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Heme / Onc > SM_278b: GI Cancers > Flashcards

SM_278b: GI Cancers Flashcards

1
Q

Esophageal cancer is most commonly of ___ origin

A

Esophageal cancer is most commonly of epithelial origin

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2
Q

__ occurs in the upper 2/3 of the esophagus

A

Squamous cell carcinoma occurs in the upper 2/3 of the esophagus

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3
Q

___ occurs in the lower 1/3 of the esophagus

A

Adenocarcinoma occurs in the lower 1/3 of the esophagus

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4
Q

___, ___, and ___ are risk factors for esophageal cancer

A

Tobacco, smokeless tobacco, and mediastinal radiotherapy are risk factors for esophageal cancer

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5
Q

___, ___, and ___ are risk factors for squamous cell carcinoma of esophagus

A

Tobacco, alcohol, and diet low in fruits and vegetables are risk factors for squamous cell carcinoma of esophagus

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6
Q

____ is acquired metaplasia of transition zone between squamous epithelium of esophagus and columnar cells of stomach

A

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
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7
Q

Lymphatics in esophagus are located in ___, so lymph node invasion occurs ___

A

Lymphatics in esophagus are located in lamina propria, so lymph node invasion occurs early and quickly

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8
Q

Lymphatics in GI tract EXCEPT for esophagus are located in ___

A

Lymphatics in GI tract EXCEPT for esophagus are located in muscularis mucosa

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9
Q

Intestinal metaplasia is ___

A

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
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10
Q

___, ___, and ___ are universal demographic risk factors for gastric cancer

A

Increasing age, male sex, and deprivation are universal demographic risk factors for gastric cancer

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11
Q

Describe symptoms / presentation of gastroesophageal / esophageal / gastric cancer

A

Gastroesophageal / esophageal / gastric cancer

  • Dysphagia / odynophagia
  • Abdominal pain
  • Bloating / belching
  • Weight loss
  • Can get hemoptysis or melena sometimes depending on if patient has ulcerations
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12
Q

____ is maintstay of diagnosis for esophageal / gastric cancer

A

Endoscopy is maintstay of diagnosis for esophageal / gastric cancer

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13
Q

____, ____, and ____ are used for treatment of esophageal / gastric cancer

A

Surgery, chemo, and radiation are used for treatment of esophageal / gastric cancer

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14
Q

If patient has localized esophageal or gastric cancer, ____

A

If patient has localized esophageal or gastric cancer, additional imaging and procedures must be done to ensure there is no occult disease

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15
Q

Describe risk factors for pancreatic cancer

A

Pancreatic cancer risk factors

  • Hereditary (5-10%): BRCA 1 and 2, PALB2, CDKN2
  • Diabetes
  • Chronic / recurrent pancreatitis
  • Smoking
  • Pancreatic cysts
  • Metabolic syndrome
  • Obesity
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16
Q

Pancreatic cancer presents with ___, ___, ___, and ___

A

Pancreatic cancer presents with weight loss, pain, jaundice, and nausea / vomiting

  • Pain: epigastric, back, flank
  • Jaundice: dark urine, light stools
17
Q

Most pancreatic tumors arise from ____

A

Most pancreatic tumors arise from columnar cells (adenocarcinoma)

18
Q

Describe classificiation of pancreatic cancer

A

Pancreatic cancer classification

  • Exocrine: solid epithelial, cystic epithelial
  • Endocrine: non-hyperfunction, hyperfunction
19
Q

Describe endocrine pancreas

A

Endocrine pancreas

  • Islet cells produce insulin, glucagon, pancreatic polypeptide, and somatostatin
  • Loss of insulin causes diabetes mellitus
20
Q

Describe exocrine pancreas

A

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
21
Q

Describe diagnostic testing for pancreatic cancer

A

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
22
Q

Describe management of pancreatic cancer

A

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
23
Q

Describe risk factors for hepatocellular carcinoma

A

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
24
Q

Successful treatment of Hepatitis C ____ risk of hepatocellular carcinoma in patients with chronic hepatitis C

A

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
25
Q

Describe progression of non-alcoholic fatty liver disease

A

Progression of non-alcoholic fatty liver disease

  1. Normal liver
  2. Fatty liver
  3. NASH
  4. Cirrhosis
26
Q

Describe diagnosis of hepatocellular carcinoma

A

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
27
Q

____ leading to cirrhosis is main risk factor for hepatocellular carcinoma

A

Chronic inflammation leading to cirrhosis is main risk factor for hepatocellular carcinoma

28
Q

___ is best curative option for hepatocellular carcinoma

A

Resection and transplantation is best curative option for hepatocellular carcinoma

29
Q

___ in treating hepatocellular carcinoma

A

Maximize liver therapies before systemic therapy in treating hepatocellular carcinoma

30
Q

____, ____, and ____ are risk factors for gallbladder cancer

A

Primary sclerosing cholangitis, infection with flukes, and inflammatory state are risk factors for gallbladder cancer

31
Q

Gallbladder cancer presents with ___, ___, ___, and ___

A

Gallbladder cancer presents with jaundice, abdominal pain, pruritis, and weight loss

32
Q

Gallbladder cancer is classified as ___, ___, or ___

A

Gallbladder cancer is classified as intra, extra, or hilar

33
Q

Gallbladder cancer should be treated with ___ when possible

A

Gallbladder cancer should be treated with surgery when possible

34
Q

____ is used as systemic therapy for gallbladder cancer

A

Chemo with gemcitabine and cisplatin is used as systemic therapy for gallbladder cancer

Heme / Onc (41 decks)

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