PATH - GI Cancers Flashcards
Esophageal cancer
Typically presents with *progressive dysphagia (first solids, then liquids), weight loss
poor prognosis
Squamous cell carcinoma of esophagus
Upper 2/3 of esophagus affected
RISK
Alcohol, hot liquids, caustic
strictures, smoking, achalasia
More common *worldwide
Adenocarcinoma of esophagus
Lower 1/3 of esophagus affected
RISK
Chronic GERD, Barrett
esophagus, obesity, smoking, achalasia
More common in *America
Gastric cancer
Most commonly *gastric adenocarcinoma
Early aggressive local spread with node/liver metastases
Often presents late, with weight loss, early satiety, and in some cases acanthosis
nigricans or Leser-Trélat sign.
Intestinal Gastric cancer
associated with *H pylori, dietary nitrosamines (smoked foods), tobacco, achlorhydria, chronic gastritis.
Commonly on *lesser curvature
looks like ulcer with raised margins
Diffuse Gastric cancer
- not associated with H pylori
- signet ring cells
- stomach wall grossly thickened and leathery (*linitis plastica).
Virchow node
involvement of left
supraclavicular node by *metastasis from stomach
*often 1st sign of dz
Krukenberg tumor
bilateral metastases to
ovaries from gastric ca
Abundant mucin-secreting, *signet ring cells.
Sister Mary Joseph nodule
Gastric CA –>subcutaneous
periumbilical metastasis.
Colorectal CA
Most patients are > 50 years old. ~ 25% have a family history
Rectosigmoid>ascending>descending
Ascending—exophytic mass, iron deficiency anemia, weight loss.
Descending—infiltrating mass, partial
obstruction, colicky pain, hematochezia
“Right side bleeds; left side obstructs”
RISK
Adenomatous and serrated polyps, familial cancer syndromes, IBD, tobacco use, diet of processed meat with low fiber.
-Rarely, presents with *Streptococcus bovis bacteremia
*“Apple core” lesion seen on barium enema x-ray
Chromosomal instability pathway:
- Loss of APC gene
- KRAS mutation
- Loss of tumor suppressor gene(s) (p53, DCC)
“AK-53”
*CEA tumor marker: good for monitoring
recurrence, should not be used for screening
Iron deficiency anemia in males (especially > 50 years old) and postmenopausal females raises suspicion
Screen patients > 50 years old with
colonoscopy, flexible sigmoidoscopy, fecal occult blood test, or fecal DNA test
Hepatocellular
carcinoma/hepatoma
Most common 1° malignant tumor of liver
in adults
Associated with *HBV (+/−
cirrhosis) and all other causes of cirrhosis
and specific carcinogens (eg, aflatoxin from Aspergillus).
May lead to *Budd-Chiari
syndrome.
SX: jaundice, tender hepatomegaly,
ascites, polycythemia, anorexia
Spreads hematogenously
Diagnosis: INC α-fetoprotein; ultrasound or
contrast CT/MRI, biopsy.
Cavernous hemangioma
Common, benign liver tumor
typically occurs at age 30–50 years
*Biopsy contraindicated
because of risk of hemorrhage
Hepatic adenoma
Rare, benign liver tumor, often related to *oral contraceptive or *anabolic steroid use
may regress spontaneously or rupture (abdominal pain and shock).
Angiosarcoma
*Malignant tumor of *endothelial origin
associated with exposure to *arsenic, *vinyl chloride, PVC
Metastases
GI malignancies, breast and lung cancer.
Most common overall
