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Gen Med: GI > Gastric Neoplasms > Flashcards

Gastric Neoplasms Flashcards

(35 cards)

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1
Q

What are the gastric neoplasms?

A
  1. Zollinger-Ellison Syndrome (ZES)
  2. Gastric Adenocarcinoma
  3. Gastric Lymphoma
  4. Gastric Carcinoid Tumor
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2
Q

What is zollinger-ellison syndrome?

A
  1. GASTRIN-SECRETING TUMOR (GASTRINOMA) OF PANCREAS THAT STIMULATES ACID-SECRETING PAREITAL CELLS OF STOMACH → ULCER
  2. RARE

3.. ~ 20% OF GASTRINOMAS ARE PART OF SYNDROME CALLED MULTIPLE ENDOCRINE NEOPLASIA TYPE I (MEN I)

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3
Q

What age of ppl are commonly dxed with Z-E syndrome?

A

MOST PTS DIAGNOSED BETWEEN 20-50 YR

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4
Q

Where are most Z-E tumors found?

A

MOST FOUND IN PANCREAS OR DUODENUM

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5
Q

What is characterisitc of Z-E syndrome?

A

STEATORRHEA & EXCESS BILE SALTS IN FECES

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6
Q

What are the dx studies for Z-E syndrome?

A
  1. Fasting gastrin level > 150 pg/ml
    A. stop H2 blockers for 24 hrs before & PPIs 6 days prior to test
  2. (+) secretin stimulation test
    A. Confirms dx
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7
Q

What is a secretin stimulation test?

A
  1. IV secretin -> gastrin level increases by > 200 pg/ml w/in 2-30 mins in 85% of pts
  2. secretin stimulates release of gastrin by gastrinoma cells
  3. normal gastrin cells are inhibited by secretin
  4. gastrin only rises in pts w/ gastrinomas
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8
Q

What is the rx for Z-E syndrome?

A
  1. Oral PPIs
    A. Control gastrin secretion
  2. Surgical resection of gastrinoma cures if done before hepatic mets
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9
Q

What % of Z-E gastrinomas are malignant?

A

2/3 gastrinomas are malignant

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10
Q

What are gastrinomas?

A

Gastrinomas are SLOW growing tumors

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11
Q

What is the prognosis of ppl with Z-E syndrome?

A

15-yr survival of pts w/o liver mets at initial presentation is >95%

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12
Q

What iare the general characteristics of gastric adenocarcinoma?

A
  1. M > F
  2. Age > 40 yr
  3. Strong association with H. pylori
  4. 2nd most common cause of cancer death worldwide
  5. Incidence has declined rapidly over the past 70 yrs
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13
Q

What is the cure rate for gastric adenocarcinoma?

A
  1. early dX & Tx = 80% cure rate
  2. If muscularis propria involved, cure rate 50%
  3. If lymphatic spread, cure rate 10%
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14
Q

What are the risk factors for gastric adenocarcinoma?

A 
1. Chronic H. pylori gastritis
A. #1 risk factor
2. Smoking
3. Diet high in nitrates or salt
4. Diet low in Vit C
5. Genetics
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15
Q

What are the sxs of early gastric adenocarcinma?

A
  1. IN GENERAL, ASYMPTOMATIC UNTIL DISEASE IS ADVANCED

2. SX’S TEND TO BE NONSPECIFIC

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16
Q

What are the sxs of later gastric adenocarcinoma?

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A
  1. DYSPEPSIA / VAGUE EPIGASTRIC PAIN
  2. ANOREXIA / EARLY SATIETY
  3. WEIGHT LOSS
  4. ANEMIA
  5. OCCULT GI BLEEDING
  6. PROGRESSIVE DYSPHAGIA
    A. NEOPLASM IMPINGING. ESOPHAGUS
  7. LEFT SUPRACLAVICULAR NODE (VIRCHOW’S NODE) & UMBILICAL NODULE (SISTER MARY JOSEPH NODULE/NODE)
    A. METASTATIC SPREAD
17
Q

What is Virchow’s node?

Study These Flashcards
A

LEFT SUPRACLAVICULAR NODE

18
Q

What is Sister Mary Joseph nodule?

Study These Flashcards
A

UMBILICAL NODULE

19
Q

What are the dx studies for gastric adenocarcinoma?

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A
  1. IRON DEF ANEMIA
  2. MAY HAVE GUAIAC + STOOLS
  3. ELEVATED LFT’S
    A. LIVER METS
  4. ENDOSCOPY
    A. CONFIRMS DX
  5. ONCE DIAGNOSED, CT ABD/PELVIS/CHEST & PET SCAN FOR PRE-OP EVAL
    A. STAGE DISEASE (ASSESS FOR METS)
20
Q

What is the confirmatory test for gastric adenocarcinoma?

