Gastric or Duodenal Ulcer?
- 30-60 y/o
- 1st degree relative: 3 fold increase
- Blood type O
- HCl
- all ulcers infected w/ H. pylori
- 1st part of duodenum (anterior/post wal)
- Kissing ulcer
- US: incidence same for blacks/whites
- Africa: rare
- Western/Urban: all groups sucseptible
- Burning epigastric pain 1-3 hrs after meal / awakens pt at night
Duodenal
•The common factor that unites both gastric and duodenal ulcers is secretion of _____
HCl acid
Gastric or Duodenal Ulcer?
- afflict the middle-aged and elderly more than the young.
- equal incidence in men = women
- smoking
- 75% harbor H. pylori
- Usually single, from 2-10 cm in diameter.
- The edges tend to be sharply punched out, with overhanging margins. The flat base is gray and indurated. Deeply penetrating ulcers produce a serosal exudate which may cause adherence of the stomach to the surrounding structures.
- On gross examination, it may be difficult to distinguish chronic peptic ulcer
Gastric
4 complications of peptic ulcers
- Hemorrhage (MC)
- Perforations (duodenal)
- Pyloric obstruction
- Malignant transformations (gastric)
2 locations of gastric ulcer?
- Most arise in the lesser curvature of the stomach, in the antral and prepyloric regions
- 1st part of the duodenum.
MC location for oral cancer:
tongue
3 Main etiology of oral SCC not related to HPV:
Tobacco, Alcohol, genetics
- Pathologically, the metaplastic epithelium extends up the distal esophagus with thickened red-brown circumferential tissue.
- Histologically, various patterns are seen, from gastric to intestinal epithelium with marked inflammatory changes .
- Carries a serious risk of malignant transformation to an Adenocarcinoma.
Barret’s Esophagus
Main serious complication of Barretts?
Adenocarcinoma
Replacement of one epithelium to suit another environment (smoking, spicy foods).
Distal esophagous from strat sq to epithelium of stomach –> (tall columnar epithelium).
GERD (acid reflux)
Barretts Esophagus
Leukoplakie or Erythroplakia?
- Not a tumor, but can transform to squamous cell carcinoma
- More common
- Most common on tongue
- Not removed by scraping
- all cases should clinically be considered precancerous.
RFs:
- Tobacco products,
- alcoholism
- local irritation (cheek biting, malformed dentures)
- HPV infections (love strat sq)
Leukoplakia
Leuko or Erythroplakia?
- Much less common
- Red velvety and eroded area.
- Very high risk of malignant transformation >50%
RF:
- Tobacco products,
- alcoholism
- local irritation (cheek biting, malformed dentures)
- HPV infections (love strat sq)
Erythroplakia
- The most common malignant tumor of the oral mucosa (95%) and may occur at any site.
- It most frequently involves the #1tongue, followed by the #2floor of the mouth, #3palate and #4buccal mucosa.
- Male:Female ratio is 2:1.
- The average age is 50-70 years old.
- It is the single most common cancer in men of India.
Squamous Cell Carcinoma
RF of what?
tobacco products,
alcoholism,
physical and chemical irritants,
chewing of betal nuts,
poor oral hygiene (ill-fitting dentures)
U-V light on the lips.
SCC
SCC
- 5 year survival is 90% if located where?
- 30% for all others….
- Lips (people won’t kiss you if lips look bad)
- All others are inside mouth and go unnoticed
- In China, Iran and South Africa the incidence is 20-45 times higher, whereas Holland and Austria have extremely low frequencies.
- Blacks have a higher incidence than whites and urban dwellers are at a higher rate than rural.
- In the U.S., the male to female ratio is 3:1.
Esophageal Cancer
- Excessive consumption of alcohol is a major risk factor in the U.S.
- Cigarette Smoking: the number correlates with the presence of dysplasia.
- Nitrosamines: a carcinogen found in the soil or food in highly endemic areas.
- Diets lacking in fresh fruits, vegetables, proteins and trace metals.
Carcinoma of the Esophagus
Pathogenesis
- Plummer-Vinson Syndrome and Achalasia are both associated with Squamous Cell.
- Chronic Esophagus: related to cancer in endemic areas, but not in the U.S.
- Chemical injury to the Esophagus: due to ingestion of lye develop cancers 20-40 yrs. later.
- Barrett Esophagus
Carcinoma of the Esophagus
Pathogenesis
- Most common presenting symptom is ____, usually not recognized until the diameter of the lumen in reduced by 30-50%.
- Pt’s with advanced disease are usually cachetic, owing to anorexia, difficulty in swallowing and when persistent, may suggest mediastinal extension. Compression of the recurrent laryngeal nerve produces hoarseness
Cancer of Esophagus
- dysphagia
- Overall, 95% of patients will die within 2 years of diagnosis.
- This tumor is now more common in the U.S. than squamous cell carcinoma because the incidence has increased in recent years.
- Surgery and radiation therapy are useful for palliation, but prognosis remains dismal.
Cancer of Esophagus
ESophagus Cancer
•The rich lymphatic drainage of the esophagus provides a route for metastasis, so tumors of the upper third mets to which 3 nodes?
- cervical
- internal jugular
- supraclavicular nodes
Esophagus Cancer
•Cancer of the mid-third mets to which 3 nodes?
- peritracheal
- hilar
- aortic / cardiac regions
Esophagus Cancer
•Lower third mets involve which 3 nodes?
- Visceral mets to the ___ and ___ are also common.
- retroperitoneal
- celiac
- gastric
- Visceral: liver & lungs
