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GI > GI Neoplasms > Flashcards

GI Neoplasms Flashcards

1
Q

Types of GI Neoplasms

A 
Esophageal CA
Carcinoma of the stomach
Pancreatic CA
Liver CA
Small bowel CA
Colorectal CA
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2
Q

Type of Benign Esophageal Tumors

A

Leiomyoma

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3
Q

Type of Malignant Esophageal Tumor

A

Esophageal CA

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4
Q

Types of Esophageal Carcinoma

A

SCC

Adenocarcinoma (more common in US)

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5
Q

Risk Factors for SCC

A 
Long-standing esophagitis
Achalasia
Smoking
Alcohol
Diet
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6
Q

Define Barrett’s Esophagus

A

Invasion of foreign cells into the lower esophagus

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7
Q

Epidemiology of Esophageal CA

A

Increased prevalence in northern China, India, & Iran
Higher in men
50-80 years old

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8
Q

Symptoms of Esophageal CA

A 
Progressive dysphagia
Odynophagia
Regurgitation
Heartburn
Anorexia
Vomiting
Weight loss
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9
Q

Diagnostics of Esophageal CA

A

UGI/barium swallow
Endoscopic US
EGD
CT for staging & mets

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10
Q

Treatment of Esophageal CA

A

Chemo (neoadjuvent, adjuvent)
Radiation (adjuvent)
Surgery

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11
Q

Type of Benign Stomach Tumors

A

Hyperplastic polyp
Leiomyomas
Lipomas

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12
Q

Type of Malignant stomach Tumors

A

CA
Lymphoma
Sarcoma
Carcinoid

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13
Q

Carcinoma Tumors

A

Epithelial cell origin

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14
Q

Lymphoma Tumors

A

Lymphatic system

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15
Q

Sarcomas

A

Connective tissue tumor

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16
Q

Carcinoids

A

Serotonin secreting

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17
Q

Gastric Neoplastic Polyps

A

Tubular

Villous: >2cm & malignant

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18
Q

Macroscopic Appearance of Gastric Polyps

A

In antrum
Pedunculate with malignant potential
Solitary, large, ulcerated

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19
Q

Treatment of Gastric Polyps

A

Endoscopic removal

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20
Q

Gastric Leiomyoma arises from what?

A

Smooth muscle of the GI tract

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21
Q

Gastric Leiomyoma Presentation

A

Possible bleeding

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22
Q

Treatment for Gastric Leiomyoma

A

Local incision with 2-3 cm margin

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23
Q

Adenocarcinoma of the Stomach Related to

A

Low dietary intake veggies & fruit
High dietary intake of starches
More common in males (3:1)
Increased incidence with pernicious anemia & blood type A

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24
Q

Histological Typing of Adenocarcinoma of the stomach

A 
Ulcerated carcinoma (25%)
Polipoid carcinoma (25%)
Superficial spreading carcinomas (15%)
Linitis plastica (10%)
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25
Q

Ulcerated Carcinoma of the Stomach

A

Deep penetrating ulcer with shallow edges

Usually through all layers of the stomach

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26
Q

Polipoid Carcinoma of the Stomach

A

Intraluminal tumors
Large in size
Late mets

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27
Q

Superficial Spreading Carcinoma of the Stomach

A

Confined to mucosa & sub-mucosa
Mets 30% at diagnosis
Best prognosis

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28
Q

Linitis Plastica Adenocarcinoma of the Stomach

A

All layers of stomach
Poor prognosis
“Leather-bottle” appearance on Xray

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29
Q

Signs/Symptoms of Adenocarcinoma of the Stomach

A 
Vague discomfort
Anorexia: meat aversion
Epigastric mass (late)
Hematemesis (late)
Mets: Virchow's node
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30
Q

Spread of Gastric Carcinoma

A 
Through wall of stomach to peritoneum
Pancreas
Local/regional nodes
Liver
Lungs
Across peritoneal cavity (Ovaries)
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31
Q

Diagnosis of Gastric Cancer

A 
Anemia
Elevated CEA
UGI
Endoscopy
CT for mets workup
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32
Q

Treatment of Adenocarcinoma of the Stomach

A

Resection

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33
Q

Less Common Gastric Neoplasms

A

Lymphoma
Gastrointestinal stromal tumor (GIST)
Neuroendocrine (carcinoid) tumors

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34
Q

Gastric Lymphoma

A

MALT

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35
Q

Treatment of Gastric Lymphoma

A

Radiation

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36
Q

Gastrointestinal Stromal Tumors (GIST)

