onco - esophagus, stomach, colon, rectum Flashcards
Esophageal Ca is most common in what sex? Age?
M
>50
Lining of esophagus
Stratified squamous
Most common benign tumor of esophagus?
Leiomyoma
Presenting symptoms of esophageal Ca
Dysphagia - most common
Weight loss
Regurgitation
Diagnosis for esophageal Ca
Barium swallow
Esophagoscopy
Seen in barium swallow in esophageal Ca
Filling defect
Confirmatory procedure for esophageal Ca after barium swallow
Esophagoscopy
Why is biopsy contraindicated in diagnosis of esophageal Ca?
Destroys mucosa, can affect the result. Violates the mucosa making subsequent surgery (otherwise lesion will be disturbed)
Treatment for esophageal Ca
Esophagectomy
Percutaneous endoscopic gastrostomy (PEG)
Treatment of choice for esophageal Ca if upper 3rd is affected
Surgery, esophagectomy
Treatment of choice for esophageal Ca if lower 3rd is affected
RT
Why is endoscopy contraindicated during surgery?
Could perforate esophagus
Etiology of esophageal Ca
Alcohol ingestion
Cigarette smoking, opiates
Food additives (Nitrate,Fungal toxins in pickled veggie)
Poor dental hygiene
Hot drinks, lye ingestion
Esophageal disorders (Esophagitis, achalasia, Mallory-Weiss, gerd, Plummer-Vinson)
Esophagitis is an infection caused by..
Herpes simplex
CMV
Candidiasis, aspergillosis
Motor disorder characterized by aperistalsis, failure of relaxation of LES and increased basal tone of LES
Achalasia
Gross appearance of achalasia
Proximal dilatation (Bird’s beak)
Complication of long standing reflux esophagitis or gerd where in squamous cell becomes columnar
Barrett’s esophagus
Barrett’s esophagus has increased risk for what type of esophageal Ca?
Adenocarcinoma
Most common esophageal Ca
SCC
Rare esophageal Ca
Mucoepidermoid Ca
Adenoid cystic
Most commonly affected site of Ca of SCC of esophagus
Middle 1/3
Most commonly affected site of adenocarcinoma of esophagus
Distal. 1/3
Metastatic site of esophageal
Liver
Bone
Brain
Earliest metastasis of esophageal Ca
Liver, due to chronic drinking
T/F: if esophageal Ca is accompanied with pneumonia, it has poor prognosis
True
Size of esophagus
25cm
3 areas of narrowing in esophagus
- Beginning of esophagus (cricopharyngeus m)
- Where l mainstream bronchus and aortic arch cross
- At hiatus of diaphragm
Cricopharyngeus muscle
Prevents passage of excess air into the stomach during breathing
Upper esophageal sphincter UES
Physiologic sphincter
Relaxes with the initiation of pharyngeal swallow and prevents reflux of gastric content when swallowing is not occurring
Lower esophageal sphincter LES
I ate 10 eggs at noon
IVC - T8
Esophagus - T10
Aorta - T12
Contraindication for surgery of esophageal mass
Poor performance status Severe malnutrition Vocal cord palsy Broncho-esophageal fistula Invasion of great vessels Cervical/celiac node involvement Distant metastasis
Mechanical injury of esophagus with laceration with a clinical seething of chronic alcoholics after bout of severe vomiting
Mallory-Weiss syndrome
Syndrome characterized with dysphagia, iron def anemia and esophageal web
Plummer-Vinson syndrome
Most common gastric Ca
Adenocarcinoma
2nd most common gastric Ca
Lymphoma -GIST, leiomyosarcoma
Gastric Ca is commonly seen in what age?
50-70
Etiologic factors for gastric Ca
Nitrosamines Atrophic gastritis Achlorhydria Pernicious anemia (folic acid def) Blood type a Cdh1
Presenting symptoms of gastric Ca
Anorexia, weight loss, epigastric pain
Diagnosis for gastric Ca
GI series (upper gi series> Barium swallow Biopsy - guided by endoscopy
Classification of gastric Ca
Ulcerating - diffuse type
Fungating - intestinal type
Among classif go gastric Ca, which is the most common? Least common.
