GI neoplasms Flashcards
Esophageal Tumors
- Benign?
- Malignant?
- Benign
Leiomyoma - Malignant
Esophageal carcinoma
Esophageal carcinomas
Squamous cell carcinoma
1. More prevalent where?
2. Risk factors? 5
- More prevalent worldwide
- Risk factors:
- long-standing esophagitis,
- achalasia,
- smoking,
- alcohol,
- diet
Esophageal carcinomas Adenocarcinoma 1. More common where? 2. Occurs in what disease? 3. What part of the esophagus?
Adenocarcinoma
- More common in USA
- Occurs in Barrett’s esophagus
- More in distal 1/3
Cancer of the Esophagus
Symptoms?
7
- Progressive dysphagia
- Odynophagia
- Regurgitation
- Heartburn
- Anorexia
- Vomiting
- Weight loss
Diagnosis of esophageal cancer?
4
- UGI/barium swallow
- Endoscopic ultrasound
- EGD…tissue is the issue
- CT for staging and r/o mets
Treatment for esophageal cancer?
3
- Chemo (preop and post-op protocols)
- Radiation (post-op)
- Surgery (best cure)
Combined Modality Treatment leads to the best outcome
Benign stomach tumors?
- Polyps?
- Tumors? 2
- Polyps
- Hyperplastic - Tumors
- Leiomyomas (smooth muscle)
- Lipomas
Malignant stomach cancers
1. Tumors? 4
- Carcinoma (epithelial cell origin)
- Lymphoma (lymphatic system)
- Sarcoma (connective tissue tumor)
- Carcinoid (serotonin secreting)
Gastric Polyps: Neoplastic polyps?
- Types? 2
- Macroscopic appearance more often where?
- What do they look like? 4
- Treatment?
- Tubular
- Villous (often larger …> 2cm and malignant)
- More often in antrum
- Pedunculated with malignant potential
- Solitary,
- large
- ulcerated
- Treatment
- Endoscopic removal if no malignancy identified… the periodic surveillance
Gastric Leiomyoma: Pathology?
- Arise from where?
- What is it difficult to distinguish from?
- More benign or malignant?
- Differentiatied how?
- What do they look like?
- Arise from smooth muscle of the GI tract
- Difficult to distinguish from
Gastrointestinal stromal tumor
3 75% benign
4Differentiation only on mitotic index - Large protruding lesions with central ulcer
- Gastric Leiomyoma
usually present how? - Treatment?
- Usually presents with bleeding if at all
2. Treatment is local excision with 2 – 3cm margin
Adenocarcinoma of the Stomach
1. What bug is associated with this and why?
- Also related to what? 4
- HP associated due to chronic atrophic gastritis
- Also related to
- Low dietary intake vegetables and fruit
- High dietary intake of starches
- More common in males ( 3 : 1 )
- Increased incidence with pernicious anemia and blood group A
Adenocarcinoma of the Stomach
Histological typing? 4
- Ulcerated carcinoma (25%)
- Polipoid carcinoma (25%)
- Superficial spreading carcinomas (15%)
- Linitis plastica (aka Brinton’s disease or leather bottle stomach) (10%)
- Ulcerated carcinoma (25%) looks like what?
- Usually through what layers of the stomach? - Polipoid carcinoma (25%) look likw what?
- Metastasis? - Superficial spreading carcinomas (15%) are confined to where?
- Prognosis? - Linitis plastica (aka Brinton’s disease or leather bottle stomach) (10%) involves what layers of the stomach and what is the prognosis?
- what kind of appearance on XRAY?
- Deep penetrated ulcer with shallow edges
- Usually through all layers of the stomach - Intraluminal tumors, large in size
- Late metastasis - Confinement to mucosa and sub-mucosa
- Metastasis 30% at time of diagnosis (Best prognosis) - involves all layers of stomach
(poor prognosis)
-“leather-bottle” appearance on X-ray
- Adenocarcinoma of the Stomach
signs and symptoms? 3 - At late stages? 3
- Vague discomfort difficult to distinguish from dyspepsia
- Anorexia
- Pronounced weight loss
- At late stage
- Epigastric mass
- Hematemesis usually coffee ground
- Metastasis…Virchow’s node (L supraclavicular)
What kind of anorexia is specific to adenocarcinoma?
Meat aversion
Spread of Gastric Carcinoma
4
- Local infiltration (through wall of stomach to peritoneum, pancreas etc)
- Lymphatic – local and regional lymph nodes
- Blood – liver, lungs
- Transcoelomic (across peritoneal cavity).
Transcoelomic (across peritoneal cavity) often involves what?
- Often involves ovaries (esp. signet ring cancer) – Krukenberg tumour (ovarian tumor that metastasized from a primary site…colon or stomach
Diagnosis of Gastric Cancer
5
- Anemia in 40%
- Elevated CEA in 65%
- UGI
- Endoscopy…..tissue is the issue
- CT scans for metastatic work up
Adenocarcinoma of the Stomach
- Whats the only cure?
- Prognosis? 2
- What offers little benefot for treatment?
- Surgical resection only cure
- Prognosis overall…. 12% 5 year survival
- 90% for stage I disease
- Radiation and chemo offer little benefit
Adenocarcinoma of the Stomach
- What often makes surgery futile?
- Palliation controversial for what? 2
- Late presentation makes surgery often futile
- Hemorrhage
- Gastric outlet obstruction
Less Common Gastric Neoplasms
3
- Lymphoma
- Gastrointestinal stromal tumour (GIST)
- Neuroendocrine (carcinoid) tumours
Gastric Lymphoma
- Whats the lymphoma called?
- treatment?
- (MALT…mucosa associated lymphoid tissue)
2. Treatment….sensitive to radiation
- Gastrointestinal Stromal Tumors (GIST)?
2. most common site?
- Mesenchymal neoplasms
2. Stomach most common site
Neuroendocrine Tumors
1. What are the tumors of resident neuroendocrine cells in gastric glands?
carcinoids
Gastric Sarcoma
Includes a variety of tumors such as? 3
- Leiomyosarcoma
- Leiomyoblastoma
- GIST
Pathophysiology of Pancreatic Cancer
- Arises from where?
- Tumor usually discovered when?
- Describe its progression?
- Whats the most common site for it on the pancreas?
- Usually arises from epithelial cells of the pancreatic ducts
- Tumor typcially discovered in late stages so has spread throughout pancreas
- Rapid growing with spread to surrounding tissue
- Most common site is head of pancreas
Signs and Symptoms of pancreatic cancer
10
- Vague, dull, abdominal pain
- “Painless jaundice”
- Weigh loss, weakness
- Anorexia, nausea, vomiting
- Glucose intolerance
- Flatulence
- GI bleeding
- Ascites
- Leg/calf pain
- Jaundice (if head of pancreas involved)
- Clay colored stools
- Dark urine
Diagnostics of pancreatic cancer?4
- No specific blood tests to diagnose
- Elevated amylase, lipase, alkaline phosphatase, bilirubin, CEA (carcinoembryonic antigen) C19-9
- CT, Ultrasonography
- ERCP – most definitive diagnostic test
Clinical Management of pancreatic cancer?
5
- Goal is to prevent spread of tumor
- Chemotherapy or radiation
- Pain control (opioids)
- Distal resection
- Whipple procedure