A

Mesenchymal neoplasms

Stomach most common

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37
Q

Neuroendocrine Tumors

A

Tumors of resident neuroendocrine cells in gastric glands

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38
Q

Gastric Sarcomas

A

Leiomyosarcoma
Leiomyblastoma
GIST

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39
Q

Pancreatic CA Epidemiology

A

Leading causes of CA mortality
Incidence increases with age
Usually 60-70 y/o
Men > Women

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40
Q

Etiology of Pancreatic CA

A

Smoker high risk
High fat, protein & alcohol diets
May be genetic

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41
Q

Pathophysiology of Pancreatic CA

A

Arises from epithelial cells of the pancreatic ducts
Discovered in late stages
Rapidly growing
Mainly in head of pancreas

42
Q

Signs/Symptoms of Pancreatic CA

A 
Vague, dull, abdominal pain
"Painless jaundice"
Weight loss, weakness
Anorexia, N/V
Glucose intolerance
Flatulence
GI bleeding
Ascites
Leg/calf pain
Jaundice: clay colored stools, dark urine
43
Q

Diagnostics of Pancreatic CA

A

Elevated amylase, lipase, alkaline phosphatase, bilirubin, CAE 19-9
CT, US
ERCP

44
Q

What is the most definitive diagnostic test for pancreatic CA?

A

ERCP

45
Q

Clinical Management of Pancreatic CA

A 
Prevent spread of tumor
Chemoradiation
Pain control (opiods)
Distal resection
Whipple procedure
46
Q

Define Whipple Procedure

A

Excision or all or part of the pancreas together with the duodenum & usually the distal stomach

47
Q

Define Zollinger-Ellison Syndrome

A

Islet cell tumor of the pancreas or of the duodenum

48
Q

Gastrinoma (Z-E Syndrome)

A

Hypergastrinemia to gastric acid hyper secretion to PUD/GERD with or without complications

49
Q

Signs/Symptoms of Zollinger-Ellison Syndrome

A 
Pain + diarrhea
Pain without diarrhea
Diarrhea without pain
Hearburn + dysphagia
MEN-1 features
50
Q

Epidemiology of Z-E Syndrome

A

Any age group

Male > Female 3:2

51
Q

Diagnostics of Z-E Syndrome

A

Clinical suspicion

Fasting serum gastrin measurement

52
Q

Management of Z-E Syndrome

A

PPIs over tumor search
Prognosis excellent w/o mets
CT Scan for tumor search

53
Q

Other Pancreatic Tumors

A

Insulinoma

Glucagonoma

54
Q

Most Common Type of Liver CA

A

Hepatocellular carcinoma

55
Q

Epidemiology of Liver CA

A

Twice as common in men than women

56
Q

Causes of Liver CA

A

Chronic infection with HBV & HBC
Cirrhosis due to ETOH, hepatitis
Tobacco use
Aflatoxins from a fungus

57
Q

Prevention of Liver CA

A

Minimize HBV transmission
Avoid ETOH abuse
Minimize HCV

58
Q

How does HBV get transmitted?

A 
Blood
Saliva
Semen
Mucus
Vaginal fluid
Breast milk
Sexual activity
Sharing needles, toothbrushes, or razors
From mom to baby at birth
59
Q

Ways to reduce HBV transmission?

A

Wash hands after touching body fluids
Avoid sharing personal hygiene items
Cover all cuts/sores with bandage
Practice safe sex

60
Q

Prevention of HBV

A

HBV vaccination

Avoid alcohol abuse

61
Q

Transmission of HCV

A 
Blood to blood contact only
Sharing of needles
Unsterile tattooing
Body piercing
Sharing razor blades & toothbrushes
Certain sexual activities
Mother to baby
No vaccine
62
Q

Symptoms of Liver Carcinoma

A 
Anorexia
Weight loss
Jaundice
Swelling of the abdomen
Pain in the abdomen
63
Q

Diagnostics of Liver CA

A 
LFTs
AFP: detect & diagnose CA of the liver, testicles, and ovaries
Hep B & C blood tests
US of liver
CT/MRI of liver
Biopsy
Angiogram of liver
Laparoscopy
64
Q

Liver CA Treatment

A

Surgery

Chemotherapy

65
Q

Types of Surgery for Liver CA Treatment

A

Liver wedge resection
Liver lobectomy
Liver tranplantation

66
Q

Ways chemo is given for liver CA treatment?

