Neoplastic Gastric Mucosa Disorders

Question 1

• 4th most common cancer
• 1 M cases, 800k deaths annually
• 70% in developing countries
• Higher risk with higher geographic
latitudes

Answer 1

Gastric Adenocarcinoma

Question 2

Risks associated with gastric adenomarcinoma

Answer 2

Other risks: smoking, salt, nitrates

Question 3

What is true about the rate of gastric adenocarcinoma dx?

Answer 3

• Rates have been declining for distal cancers (previously 2nd most common)

Question 4

Most common type of gastric adenomacarcinoma and where does it occur

Answer 4

• Most common type (50-75%)

* Occurs in distal stomach

Question 5

Main risk factor for Intestinal type of gastric adenocarcinoma

Answer 5

• H. pylori infection main risk factor
– Also increased with pernicious anemia
• Background of intestinal metaplasia
– Precursor stem cells from bone marrow, not gastric epithelium
• More common in men, older age

Question 6

What type of gastric adenocarcinoma has an unknonw precursor lesion and affects men and women the same?

Answer 6

Diffuse type adenocarcinoma

Question 7

YOu see Signet ring on histology (– Mucin-filled vacuol diplaces nucleus ) what is this indicitive of?

Answer 7

Diffuse type adenocarcinoma

Question 8

Diffuse type adenocarcinoma is more aggresive then intestinal and associated with what blood type?

Answer 8

Blood group A

Question 9

Hereditary Diffuse Type Adenocarcinoma has what type of inheritance

Answer 9

Autosomal dominant with high
penetrance
• 80% of carriers will develop disease

Question 10

What is the mutation in heriditary diffuse type adenocarcinoma

Answer 10

• Mutation in E-cadherin gene (CDH1)
• Tumor suppressor gene affecting cellular adhesion/motility
• Mutations also seen in 50% of sporadic diffuse gastric cancers

Question 11

Average age of onset of heridiatry diffuse type and assoicated with risk of what other type of cancer?

Answer 11

• Average age of onset is 38 years
• < 1% risk before age 20
• 4% risk by age 30
• Increased risk of breast cancer
• 39% risk of lobular breast cancer by age 80

Question 12

What are some other heritable associations of adenocarcinoma

Answer 12

Familial adenomatous polyposis(FAP)
• Lynch Syndrome
• Peutz-Jeghers syndrome
• Li-Fraumeni syndrome

Question 13

Gastric Adenocarcinoma
Diffuse Type EBV-Associated
seen in what population?

Answer 13

• Male predominant
• No age predilection
• Higher proportion of all cancers in developed countries

Question 14

Gastric Adenocarcinoma
Diffuse Type EBV-Associated…
aggresive? represents what % of cancers?

Answer 14

About 10% of gastric
carcinomas world wide
less aggresive

Question 15

What is different about incidence of Adenocarcinoma of Cardia compared to other gastric adenocarcinoma

Answer 15

Unlike other gastric adenocarcinomas,
incidence is rising, similar to
esophageal adenocarcinoma in GERD

Question 16

Risk factors for adenocarcinoma of cardia

Answer 16

– Lack of H. pylori
– Male gender
– Obesity
– Smoking

Question 17

Pt presents with abdominal pain, quickly full after meals and get nauseaous. Recent weight loss, dysphagia, vomitting and GI bleeds.

Answer 17

Symptoms of Gastric adenocarcinoma

Question 18

a (aggressive form of diffuse type gastric adenocarcinoma)

Answer 18

Linitis plastica

Question 19

most common extranodal site of lymphoma (70%)

Answer 19

Gastric lymphoma

Question 20

Peak incidence of gastric lymphoma, male or female what type of lymphoma most common?

Answer 20

50-60 yrs
male
most are non-hodgkin (NHLs)

Question 21

LYmphoma in gastric area associated with H.pylori

Answer 21

MALToma (marginal zone B cell, mucosa associated)

Question 22

80% regression with eradication for gastric MALToma only if:

Answer 22

Does not extend below submucosa

– No t(11:18) chromosomal translocation

Question 23

What is more common; primary or secondary gastric lymphomas

Answer 23

• Primary NHLs: rare (1-4% of all
gastrointestinal malignancies)
• Secondary involvement: common
• Limited stage: 10%; advanced: 60%

Question 24

Risk factors for gastric lymphomas

Answer 24

• Immunodeficiency/ immunosuppression
• Celiac disease
• Autoimmune disorders

Question 25

most common presentation of gastric lymphoma

Answer 25

• Epigastric pain: 78-93%
• Anorexia: 47%
• Weight loss: 25%

Question 26

Less common clinical presentaiton of gastric lymphoma

Answer 26

• Nausea and/or vomiting: 18%
• Occult gastrointestinal bleeding: 19%
• B symptoms: 12%
• Rarely perforation (risk after treatment)

Question 27

Endoscopy of this presents all the following ways:
• Mucosal erythema
• Mass
• Ulcer
• Nodularity
• Thickened gastric folds

Answer 27

Gastric lymphoma

Question 28

Gastric carcinoid tumors are derieved from:

Answer 28

Derived from enterochromaffin-like (ECL) cells

Question 29

Gastric carcinoid tumor Proliferate and transform in response to

Answer 29

high circulating levels of gastrin

Question 30

• Achlorhydria:

* Ectopic gastrin secretion:

Answer 30

• Atrophic gastritis

- • Sporadic gastrinoma or MEN 1

Question 31

Common age, gender, location of Gastric Carcinoid Tumors

Answer 31

women
60-70
Usually smaller than 1 cm and multiple
• Usually indolent, nonfunctioning, and benign

Question 32

Do Gastric Carcinoid tumors commonly metestasize?

Answer 32

• Metastasis in < 10% of tumor < 2 cm, 20% in larger tumors

Question 33

What are gastrin levels like in gastric carcinoid tumors?

Answer 33

NORMAL gastrin

Question 34

In Aggresive Gastric Carcinoid tumors, up to 65% present with

Answer 34

hepatic or local metastases

Question 35

What do gastric carcinoid tumors look like with endoscope?

Answer 35

multiple nodules