Ulcerating - most common
Fungating - least common
Ulcerating/fungating: No cell cohesion Ca develops throughout stomach Poor prognosis No asso risk factor Younger pts
Diffuse, ulcerating
Ulcerating/fungating: Cohesive neoplastic cells Ca appears in atrium and lesser curvature Good prognosis Asso risk factor: h.pylori Older pts
Fungating, intestinal
A loss of distensibility of gastric wall resulting to a leather bottle appearance called
Linitis plastica
Linitis plastica is seen in what type of gastric Ca?
Diffuse, ulcerating
Treatment of choice for gastric Ca if distal part is affected
Subtotal gastrectomy
Treatment of choice for gastric Ca if proximal part is affected
Total gastrectomy
T/f: Gastric Ca is radioresistant
True. RT is for palliation of pain
Closely asso with gastric Ca, where Ca starts.
Adenomatous polyps
T/f: duodenal Ca is not asso with gastric Ca
True
Gastric Ca that metastasize to ovaries
Krukenberg tumor
Signet ring appearance
Gastric Ca that metastasize to Periumbilical region
St Mary Joseph node
Gastric Ca that metastasize to peritoneal cul de sac
Blumer’s tumor
Most common site of hematogenous spread of gastric Ca
Liver
Post gastrectomy complication
Dumping syndrome
Postvagotomy diarrhea
Gastritis
Dumping syndrome
Symptoms: Epigastric pain Diarrhea Nausea and vomiting Palpitations Dizziness Flushing, sweating Signs: Tachycardia, elev.bp
Prevention for dumping syndrome
Eat Small quantity of food
Avoid carbs
Decrees fluid intake
Postvagotomy diarrhea resolves after
1yr
Most commonly affected by gastrectomy which makes it more difficult to perform
Pancreas
If pancreas and duodenum is affected and performed after gastrectomy, what do you call the procedure
Whipple’s procedure - pancreaticoduodenectomy
Prognosis or staging of gastric Ca depends on
Depth of invasion to gastric wall
Extent of mets and lymph node involvement
Most common small bowel Ca
Adenocarcinoma > carcinoid > lymphoma
Presenting signs of small bowel or colon Ca
Abdominal distention Obstruction Intussusception Diarrhea Melina
Asso disease with adenocarcinoma of small bowel or colon Ca
Celiac disease Crohn's disease Celiac disease FAP PJ syndrome
Small intestine enters large intestine due to persistent peristalsis without intake
Intussusception
Intussusception is more common in what age?
Children
Treatment for Intussusception
Surgery, reduction
If in Intussusception there is cyanosis what procedure will you do?
Segmental resection, colostomy
Most common site of adenocarcinoma of small bowel Ca
Distal duodenum > jejunum > ileum
SR of small bowel Ca
25% 5 year survival
Most common site if carcinoid tumor of small bowel Ca
Appendix > ileum > rectum
An inflammatory bowel disease which forms granulomatous ileitis with bloody diarrhea and pain
Crohn’s disease
Most common site of crohn’s disease
Ileum
What can you see in barium enema in person with Crohn’s disease?
Skip lesions of Cobblestone appearance
Treatment for crohn’s disease
Metronidazole
Which is most common.. L or R colon Ca.
R colon Ca
Colon Ca is most common in what sex?
Female
Rectal Ca is most common in what sex?
Male
Left sided colon Ca presenting signs
Change in bowel habit
Small caliber stool
Obstruction
R sided colon Ca presenting signs
Anemia Fatigue Melena Less solid stools Occult bleeding Weakness
What can yours see in barium enema of left sided Colon ca?
Apple core
Risk factors for colon Ca
>50 y/o Personal history of Resected colon Family history Low fiber, high fat diet FAP, HNPCC Long standing UC or crohn's disease
Colon Ca diagnosis
Barium enema Endoscopy Proctosigmoidoscoy Colonoscopy CT scan Intravenous pyelography (IVP)
Mutated gene in APC.
C5
FAP + osteomas
Gardner’s syndrome
FAP + Gliomas
Turcot’s syndrome
Most common site of rectal Ca
Lower 3rd
S&s of rectal Ca
Change in bowel habits Alternating constipation and diarrhea Tenesmus Anal bleeding Lump Itching
Risk factors for rectal Ca
HPV HIV Smoking Multiple sexual parter Anal inter ours Immunosuppressed state
2 unique in situ tumors of perianal skin
- Paget’s disease - adenoca in situ
2. Bowen’s disease - SCC in situ
Diagnosis of rectal Ca
Direct rectal examination