A

Hepatic artery infusion

Chemo embolization

67
Q

Types of Benign Small Bowel Tumors

A 
Leiomyoma
Adenoma
Lipoma
Brunner's gland hematoma
Hemangioma
Nodular lymphoid hyperplasia
68
Q

Types of Malignant Small Bowel Tumors

A 
Adenocarcinoma
Lymphoma
Leiomyosarcoma
Other sarcomas
Ampullary adenocarcinoma
69
Q

Types of Neuroendocrine Small Bowel Tumors

A 
Carcinoid
Gangliomeuroma
Gastrinoma
Somatostatinoma
Vipoma
70
Q

Conditions Associated with SB Tumors

A 
Peutz-Jeghers syndrome
Celiac disease
IPSID
Crohn's disease
Neurofibromatosis
AIDS
Hereditary multiple polyposis syndromes
71
Q

Mets of Small Bowel Tumors

A

Malignant melanoma
Bronchogenic
Breast CA

72
Q

Types of Small Bowel Malignancies

A

Adenocarcinomas (30-50%)
Carcinoids (25-30%)
Lymphomas (15-20%)
Gastrointestinal stromal tumors (10-20%)

73
Q

Risk Factors for Small Bowel Adenocarcinoma

A 
Pre-existing adenoma
Crohn's
Celiac disease
IgA deficiency
Alcohol abuse
Neurofibromatosis
Urinary diversion procedures
Red meat
74
Q

Clinical Presentation of Small Bowel CA

A 
Abdominal pain
N/V
Bleeding/anemia
Weight loss
Gastric outlet obstruction
Diarrhea
75
Q

Diagnostics of Small Bowel Malignancies

A

UGI/SBFT (small bowel follow through)
Single contrast flouroscopy: mass, mucosal defect
CT
Capsule endoscopy

76
Q

Prognosis & Treatment of Small Bowel Malignancies

A

Pretty good with surgery

77
Q

Colorectal CA

A

Common in both sexes
3rd leading cause of CA death in both sexes
Preventable disease

78
Q

Colorectal CA Screening

A

Colonoscopy

79
Q

Adenoma Carcinoma Sequence

A 
Normal epithelium
Adenoma
Late adenoma
Early CA
Late CA
80
Q

2 Main Types of Colorectal Polyps

A

Adenomas

Hyperplastic polyps

81
Q

Screening Tests for Colorectal CA

A

FOBT/FIT
Flexible sigmoidoscopy
Colonoscopy

82
Q

Why has colonoscopy become the screening test of choice?

A

Looks at entire colon
Polyps can be removed
Abnormalities can be identified

83
Q

Risk Factors for Colorectal CA

A 
Polyps
Age
IBD
Diet high in saturated fats
Personal or family Hx. of CA
Obesity
Smoking
84
Q

Hereditary Colorectal CA Syndromes (HNPCC)

A

Accounts for 5-10% of all CA cases

Usually diagnosed at average age of 45

85
Q

Hereditary Colorectal CA Syndromes (FAP)

A

Develop hundreds to thousands of colon polyps
Polyps initially benign but 100% chance will develop into CA
Usually

86
Q

Symptoms of Colorectal CA

A

Change in bowel habits: diarrhea or constipation
Bright red or dark blood in stools
Abdominal discomfort

87
Q

Treatment for Colorectal CA

A

Surgery: resection
Chemo: fluorouracil (5-FU), oxaliplatin (Eloxatin), irinotecan (Camptosar), capecitabine (Xeloda)
Radiation: neoadjuvent or adjuvent, external beam
Antiangiogenesis: disrupts its blood supply; Bevacizumab (Avastin)

88
Q

Staging of Cancer

A

TNM system

89
Q

Stage 1 Colorectal CA

A

CA grown through mucosa & invades muscularis

90
Q

Treatment of Stage 1 Colorectal CA

A

Surgical resection

91
Q

Stage 2 Colorectal CA

A

CA grown beyond the muscularis but hasn’t spread to lymph nodes

92
Q

Treatment of Stage 2 Colorectal CA

A

Surgery

Adjuvent chemo

93
Q

Stage 3 Colorectal CA

A

CA has spread to regional lymph nodes

94
Q

Treatment of Stage 3 Colorectal CA

A

Surgery

Chemo

95
Q

Stage 4 Colorectal CA

A

CA spread outside of colon to other areas of the body

96
Q

Treatment of Stage 4 Colorectal CA

A

+/- surgery

Chemotherapy

97
Q

Follow-Up Care of Colorectal Surgery

A

Serial CEA measurements
Colonoscopy 1 year post resection of colorectal CA
Surveillance colonoscopy every 3-5 years

98
Q

Colon vs. Rectal CA

A 
Rectal better prognosis
Radiation not beneficial for colon
DRE/Hemocult
CEA
Surgery
99
Q

Anal Cancer

A

SCC
Women > Men
HPV association

100
Q

Signs/Symptoms of Anal CA

A

Bowel changes

Bleeding

101
Q

Treatment of Anal CA

A

Surgery

Chemoradiation

GI (20 decks)

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