SM_278b: GI Cancers Flashcards
Esophageal cancer is most commonly of ___ origin
Esophageal cancer is most commonly of epithelial origin
__ occurs in the upper 2/3 of the esophagus
Squamous cell carcinoma occurs in the upper 2/3 of the esophagus
___ occurs in the lower 1/3 of the esophagus
Adenocarcinoma occurs in the lower 1/3 of the esophagus
___, ___, and ___ are risk factors for esophageal cancer
Tobacco, smokeless tobacco, and mediastinal radiotherapy are risk factors for esophageal cancer
___, ___, and ___ are risk factors for squamous cell carcinoma of esophagus
Tobacco, alcohol, and diet low in fruits and vegetables are risk factors for squamous cell carcinoma of esophagus
____ is acquired metaplasia of transition zone between squamous epithelium of esophagus and columnar cells of stomach
Barrett’s esophagus is acquired metaplasia of transition zone between squamous epithelium of esophagus and columnar cells of stomach
- Risk factors for Barrett’s metaplasia and adenocarcinoma: male, > 45 years, > 8 cm of Barrett’s, GER > 3 times / week, GER > 10 years, white, obese, H. pylori absent, heavy tobacco, mucosal damage, low fruit and vegetable diet
Lymphatics in esophagus are located in ___, so lymph node invasion occurs ___
Lymphatics in esophagus are located in lamina propria, so lymph node invasion occurs early and quickly
Lymphatics in GI tract EXCEPT for esophagus are located in ___
Lymphatics in GI tract EXCEPT for esophagus are located in muscularis mucosa
Intestinal metaplasia is ___
Intestinal metaplasia is transformation of epithelium, usually of stomach or esophagus, into a type of epithelium resembling that found in intestine
- Called Barrett’s esophagus in esophagus
___, ___, and ___ are universal demographic risk factors for gastric cancer
Increasing age, male sex, and deprivation are universal demographic risk factors for gastric cancer
Describe symptoms / presentation of gastroesophageal / esophageal / gastric cancer
Gastroesophageal / esophageal / gastric cancer
- Dysphagia / odynophagia
- Abdominal pain
- Bloating / belching
- Weight loss
- Can get hemoptysis or melena sometimes depending on if patient has ulcerations
____ is maintstay of diagnosis for esophageal / gastric cancer
Endoscopy is maintstay of diagnosis for esophageal / gastric cancer
____, ____, and ____ are used for treatment of esophageal / gastric cancer
Surgery, chemo, and radiation are used for treatment of esophageal / gastric cancer
If patient has localized esophageal or gastric cancer, ____
If patient has localized esophageal or gastric cancer, additional imaging and procedures must be done to ensure there is no occult disease
Describe risk factors for pancreatic cancer
Pancreatic cancer risk factors
- Hereditary (5-10%): BRCA 1 and 2, PALB2, CDKN2
- Diabetes
- Chronic / recurrent pancreatitis
- Smoking
- Pancreatic cysts
- Metabolic syndrome
- Obesity
Pancreatic cancer presents with ___, ___, ___, and ___
Pancreatic cancer presents with weight loss, pain, jaundice, and nausea / vomiting
- Pain: epigastric, back, flank
- Jaundice: dark urine, light stools
Most pancreatic tumors arise from ____
Most pancreatic tumors arise from columnar cells (adenocarcinoma)
Describe classificiation of pancreatic cancer
Pancreatic cancer classification
- Exocrine: solid epithelial, cystic epithelial
- Endocrine: non-hyperfunction, hyperfunction
Describe endocrine pancreas
Endocrine pancreas
- Islet cells produce insulin, glucagon, pancreatic polypeptide, and somatostatin
- Loss of insulin causes diabetes mellitus
Describe exocrine pancreas
Exocrine pancreas
- Acinar cells produce digestive enzymes: key enzyme is trypsinogen, premature activation of trypsinogen causes pancreatitis
- Duct cells produce bicarbonate-rich fluid: key molecule is CFTR, loss of CFTR causes cystic fibrosis
Describe diagnostic testing for pancreatic cancer
Pancreatic cancer diagnostic testing
- Endoscopy: ERCP for stent placement if present with jaundice
- CT chest / abdomen / pelvis: evaluate for distant disease
- If no distant mets, do not need PET scan
- Ca19-9 / CEA: cancer markers but not present in all
Describe management of pancreatic cancer
Pancreatic cancer management
- TNM staging not relevant
- Surgery is best option if localized and no vascular involvement, non-surgical otherwise
- Most patients present with metastases
Describe risk factors for hepatocellular carcinoma
Hepatocellular carcinoma risk factors
- Hepatitis B
- Hepatitis C: degree of inflammation in patients correlates with prognosis once Hep C is diagnosed
- NALFD / NASH: largest proportion among patients in western world
- Obesity
- Hemachromatosis
- Alpha-1 antitrypsin
Successful treatment of Hepatitis C ____ risk of hepatocellular carcinoma in patients with chronic hepatitis C
Successful treatment of Hepatitis C decreases but does not eliminate risk of hepatocellular carcinoma in patients with chronic hepatitis C
- Direct acting antiviral agents resulting in SVR also lowers the risk of hepatocellular carcinoma
Describe progression of non-alcoholic fatty liver disease
Progression of non-alcoholic fatty liver disease
- Normal liver
- Fatty liver
- NASH
- Cirrhosis
Describe diagnosis of hepatocellular carcinoma
Hepatocellular carcinoma diagnosis
- Alpha-fetoprotein: Hx of cirrhosis and elevated AFP > 500 usually diagnosis, higher in viral hepatitis than NASH or alcohol cirrhosis
- Imaging: characteristic washout images with MRI
- Biopsy
____ leading to cirrhosis is main risk factor for hepatocellular carcinoma
Chronic inflammation leading to cirrhosis is main risk factor for hepatocellular carcinoma
___ is best curative option for hepatocellular carcinoma
Resection and transplantation is best curative option for hepatocellular carcinoma
___ in treating hepatocellular carcinoma
Maximize liver therapies before systemic therapy in treating hepatocellular carcinoma
____, ____, and ____ are risk factors for gallbladder cancer
Primary sclerosing cholangitis, infection with flukes, and inflammatory state are risk factors for gallbladder cancer
Gallbladder cancer presents with ___, ___, ___, and ___
Gallbladder cancer presents with jaundice, abdominal pain, pruritis, and weight loss
Gallbladder cancer is classified as ___, ___, or ___
Gallbladder cancer is classified as intra, extra, or hilar
Gallbladder cancer should be treated with ___ when possible
Gallbladder cancer should be treated with surgery when possible
____ is used as systemic therapy for gallbladder cancer
Chemo with gemcitabine and cisplatin is used as systemic therapy for gallbladder cancer
