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Medicine > esophageal and stomach tumors > Flashcards

esophageal and stomach tumors Flashcards

1
Q

the 2 distinctive histological types of esophageal @ gastric cancer are:

A

SCC- upper 2/3 of esophagus

Adenoca- lower 1/3 and GEJ

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2
Q

what are the similarities and differences of SCC @ Adenoca?

A

different etiological factors

similar clinical, endoscopic and radiologic findings.

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3
Q

epidemiology of esophageal SCC?

A 
m:f 3:1
from east asia to west euro and north africa
lower socioeconomic status
blacks>whites
>50's
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4
Q

epidemiology of esophageal Adenoca?

A

m:f 6:1
white>black
>50’s

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5
Q

risk of esophageal Adenoca?

A 
obesity 
GERD
Barettes esophagus 
smoking
p53 aneuploidity and mutations in dysplastic epithel
hereditary mutation in 15%
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6
Q

risk of esophageal SCC?

A 
smoking
alcohol
ingested carcinogenes
achlasia (food remains cause inflammation)
congenital 
head @ neck tumors association
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7
Q

symptoms of esophageal cancer

A

progressive dysphagia
disproportionate weight loss
iron.d anemia
reflux and regurritation (in Adenoca)

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8
Q

symptoms of complicated esophageal cancer

A 
odynophagia 
chest/back pain
aspiration pneumonia
hoarsness 
metastsis
fistula (upper and mid  1/3's)
hypercalcemia in SCC
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9
Q

esophageal cancer staging

A

T depth of tumor
N lymph node involvement (ajacent and supraclavicular)
M metastasis

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10
Q

staging procedures in esophageal cancer:

A 
CT
EUS for local staging (T>N)
PET (occults mets 15%) 
laryngo/bronchioscopy in SCC
HER2, PD-L1, MSI immuno-staining
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11
Q

what is the 5 year rate survival rate in esophageal cancer?

A

10%

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12
Q

treatment for stage 1 esophageal cancer?

A

endoscopic mucosal resection (EMR)
endoscopic submucosal disection (ESD)
surgery- total resection at 45% of cases, 5year survival rate on 20%
chemo+ radio therapy

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13
Q

treatment for stage 2+3 esophageal cancer?

A

chemo+ RT for shrinking and then surgery

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14
Q

treatment for stage 4 esophageal treatment?

A

palliative:
+disphagia: endoscopic diatlition, chemo, RT, feeding tube
-disphagia: systemic chemo
chemo: platinum, trastuzumab (+herceptin, HER2)

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15
Q

what is the etiological differance between esophagial adenoca and gastric cance?

A

esophageal adeno etiology: reaccurent acid irritations

gastric cancer: chronic gastritis with H.pylori establishment

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16
Q

favored location of well differentiated gastric adenocarcinoma

A

anrtum and lesser curvature

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17
Q

morphology of gastric intestinal (well differrentiated) adenoca

A

single lesion

ulcerative

18
Q

patophysiology of diffuse (poorly differentiated) gastric adenoca?

A

naive cells
E-cahedrin LOF (loss of tight junctions)
linitis plastica (infiltration and thicking of stomach wall)

19
Q

enviromental risk factors of gastric cancer

A 
H.pylori
diet nitrates
gastritis @intestinal metaplasia
gastric surgery 
low socioeconomic tendency 
obisity, smoking, alcohol
mentrier's disease
20
Q

genetic risk factors of gastric cancer

A

heredetary diffuse gastric cancer HDGC- CDH1 gene
other cancer predisposing syndromes (lynch, brac2, APC)
blood group A»O

21
Q

heredetary diffuse gastric cancer treatment

A

prophylactic gastrectomy

refuse/genetic diagnosis wasnt done?
annualy gastric endoscopy with 30 biopsies.

22
Q

symptoms of early gastric cancer?

A

80% asymptomatic thus late stage diagnosis and bad prognosis

23
Q

symptoms of advanced gastric cancer?

A 
50% UAP varying in intensity 
weight loss 60%
nausea
vomit
anorexia
dysphagia
early satiety
iron.d anemia
rare: paraneoplastic syndroms and dermatologic sings.
24
Q

heredetary gastric cancer cause

A

germline mutation in CDH1

25
Q

what is a wirchow tumor?

A

supraclavicular LN involved in spread of gastric carcinoma

26
Q

what is a krukenberg tumor?

A

overy LN involved in spread of gastric cancer

27
Q

what is a sister mary joseph tumor?

A

periumbilical LN involved in spread of gastric tumor

28
Q

what is blummer’s shelf tumor?

A

peritoneal cul- de-sac (near-rectal) LN involved which can be felt in anal checkup

29
Q

what is the first site of hemoragical metastasis of gastric carcinoma?

A

liver

30
Q

which are the staging procedures of gastric cancer?

A

CT
EUS (early)
PET (GEJ cancer)
HER2, PD-L1, MSI immuno- stating

31
Q

gastric cancer stage 1A treatment?

A 
EMR
ESD
surgery:
   antrum- sub total gastrectomy 
   proximal- total gastrectomy
32
Q

gastric cancer stage 1B THROUGH 3C treatment?

A

surgery + adjovant chemo +-RT
or
the ‘sandwich’: chemo-> surgery->chemo

33
Q

gastric cancer stage 4 treatment?

A

systemic chemo

trastuzumab- for Herceptin possitive patients (HER2)

34
Q

what endoscoping finding differ between primary gastric lymphoma and gastric adenocarcinoma?

A

none!

biopsies are crutial for diagnosis

35
Q

what cell does primary gastric lymphoma originate from?

A

B cells

36
Q

etiology of primary gastric lymphoma?

A

most cases are H.pylori related
translocation at (14,18)
t(11,18)
t(1,14)

37
Q

primary gastric lymphoma associated with H.pylori treatment?

A

eradication of H.pylori / antibiotics

the 25% that fail treatment due to t(11, 18) will be treated with RT

38
Q

primary gastric lymphoma advanced stage treatment?

A

CHAP + rituximab

39
Q

favored GIST location?

A

fundus

40
Q

location of GIST metastates?

A

liver and lungs (not the adjacent LN and visera)

41
Q

treat ment for GIST?

A

local - surgery

spread (c-kat receptor mutation) - imatinib (comertial: gleevec), effictive at 50%

Medicine (17 decks)

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