GIT Cancer NM Flashcards
Esophageal cancer stage II
IIA - lower 1/3 T3
IIB - upper 2/3 T3
Esophageal cancer unresectable
Aorta, vertebral body, trachea, bronchi, lung
Esophageal cancer stage III
N1
Esophageal cancer M
Liver
Lung
Bone
Smoking + alco
Esophagus
SCC, middle 1/3
Obesity, reflux
Adenocarcinoma, distal, GEJ within proximal 5 cm
Esophageal cancer diagnosis
EUS - most sensitive for tumor depth
FDG - more sensitive than CT in LN
Esophageal cancer FDG indication
Distant MTS
LN involvement
Response to neoadj treatment
Local recurrence - - dd fibrosis vs edema
False negative - - small T1-2, necrotic, mucinous
3-4 weeks after chemoradio
6 weeks after surgery
FDG T staging esophageal cancer
T1-2 - asymmetric thickening
T3 - wall thickening >5 mm or mass causing luminal obstruction
Esophageal cancer LN
> 1 cm in short axis or >5 mm supraclavicular
Upper esophagus - cervical and mediastinal
Lower esophagus - abdominal
Esophageal cancer treatment
Chemo radio + surgery
T3 dd esophageal vs gastric
Esophageal - no serosa - - adventitia - - easy to spread
Gastric - subserosa - serosa
Gastric T4
Not duodenum or esophagus
Gastric cancer LN
Sister Mary Joseph’s LN - Periumbilical
Celiac >6 mm
Perigastric >8 mm
Clustering >3 LN
Risk for LN:
T4, tumor >2 cm, ulcer, mucinous
Gastric cancer M
Liver
Peritoneum - - Krukenberg
Lung
Bone
Gastric cancer type
Adenocarcinoma 90%
Intestinal type - older, distal, pernicious anemia
Diffuse type (signet ring cell) - <50 y, cardia, linitis plastica (diffuse thickening), reflux, obesity, ILC breast ca
Gastric cancer risk
H. Pylori, alco, salt, meat - - distal, antral
Obesity, dysphagia - - proximal, cardia
Reflux - - GEJ
Vomit - - pylorus
Menetrier disease (giant hypertrophic gastritis)
Peutz-Jeghers syndrome
Smoking
Gastric cancer staging
EUS - local invasion
CT thorax+abdomen+pelvis - - wall thickening >5 mm, advanced T, LN
FDG detection rate of primary tumor 55% - - no role in T staging, higher accuracy in LN, not sensitive for detecting peritoneal involvement
Gastric cancer low FDG uptake
Mucinous, signet ring cell, poorly diff
Gastric cancer treatment
Surgery + post-op chemo radio
RT hemicolectomy if appendix cancer
Involvement of colon or base of appendix
Periappendicular area
Tumor size >2 cm
High grade
LN
Invades through muscularis propria
Colonic-type adenocarcinoma
Colon cancer type
Right - anemia, occult blood, polypoid
Left - bleeding, altered bowel habits, pain, obstruction
Distal - circumferential, apple core
Adenocarcinoma 90%
Mucinous - - peritoneal spread - - Krukenberg
Ascending/descending - - retroperitoneum
Rectosigmoid - - worse prognosis
Premalignant colon polyp
Tubular
Tubulovillous
Villous
Sessile
Pedunculated
Depressed
Anal carcinoma T
Anal cancer N
Proximal - - perirectal along IMA
Below dentate line - - inguinal, external iliac
Above dentate line - - mesorectal, internal iliac
Colon cancer FDG
Focal uptake malignant
No diff radio necrosis vs recurrence
At least 4 weeks after radio
Any incidental focal Colonic uptake - - colonoscopy
Mucinous - - calcification in liver MTS dd after chemo
Response to chemo radio not superior than CT, except for rectal cancer
Anal cancer FDG
98% avid
Big role for staging
Not for treatment response: min residual activity 1 month follow up
Colon cancer M
Liver (portal vein) - - resection
Lung (recto sigmoid through paravertebral venous)
Bone
Brain
Colon cancer diagnosis
Colonoscopy
CT
MRI
Anal cancer risk
HPV - - SCC
Female > male
Anal cancer imaging
Pelvic MRI not T1 or endo anal US
FDG - LN staging, 20% change in staging
FDG benefit - detect residual subclinical pelvic or extra pelvic /para aortic node involvement
Anal cancer type
<2 cm above dentate line - - anal ca
>2 cm above dentate line - - rectal ca
Skin within 5 cm of anus - - perianal ca
SCC 90% better prognosis
Adenocarcinoma, melanoma, small cell carcinoma
Liver MTS from colon cancer
Recurrence of colorectal cancer in liver
GIST T
GIST M
Liver
Peritoneum
Retroperitoneum
Lung
Carney triad
GIST
Pulmonary chondroma
Extraadrenal paraganglioma
GIST risk
Neurofibromatosis type 1 - - small bowel
Anemia
Pulpable mass, obstruction
Exophytic growth, 2-30 cm
Treatment - glivec
GIST PET
Response grade based on changes in SUV
GIST small bowel