EXAM #1: GI NEOPLASIA Flashcards Preview

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Flashcards in EXAM #1: GI NEOPLASIA Deck (75):
1

What type of tumor is the most common in the GI tract?

Adenocarcinoma

2

What site is most commonly affected by neoplasia in the GI system?

Colon

3

What are the most common benign tumors of the small bowel?

1) Adenomas
2) Mesenchymal tumors i.e. GISTs

4

What are the most common malignant tumors of the small bowel?

1) Adenocarcinoma
2) Carcinoids

5

What genetic conditions predipose patients to carcinomas of the small bowel?

1) Familial Adenomatous Polyposis (FAP)
2) Gardner's Syndrome

6

What is an adenoma?

Neoplastic proliferation of glands

7

Where are adenomas in the small bowel most common?

Amupulla of Vater --this is the union of the pancreatic duct and common bile duct

8

What are the clinical features of adenomas?

- Seen in middle age
- Cause occult blood loss
- Can precipitate obstruction/ intussusception

9

Where do most adenocarcinomas occur in the small bowel?

Duodenum

10

What type of pattern do adenocarcinomas grow in?

Napkin ring i.e. encircling

11

What is the major non genetic risk factor for adenocarcinomas?

Crohn's Disease

12

What is a polyp?

Benign mass protruding from the mucosa into the lumen of the gut

13

Are most polyps malignant or non-malignant?

Non-malignant

14

What are the two types of polyps seen in the colon?

1) Adenomatous
2) Hyperplastic

15

What is a hyperplastic polyp?

Hyperplasia of glands

16

What is a Hamartomatous polyps?

A polyp formed by disorganized normal tissue (seen mostly in kids; therefore, called a "Juvenile Polyp")

17

What is an inflammatory polyp?

This is an alternate name for pseudopolyps seen in Ulcerative Colitis

18

What type of polyp is most common?

Hyperplastic

19

Where do most hyperplastic polyps occur?

Rectosigmoid region

20

What are harmatomatous polyps called in kids?

Juvenile polyps

21

What are harmatomatous polyps called in adults?

Retention polyps

22

What are Peustz-Jegher's polyps?

Hamartomatous polyps seen in Peutz-Jegher's Syndrome
- Polyps seen throughout the GI tract (vs. solitary)

23

What is Peutz-Jegher's Syndrome?

- Autosomal Dominant disorder
- Characterized by:
1) Mucocutaneous pigmentation around the mouth (freckles around the mouth)
2) Multiple hamartomatous polyps

24

What gene is mutated in Peutz-Jegher's Syndrome?

STK11

25

What are the hamartomatous polyps of Peutz-Jegher's Syndrome composed of?

1) Connective tissue
2) Smooth muscle

26

What are patients with Peutz-Jegher's Syndrome at risk for?

- Intussusception
- Cancer
1) Colorectal
2) Breast
3) GYN

27

What are the four different types of adenomas?

1) Tubular
2) Tubulovillous
3) Villous
4) Serrate

28

What is the most common type of ademona? What is the association with carcinoma?

Tubular

****Lowest neoplastic potential b/c of "buffering" of the stalk*****

29

Which type of adeoma is most associated with carcinoma?

Villous adenomas

30

What are the three risk factors that confer greatest potential to transition from adenoma to carcinoma?

1) Size greater than 2cm
2) Sessile (flat) growth
3) Villous histology

31

What is the cancer risk associated with Tubulovillous Adenomas?

Intermediate

(Associated with the villous portion)

32

When is there highest concern for cancer in villous adenoma?

Progression to greater than 4 cm

33

What type of adenomas are most associated with being symptomatic? What is the presentation?

Villous adenomas:
- Overt rectal bleeding causing
- Hyponatremia
- Hypokalemia

34

What is the only adequate treatment for pedunculated or sessile adenoma?

Complete resection

35

What is carcinoma in situ?

Neoplastic cells that have NOT breached the basement membrane

36

What is the Adenoma-Carcinoma Sequence?

1) APC mutations= increased risk
2) K-ras mutation= adenoma
3) p53 and increased COX= carcinoma

37

What are the risk factors for colorectal carcinoma?

1) Increased age
2) Prior colorectal CA or polyps
3) UC/ CD
4) Poor diet

38

What environmental factors may be protective in colorectal carcinoma?

