Malignancies of Esoph, Stomach, Colon Flashcards
What is the distribution of Barret’s Related Dysplasia?
Patchy, irregular
What is the endoscopic appearance of Barrets Related Dysplasia?
Polypoid (small mass) or
thickened velvety mucosa
What are Sx of Esophageal Neoplasms? (4)
dysphagia
odynophagia
weight loss
obstruction
What are the most common type of of neoplasm of esophagus? what are risk fx? where does it occur?
Adenocarcinoma risks: 1. M>>F 2. Distal 1/3 esophagus 3. tobacco, EtOH, obesity, irradiation 4. Barrett's (GERD)
What does the adenocarcinoma invasion look like? (T1, T2-4)
T1: limitedto mucosa or submucosa
T2-4: invasion through muscularis propria
What are risk factors for Squamous Cell Carcinoma of esophagus? where in the esophagus does this occur?
- M>F
- Plummer-Vinson syndrome
- achalasia
- HPV 16, 18
- alcohol, tobacco, poverty
Middle 1/3 of esophagus
what are the 3 types of gastric polyps?
- Inflammatory - reactive epithelial proliferation
- Hyperplastic - most common GI bx specimen
- Fundic gland polyps - cystically dilated glands
What does Neoplastic polyps/Gastric Adenomas typically occur with?
Chronic gastritis w atrophy and intestinal metaplasia
-a/w H. pylori
What are the two types of Gastric Adenocarcinomas?
- Intestinal Type - majority, glandular structure
2. Diffuse Type - signet ring cell
What is Intestinal type of Gastric adenocarcinoma a/w?
glandular structures
atrophic gastritis - antecent dysplasia
Discrete metastasis to lymph nodes, liver
What causes Diffuse type of Gastric adenocarcinoma?
- Decreased E-cadherin activity
- Signet ring cell (discohesive cell invasion)
- LINITIS PLASTICA = leather bottlle stomach
- metastasis to peritoneal cavity, mesentery
What is a Virchow node (Troisier’s sign)
Gastric carcinoma metastases as lymph node
via THORACIC DUCT
What is a Sister Mary Joseph Node?
Gastric carcinoma presenting as metastasis to lymph node @ subcutaneous periumbilical area
What is a Krukenburg tumor?
Carcinoma (usually diffuse gastric) that metastasizes to ovaries = looks like primary ovarian carcinoma
What type of tumor is Carcinoid tumor?
Well-differentiated neuroendocrin tumor (NET)
What are Sx of Carcinoid syndrome?
- Cutaneous flushing
- Sweating
- bronchospasm
- diarrhea
- colicky abdominal pain
What is the difference in prognosis based on location for GI NETs? (fore, mid, hind gut)
Hindgut (APPENDIX + colorectum): --Benign Foregut (prox to ligament of treitz) --Good prognosis Midgut (jejunum and ileum) --multiple and Aggressive
What is Zollinger Ellison Syndrome (ZES)? What genetic dysfuntion is it a/w??
Gastrin secreting tumors
Multiple endocrine neoplasia type 1 (MEN 1)
What is the result of elevated gastrin from ZES?
Mucosal hyperplasia (increased parietal cells) Gastritis/PUD (Tx: PPI, H2 blockers)
What type are most GI lymphomas?
MALT lymphomas (extranodal marginal zone B-cell lymphoma)`
What are the 3 genetic translocations associated with MALT lymphomas that result in increased NF-kB activity? What are the protein results?
t(11;18) - API2-MLT fusion protein
t(14;18) - MLT under promoter for Ig heavy chain
t(1;14) - MLT under promoter for Ig heavy chain
What is NF-kB? what kind of infection can trigger activation?
transcription factor promoting cell growth
H. pylori causes inflammation = NF-kB activation
What are the 3 types of small bowel benign tumors?
Tubular
Tubulovillous
villous(periampullay)
What are Sx Peutz-Jehger polyps? What does it increase the risk of?
Autosomal dominant: 1. hamartomatous polyps (benign) 2. Mucocutaneous melantoic pigmentation Increased Risk: 1. Obstruction/Intussusception 2. cancers of: breast, pancreas, testis, ovaries
What kind of malignancy is associated with Celiac Disease?
Enteropathy-associated T-cell lymphoma
What are 3 Sx of Cowden Syndrome?
- Hamartomatous polyps of all three germ layers
- Inflammatory polyps (colorectal)
- Mucocutaneous lesions;macrocephaly
What is the mutation a/w Cowden Syndrome?
PTEN - germline auto dominant mutations
What is the mutation a/w Peutz-Jegher’s Syndrome?
STK11 - germline auto dominant mutations
What is the Adenocarcinoma genetic mutation sequence?
APC - RAS - p53
What are the two gene mutations involved with HNPCC (Lynch Syndrome)
MLH1, MSH2
Microsatellite instability
What is the difference between Left and Right sided Colorectal Cancer?
Left: obstructive, Streptococcus bovis endocarditis
Right: larger, more substantial BLEEDING
