pain, heartburn

MC in men.

Dx: begins with clinical suspicion
-fasting serum gastrin measurement = highly sensitive.

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16
Q

Zollinger-ellison syndrome:

-management

A

PPI (nexium)

tumor search via CT

resection if surgical candidate.

17
Q

Cancer of liver:

  • MC type
  • causes
  • can cancer of liver be prevented?
  • how do we prevent liver cancer?
A

MC is hepatocellular carcinoma

Causes:

  • chronic infection w/ Hep B and Hep C.
  • cirrhosis d/t alcohol, hepatitis
  • tobacco use
  • aflatoxins from a fungus that can contaminate peanuts, wheat, soybeans, groundnuts, corn, rice.

Well ideally yes, if you could just cut down on the transmission.

Prevention:

  • Hep B vaccine
  • avoid alcohol abuse
18
Q

Hep B transmission? Ways to reduce transmission??

A

Hep B transmission:

  • blood, saliva, semen, mucus, vaginal fluid, and breast milk.
  • sharing needles, toothbrushes, razors, sexual activity
  • mother-child (verticle)

Reduce transmission:

  • wash hands after touching blood/bodily fluids
  • avoid sharing personal hygiene items that may come into contact with body fluids
  • cover all cuts and open sores with bandage
  • safe sex.
19
Q

Hep C transmission?

A

Transmission:

  • blood to blood only
  • sharing needles, unsterile tattooing, body piercing, sharing razor blades, and toothbrushe
  • mother to baby
20
Q

Liver Ca:

  • sx
  • dx
  • tx
  • prognosis
A

Sx:

  • loss of appetite and weight
  • jaundice
  • swelling of abd
  • pain in abdomen

Dx:

  • LFTs
  • AFP (alpha fetoprotein)
  • blood tests for hep B and C
  • US of liver
  • CT or MRI
  • Bx
  • angiogram
  • laparoscopy

Tx:

  • surgery is curative in stages I and II;
  • -liver wedge resection
  • -liver lobectomy
  • -liver transplantation

-chemo; via hepatic artery infusion of chemo embolization

Prognosis:
survival rate at 5 years = 10-40% depending upon stage.

21
Q

Small Bowel Cancers

  • MC type?
  • risk factors
  • clinical presentation
A

adenocarinoma

Risk factors:

  • pre-existing adenoma
  • crohns
  • celiac dz
  • IgA deficiency
  • alcohol abuse
  • neurofibromatosis
  • red meat

Presentation:

  • -abd pain
  • n/va
  • bleeding/anemia
  • wt loss
  • gastric outlet obstruction
  • diarrhea
22
Q

Small bowel CA:

  • dx
  • tx
A

Dx:

  • Upper GI series/ SBFT
  • Single contrast flouroscopy looking for mass, mucosal defect
  • CT
  • capsule endoscopy

Tx:
-surgery

23
Q

Colorectal Cancer:

  • purpose of colorectal screening?
  • arise from what?
  • how long does dysplastic tissue take to progress to CA?
  • what are the two main types of colorectal polyps? how do you differentiate between the two?
A

Purpose: catch dysplastic cells in their tracts, resect them, and prevent the development to colon CA.

Most arise from adenomatous polyps, but may also arise from flat adenomas (can be missed by inexperienced practitioners)

progression takes at least 10 years in most people. The larger the polyp the more likely to progress to CA.

Two main types are adenomas or hyperplastic polyps, require bx for dx.

24
Q

Colon CA:

-screening tests

A

Fecal Occult Blood

Flexible SIgmoidoscopy

Colonoscopy**(screening and therapeutic)

25
Q

Colorectal CA:

-risk factors

A

Risk:

  • polyps
  • age
  • IBD
  • Diet in high sat fats, such as red meat
  • personal or fam hx of CA
  • obesity
  • smoking
26
Q

Hereditary colorectal Cancer syndromes?

A

Hereditary non-polyposis colorectal CA, aka lynch syndrome. (risk of CA in families with HNPCC is 70-90%)
*Usually occurs by age 45

Familial Adenomatous polyposis (FAP); develop hundreds to thousands of colon polyps that are initally benign but there is nearly 100% chance the polyps will develop into CA if left untreated.
*usually occurs by age 40

27
Q

Colorectal CA:

  • sx
  • dx
  • tx
A

Sx:

  • change in bowel habits, diarrhea, constipation, feeling that bowel doesnt empty completely
  • bright red or dark blood in stool
  • abd discomfort.

Dx:

  • confirmed by bx
  • stage of dz comfirmed by pathologist, imaging, CT
  • endoscopic US and MRI also used to stage CA

Tx:

  • surgery; tumor along with adjacent healthy colon, rectum, and LN
  • chemo & radiation
  • newer therapy: antiangiogenesis: starves the tumor by disrupting its blood supply. + Chemo.
28
Q

How is Colorectal CA staged?

What are the stages?

A

TNM system:

  • tumor (depth of penetration into the wall of the bowel)
  • Nodes (whether it has spread to LN)
  • metastasized

Stages:
-I: grown through mucosa and invaded the muscularis; tx is surgical removal of tumor and surrounding LN

  • II: grown beyond the muscularis of the colon or rectum and has not spread to LN: tx surgery and chemo
  • III: spread to regional LN; Tx is surgery andd chemo
  • IV: spread outside colon or rectum to other areas of body; Tx is chemo, surgery to remvove the colon or rectal tumor
29
Q

Colorectal CA:

-follow up care

A

serial CEA measurements

colonoscopy 1 year after resection of CA, surveillance colonoscopy every 3-5yrs

30
Q

Anal Cancer:

  • what type of cancer?
  • sx
  • cause
  • tx
  • prognosis
A

Type: Squamous cell carcinoma

Sx: bowel changes, bleedin

Cause: HPV, smokers, HIV

Tx: surgery, radiation, chemo

Prognosis: often effective/cured, better survival than colorectal CA.

GI 2 (9 decks)

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