NSAIDs esp. ASA b/c of COX inhibition

39

Where to colorectal cancers commonly metastasize?

Liver

40

Iron-deficiency anemia in an older male is ____ until proven otherwise?

Colorectal carcinoma

41

What side of the colon is commonly implicated in colorectal carcinoma leading to anemia?

Right-sided

42

What familial syndromes cause colorectal cancer?

1) Classic FAP
2) Attenuated FAP
3) Gardner Syndrome
4) Turcot Syndrome

FAP= Familial Adenomatous Polyposis

43

What is Classic Familial Adenomatous Polyposis?

- AD
- Avg. onset at 25 y/o
- Causes thousands of polyps

44

What gene is implicated in Classic FAP?

APC on chromosome 5q21

45

What treatment is available for patients with Classic FAP?

Total colectomy (preventative)

46

What is Attenuated FAP?

- Delayed appearance (50 y/o)
- Fewer polyps
- Proximal colon

47

What mutations are associated with Attenuated FAP?

APC and MUTYH

48

What is Gardner Syndrome?

Classic FAP +
- Osteomas of skull/ mandible
- Epidermal cysts

49

What is Turcot Syndrome?

FAP + CNS tumors

50

What is HNPCC?

Hereditary Nonpolyposis Colorectal Cancer
- Genetic mutation predisposes to carcinoma
- NO adenoma first

51

What is the eponym for HNPCC?

Lynch Syndrome

52

What gene is involved in HNPCC?

MSH1 and MSH2
- DNA mismatch repair enzymes
- DNA microsatellite instability

53

What cancers are seen in HNPCC?

Colorectal cancer WITHOUT polyps + cancer outside the colon

54

Outline the associations with left-sided carcinoma and right sided colorectal carcinoma.

Left=
- "Pencil thin" stool
- Napkin ring
- APC related mutations

Right=
- Iron deficiency anemia/occult bleeding
- Raised lesions
- MSH mutations

55

In colon cancer, what is mucin production associated with?

Poor prognosis

56

What is the relationship between lymph node mets and prognosis in colorectal cancer?

- Less than 3 nodes= better prognosis
- More than 3 nodes= poor prognosis

57

What is Stage TI colorectal cancer?

Invasion of the submucosa

58

What is Stage TII colorectal cancer?

Invasion of the muscularis propria

59

What is Stage TIII colorectal cancer?

Penetration through the bowel wall

60

What is Stage TIV colorectal cancer?

Spread to other organs

61

In the Modified Duke's Staging scheme for colorectal cancer, what indicates a better prognosis? Poor prognosis?

A= good
B= bad

62

What is a carcinoid tumor?

- Neuroendocrine cell tumor
- Forms a polyp most common in small bowel
- Produces 5-HT and bradykinin

63

What is Carcinoid Syndrome? What is Carcinoid Syndrome associated with?

Carcinoid syndrome is the process initiated by systemic 5-HT; associated with liver mets b/c this allows 5-HT to bypass liver MAO

64

What are the symptoms of Carcinoid Syndrome?

Flushing
Bronchospasm
Diarrhea

65

What is Carcinoid Heart Disease?

Carcinoid Syndrome that causes right-sided valvular fibrosis
- Tricuspid valve regurgitation
- Pulmonary stenosis

66

What are the three types of GI Lymphomas?

1) MALToma
2) Sprue-associated
3) Mediterranean

67

What is Mediterrranean Lymphoma?

B-cell lymphoma in patients of Mediterranean ancestry

68

What is the hallmark of Mediterranean Lymphoma?

Abnormal IgA heavy chain synthesis

69

What type of Lymphoma is associated with Spure-associated Lymphoma?

Intestinal T-cell Lymphoma
- Seen in patients with longstanding malabsorption

*Worst prognosis*

70

What is acute appendicitis?

Inflammation of the appendix

71

What is the most common cause of appendicitis?

Impacted fecolith

72

What are the hallmark symptoms of acute appendicitis?

Anorexia
RLQ pain
N/V
Fever

73

What is the classic immune cell associated with acute appendicitis?

Neutrophils

74

What is the most common tumor of the appendix?

Carcinoid

75

What are the three mucus related tumors of the appendix? Which has the worst prognosis?

1) Mucocele
2) Mucinous cystadenoma
3) Mucinous cystadenocarcinoma