21
Q

What are the curative treatment options for gastric adenocarcinoma?

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A
  1. SURGICAL RESECTION IN STAGES I – III
    A. SUBTOTAL OR TOTAL GASTRECTOMY
    B. ADJUNCTIVE CHEMO IF (+) LYMPH NODES
22
Q

What are the palliative treatment options for gastric adenocarcinoma?

Study These Flashcards
A
  1. PERITONEAL AND/OR DISTANT METS
  2. PALLIATIVE RESECTION MAY BE INDICATED TO RELIEVE PAIN, BLEEDING, OR OBSTRUCTION
  3. CHEMOTHERAPY
23
Q

What is the prognosis for gastric adenocarcinoma?

Study These Flashcards
A
  1. Tumors of proximal stomach have far worse prognosis than distal Tumors
  2. 5-yr survival for pts with successful curative resection is > 45%
  3. Survival related to tumor stage, location and histology
24
Q

What are the general characteristics for gastric lymphoma?

Study These Flashcards
A
  1. lymphoma that originates in the stomach itself
    A. common extranodal site for lymphomas - originating somewhere else w/ mets to stomach
  2. < 15% of gastric malignancies & about 2% of all lymphomas
  3. Risk gastric lymphoma ↑ 6-fold if:
    A. (+) H pylori,
    B. HIV
    C. Long-term immunosuppressant tx
  4. ↑ > 60 yr
25
What are the sxs of gastric lymphoma?
1. Dyspepsia 2. Weight loss 3. Anemia 4. Occult GI bleeding
26
What are the dx studies for gastric lymphoma?
1. IRON DEF ANEMIA 2. elevated LFTs A. LIVER METS 3. ENDOSCOPY A. CONFIRMS DX B. BX REVEALS LESION W/ LYMPHOCYTIC INFILTRATION (B CELLS) OF STOMACH WALL 4. CT ABD /PELVIS / CHEST & PET SCAN A. STAGE DISEASE
27
What is the rx for gastric lymphoma?
1. Depends on tumor histology, grade & stage 2. Pts should be tested for H pylori & treated if (+) A. Complete lymphoma regression after H. pylori eradication occurs in 75% of cases w/ low grade lymphoma 3. Radiation & Chemotherapy chemotherapy w/ or w/out rituximab 4. Surgical resection not recommended
28
What are the general characteristics for gastric carcinoid tumor?
1. RARE NEUROENDOCRINE TUMORS OF THE LUMINAL GI TRACT 2. SLOW-GROWING TYPE OF CANCER 3. CAN BE CURED IF CAUGHT EARLY 4. DIFFICULT TO DIAGNOSE
29
What does carcinoid tumor mean?
REMEMBER, “CARCINOID” MEANS WELL-DIFFERENTIATED NEUROENDOCRINE TUMOR ORIGINATING IN GI TRACT, LUNGS, APPENDIX, RARE PRIMARY SITES SUCH AS KIDNEY OR OVARIES
30
What are the types of gastric carcinoid tumors?
Type I, II, III | Type I most common
31
Where are common met sites for gastric carcinoid tumors?
Carcinoid tumors, in general, have a strong propensity for liver mets
32
What are gastric carcinoid tumors asst. with?
1. Assoc w/ MEN Type I | 2. Can occur in association w/ pernicious anemia & ZES
33
What are the risks of gastric carcinoid tumors?
Leads to: 1. SECRETE HORMONES THAT CAUSE SX’S OF FLUSHING, STOMACH CRAMPS/PAIN, DIARRHEA, SOB, PALPS (AKA CARCINOID SYNDROME) 2. CUSHING’S SYNDROME
34
What are the sxs of gastric carcinoid tumors?
1. FLUSHING &/OR DIARRHEA 2°TO SEROTONIN SECRETION 2. CAN HAVE ABD PAIN OR BOWEL OBSTRUCTION AS RESULT OF TUMOR GROWTH 3. CAN BE DISCOVERED INCIDENTALLY ON UPPER EGD OR CT SCAN/MRI
35
What are the dx studies for gastric carcinoid tumors?
1. 24-HR EXCRETION OF 5-HIAA (URINE TEST) A. 5-HYDROXYINDOLEACETIC ACID URINE TEST B. ELEVATED IN CARCINOID SYNDROME C. END PRODUCT OF SEROTONIN METABOLISM 2. CT SCAN ABD/PELVIS 3. MRI – FOR LIVER METS, MORE SENSITIVE THAN CT SCAN 4. SOMATOSTATIN-RECEPTOR SCINTIGRAPHY (SRS)- AKA OCTREOSCAN 5. UEGD W/ BX

Gen Med: GI (16 decks)

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