04a: Esophagus, Gastric

Question 1

T/F: Squamous cell carcinoma is the most common esophageal cancer worldwide.

Answer 1

True - but incidence gradually decreasing

Question 2

In high-incidence areas, how might diet be increasing Squamous cell carcinoma of esophagus?

Answer 2

Nutritional deficiency; high level nitrosamines or aromatic hydrocarbons; drinking hot tea

Question 3

SCC of esophagus: Two most important risk factors in low-incidence areas.

Answer 3

EtOH and smoking

Question 4

(X) cancer is associated with high risk of esophageal SCC.

Answer 4

X = SCC of head and neck

Question 5

Pt with Barretts has (X)% yearly risk of cancer, which is (Y)x that of general population

Answer 5

X = 0.1-0.5
Y = 30-60

Question 6

(Hyper/hypo)-calcemia occurs in up to 30% of patients with esophageal cancer. Why?

Answer 6

Hypercalcemia; PTHrP secretion

Question 7

(SCC/AdenoCa) of esophagus is very locally invasive and may affect which structures?

Answer 7

SCC;

Recurrent laryngeal n (hoarseness) or cause tracheoesophageal fistula

Question 8

List two key reasons why esophageal cancer is advanced at time of diagnosis in most cases.

Answer 8

1. Absence of serosa in esophagus

2. Rich lymphovascular network in LP and submucosa

Question 9

Preferred method of esophageal and gastric cancer diagnosis.

Answer 9

EGD (esophagogastroduodenoscopy) with biopsy

Question 10

T/F: Screening for esophageal cancer has not proven useful for low-risk populations.

Answer 10

True - but benefit in screening high-risk pop

Question 11

T/F: T1 stage of esophageal cancer has nearly 100% 5-year survival

Answer 11

False - only 46%!!

Question 12

T/F: Metastasized esophageal cancer has under 5% 5-year survival

Answer 12

True

Question 13

Esophageal and gastric cancer: (X) is the most accurate modality for staging.

Answer 13

X = endoscopic ultrasound

Question 14

T/F: Surgery can be curative for esophageal cancer.

Answer 14

True - in early lesions (rarely seen in US)

Question 15

2 cause of cancer death worldwide

Answer 15

Gastric cancer (used to be #1 until 1930s)

Question 16

(X) cancer was the most common cancer in US in 1930s, but is not no longer in top 10 US cancers.

Answer 16

X = gastric

Question 17

Most common histological type of gastric cancer:

Answer 17

Intestinal type adenocarcinoma

Question 18

Diffuse type gastric cancer is (more/less) common than intestinal type adenocarcinoma, associated with (better/worse) prognosis, and has “(X) cell” pathology.

Answer 18

Less; worse

X = signet

Question 19

(Diffuse/intestinal) type gastric cancer is associated with cancer family syndrome.

Answer 19

Diffuse

Question 20

H. pylori strains that are cagA (pos/neg) are associated with higher risk of atrophy and cancer.

Answer 20

Pos

Question 21

T/F: Smoking is independent risk factor for gastric cancer, but alcohol is not.

Answer 21

True - 2-fold increased risk for smoking

Question 22

T/F: Diet rich in fruits and veggies is protective against gastric cancer.

Answer 22

True - 30-50% risk reduction

Question 23

T/F: Regular aspirin use increases risk of gastric cancer by about 1.5.

Answer 23

False - protective (relative risk is 0.5)

Question 24

Patient’s father died of gastric cancer. He’s worried about his risk of also developing gastric cancer. What do you tell him about his risk?

Answer 24

2-3x increased risk

Question 25

Which genetic syndromes/mutations are associated with high risk of gastric cancer?

Answer 25

1. FAP (10-fold increased risk; screen via EGD every 3-5y) 2. HNPCC (11% risk) 3. E-cadherin gene mutation (diffuse type with high penetrance)

Question 26

List causes of chronic atrophic gastritis, which carries (X)x risk of gastric cancer. Star the cause that carries highest risk.

Answer 26

X = 6 1. H. pylori* 2. Pernicious anemia (anti-parietal cell Ab)

Question 27

Gastric polyps: (common/uncommon), most (rarely/always) undergo malignant transformation, except for the 10% of them that are (X).

Answer 27

Uncommon; Rarely X = Adenomas (excision recommended for these due to high risk of malignant transformation)

Question 28

T/F: Gastrectomy is protective against gastric cancer.

Answer 28

False - premalignant group of patients (maybe due to decreased acid production, bac, atrophy, etc)

Question 29

List the most common physical signs of gastric cancer

Answer 29

1. Cachexia | 2. Abdominal tenderness (and maybe a mass)

Question 30

Patient with abdominal pain and weight loss has a hard, purple nodule at the umbilicus. What is this nodule formally called and what is toward the top of your differential?

Answer 30

Sister Mary Joseph nodule; | Advanced Gastric cancer (metastatic deposit)

Question 31

(R/L) supraclavicular lymph node, called (X), is often associated with intra-abdominal malignancy, usually (Y) cancer.

Answer 31

L; X = Virchow's Y = gastric

Question 32

Blumer shelf can be a sign of (X), detected on (Y) exam. How do these come about?

Answer 32

``` X = gastric cancer Y = digital rectal ``` Metastatic cells in peritoneum rest in pouch of Douglass and grow into mass lesions

Question 33

Most common sites of gastric cancer metastasis.

Answer 33

Liver, lung, peritoneum, marrow

Question 34

(X) are velvety black lesions in axilla and neck that are most often associated with (Y), but may be a sign of (Z).

Answer 34

``` X = Acanthosis nigricans Y = metabolic syndrome Z = internal malignancy (paraneoplastic syndrome) ```

Question 35

You diagnose patient with gastric ulcer on EGD and the biopsy comes back negative for cancer. Can you rule out cancer in this case?

Answer 35

No! Repeat EGD after 12weeks to confirm ulcer is healing; biopsy may be initially false neg due to inflammation

Question 36

Median life expectancy of untreated gastric cancer is (X) with liver metastases and (Y) with peritoneal carcinomatosis.

Answer 36

``` X = 4-6 months Y = 4-6 weeks ```