GI Tumors Flashcards
Patient with a history of tobacco use presents w/ weight loss, fatigue, anorexia, and painless jaundice with dilation of the common bile duct on ultrasound.
Labs show: Cholestasis (↑↑↑ ALP & direct bilirubin)
& ↑ AST/ALT
This presentation is concerning for ____.
pancreatic cancer
↑CA-19-9 (not as a screening test)
If there is a concern for GI cancer initial work up includes:
1. _____ (if jaundiced)
or
2. ______ (abdominal pain w/o jaundice or 1 isn’t helpful)
Abdominal ultrasonography
CT scan
***Abdominal u/s is used in the initial evaluation of patients with painless jaundice, anorexia, or weight loss.
However, it is not the preferred modality for screening patients who have abdominal pain without jaundice;
Presentation of pancreatic cancer depends on location:
Tumors in the pancreatic HEAD cause → ___
Tumors in the pancreatic body or tail cause → ___
painless obstructive jaundice
abdominal pain w/o jaundice
Bile acids are primarily reabsorbed in the ___; impaired absorption can cause malabsorption of fats.
ileum
Steatorrhea is s/t malabsorption of fats.
This is typically seen following extensive ileal resection in pts with [illness]
Crohn disease (CD)
[illness] should be suspected in patients with MULTIPLE duodenal ulcers refractory to treatment or ulcers distal to the duodenum.
Zollinger-Ellison syndrome
*INACTIVATION of pancreatic enzymes by increased production of stomach acid may lead to malabsorption.
Pancreatic exocrine (enzyme) DEFICIENCY can be seen in:
- ____
- ____
- pancreatic resection
chronic pancreatitis
cystic fibrosis
↑ ALP & ↑ gamma glutamyl transpeptidase (GGT) suggests _____
biliary compression or obstruction
____ are caused by Echinococcus tapeworm infections.
Commonly seen in immigrants, exposed to sheep and dogs.
Hydatid cysts
multiple cystic lesions in liver
Occurs in patients with cirrhosis or chronic Hepatitis B or C.
Characterized by a rapidly enlarging liver mass, often with satellite lesions.
Hepatocellular carcinoma
Trousseau syndrome is a hypercoagulability disorder presenting with recurrent and migratory superficial thrombophlebitis at unusual sites (arm, chest area).
It is usually associated with an occult visceral malignancy such as ____ (most common), stomach, lung, or prostate carcinoma.
pancreatic
Microcytic anemia and a positive fecal occult blood should raise concern for GI bleeding or ___
Colorectal Cancer
Microcytic anemia and a positive fecal occult blood should raise concern for GI bleeding or ___
Colorectal Cancer
____ typically presents with symptoms of biliary obstruction:
- jaundice
- pruritus
- light-colored stools
- dark urine.
Cholangiocarcinoma
*Risk factor: primary sclerosing cholangitis
Pt presents with anorexia and weight loss.
Physical remarkable for Hepatomegaly and mucosal pallor.
Labs show microcytic anemia and ↑ ALP.
Fecal occult blood is +
U/S shows solitary liver mass.
DIagnosis?
Colorectal Cancer met to liver
___ and hepatic adenoma are usually benign liver tumors seen in young women
Focal nodular hyperplasia (FNH)
Asymptomatic
Fecal occult blood +
causes (3)
Colorectal cancer
Gastric/Duodenal ulcers (Zollinger-Ellison/ H.pylori)
Gastric (adenocarcinoma) cancer typically causes anemia (due to tumor bleeding into the stomach)
Helicobacter pylori infection is a significant risk factor for ____ and MALT lymphoma
(Mucosa-Associated Lymphoid Tissue)
gastric adenocarcinoma
Helicobacter pylori infection is a significant risk factor for gastric adenocarcinoma and ____
MALT lymphoma
Mucosa-Associated Lymphoid Tissue
In gastric adenocarcinoma, tumor stage at the time of diagnosis determines prognosis and treatment options.
_____ is the initial staging modality.
CT scan
Limited stage→ resect
Advanced stage → Chemo +/- pallative sx.
Primarily used to excludecholecystitis in patients with suggestive symptoms but no gallbladder inflammation or biliary obstruction on ultrasound.
HIDA scan
Chronic mesenteric ischemia
presents with postprandial, severe, intermittent pain and food aversion.
Diagnosis is made with ___
CT angiography (noninvasive)
vs Mesenteric angiography (an invasive procedure)
The most common symptom of pancreatic cancer is insidious, [timing, location] pain that may radiate to the flanks or back and is sometimes worse with eating and lying down.
CONTINUOUS midepigastric
Around 25% of ____ cancer is preceded by a recent (<2 years) diagnosis of diabetes mellitus.
pancreatic
Pts w/ new-onset ___ AND who have symptoms like
(constant abdominal pain, weight loss) should undergo abdominal CT scan for pancreatic cancer screening.
Diabetes Mellitus
Patients with __ or ___ often have
gnawing epigastric pain that is worse several hours after meals (when the food buffer is cleared).
gastric/duodenal ulcers
gastric tumors
*Diagnosed by EGD followed by H. pylori stool antigen test
Patients with L colon adenoma/carcinomas seen on sigmoidoscopy have increased risk for R colon tumors and require a ____.
colonoscopy
- to visualize the entire colon
Patients with Lynch syndrome (hereditary nonpolyposis colorectal cancer) are at increased risk for gastric adenocarcinoma and warrant periodic __ to detect early adenomatous polyps.
upper endoscopy
Familial adenomatous polyposis (FAP) is caused by mutations in the Adenomatous Polyposis Coli (APC) gene and confers a very high risk of [cancer].
colorectal adenocarcinoma
*Typically have numerous colon adenomas
FAP is AD w/ nearly 100% penetrance
Chinese immigrant with 4m h/o deep, mid-epigastric, persistent, and non-radiating abdominal pain, nausea, and emesis w/ no consistent relationship between the pain and food. Physical exam reveals abdominal TTP and Hepatomegaly. Labs show microcytic anemia and ↑↑ ALP & ↑ AST/ALT
Diagnosis?
Gastric Cancer
Microcytic (iron deficiency) anemia in an elderly patient is more likely due to ___ or ____ cancer than to ___ cancer, which does not typically bleed into the gastrointestinal tract.
colonor gastric
pancreatic
___ cancer is common in those from Eastern Asia, Eastern Europe, and South America. It generally presents with progressive epigastric pain and weight loss. Friable tumor vessels can bleed into the stomach lumen, leading to iron deficiency anemia. Metastasis to the liver can result in hepatomegaly and elevated transaminases and alkaline phosphatase.
Gastric cancer
Hyperplastic polyps in the colon are a non-neoplastic and most commonly found in the rectosigmoid colon on colonoscopy.
Colorectal screening intervals for pts with:
Small (<1 cm) polyps → Repeat colonoscopy in ____
Repeat colonoscopy in ___ for individuals with a high-risk FMH of 1º relative w/colorectal cancer at age <60
10 years
5 years
