249b Esophagus and gastric cancer

Question 1

esophagus cancer - what types? presentation?

Answer 1

squamous and adenocarcinoma

progressive dysphagia (solids then liquids)
weight loss

poor prognosis

Question 2

where do esophagus cancers present? which is more common in US? World?

Answer 2

upper 2/3 - squamous

lower 1/3 - adenocarcinoma

US - adenocarcinoma
world - squamous cell

Question 3

risk factors for esophagus cancer? what cancer does each predispose to?

Answer 3

AABCDEFFGH

Achalasia
Alcohol - squamous
Barret esophagus - adeno
Cigarettes - both
Diverticula (Zenker) - squamous
Esophageal web - squamous
Familial
Fat (obesity) - adeno
GERD - adeno
Hot liquids - squamous

Question 4

stomach cancer - what type? where does it spread? presentation?

Answer 4

adenocarcinoma - intestinal vs diffuse

early spread to nodes and liver

presents with acanthosis nigricans

Question 5

intestinal gastric adenocarcinoma

Answer 5

associated with H. pylori infection, dietary nitrosamines (smoked foods), tobacco smoking, achlorhydria, chronic gastritis. Commonly on lesser curvature; looks like ulcer with raised margins.

Question 6

diffuse gastric adenocarcinoma

Answer 6

not associated with H. pylori; signet ring cells; stomach wall grossly thickened and leathery (linitis plastica).

Question 7

gastric adenocarcinoma virchow node

Answer 7

involvement of left supraclavicular node by metastasis from stomach.

Question 8

gastric adenocarcinoma krukenberg tumor

Answer 8

bilateral metastases to ovaries. Abundant mucus, signet ring cells.

Question 9

gastric adenocarcinoma Sister Mary Joseph nodule

Answer 9

subcutaneous periumbilical metastasis.