Gastric Neoplasms Flashcards Preview

Gen Med: GI > Gastric Neoplasms > Flashcards

Flashcards in Gastric Neoplasms Deck (17):
1

What is Zollinger-Ellison Syndrome?

1. GASTRIN-SECRETING TUMOR (GASTRINOMA) OF PANCREAS THAT STIMULATES ACID-SECRETING PAREITAL CELLS OF STOMACH → ULCER
2. RARE
3. MOST FOUND IN PANCREAS OR DUODENUM

2

Diagnostic Studies for Zollinger-Ellison Syndrome?

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
IV secretin  gastrin level increases by > 200 pg/ml w/in 2-30 mins in 85% of pts
- Secretin stimulates release of gastrin by gastrinoma cells
- Normal gastrin cells are inhibited by secretin
- Gastrin only rises in pts w/ gastrinomas

3

Treatment for Zollinger-Ellison Syndrome?

1, Oral PPIs
A. Control gastrin secretion
2. Surgical resection of gastrinoma cures if done before hepatic mets
3. 2/3 gatrinomas are malignant

4

Gastric adenocarcinoma characteristics

- M > F
- Age > 40 yr
- Strong association with H. pylori
- Early dX & Tx = 80% cure rate
- If muscularis propria involved, cure rate 50%
- If lymphatic spread, cure rate 10%
- 2nd most common cause of cancer death worldwide
- Incidence has declined rapidly over the past 70 yrs

5

Risk Factors for Gastric adenocarcinoma

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

6

Sxs of Gastric adenocarcinoma

1. IN GENERAL, ASYMPTOMATIC UNTIL DISEASE IS ADVANCED
2. SX’S TEND TO BE NONSPECIFIC
3. DYSPEPSIA/VAGUE EPIGASTRIC PAIN
4. ANOREXIA/EARLY SATIETY
WEIGHT LOSS
5. ANEMIA
6. OCCULT GI BLEEDING
7. PROGRESSIVE DYSPHAGIA
(NEOPLASM IMPINGING ESOPHAGUS)
8. LEFT SUPRACLAVICULAR NODE (VIRCHOW’S NODE) & UMBILICAL NODULE (SISTER MARY JOSEPH NODULE/NODULE)
A. METASTATIC SPREAD

7

Diagnostic Studies: Gastric adenocarcinoma

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)

8

Treatment: Gastric adenocarcinoma

1. CURATIVE
A. SURGICAL RESECTION IN STAGES I – III
-SUBTOTAL OR TOTAL GASTRECTOMY
-ADJUNCTIVE CHEMO IF (+) LYMPH NODES
2. PALLIATIVE
A. PERITONEAL AND/OR DISTANT METS
B. PALLIATIVE RESECTION MAY BE INDICATED TO RELIEVE PAIN, BLEEDING, OR OBSTRUCTION
C. CHEMOTHERAPY

9

Prognosis: Gastric adenocarcinoma

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

10

General characteristics of gastric lymphoma

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 (+) H pylori
A. HIV
B. Long-term immunosuppressant tx
4. ↑ > 60 yr

11

Signs & Symptoms of gastric lymphoma

-Dyspepsia
-Weight loss
-Anemia
-Occult GI bleeding

12

Diagnostic Studies for gastric lymphoma

1. IRON DEF ANEMIA
2. ELEVATED LFT’S
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

13

Treatment: gastric lymphoma

Depends on tumor histology, grade & stage

Pts should be tested for H pylori & treated if (+)
-Complete lymphoma regression after H. pylori eradication occurs in 75% of cases w/ low grade lymphoma

Radiation & Chemotherapy
-chemotherapy w/ or w/out rituximab

Surgical resection not recommended

14

Characteristics: 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
5. REMEMBER, “CARCINOID” MEANS WELL-DIFFERENTIATED NEUROENDOCRINE TUMOR ORIGINATING IN GI TRACT, LUNGS, APPENDIX, RARE PRIMARY SITES SUCH AS KIDNEY OR OVARIES

6. Type I, II, III
7. Type I most common
8. Carcinoid tumors, in general, have a strong propensity for liver mets
9. Assoc w/ MEN Type I
10. Can occur in association w/ pernicious anemia & ZES

15

Risks: GASTRIC CARCINOID TUMOR

CAN LEAD TO TWO CONDITIONS:

SECRETE HORMONES THAT CAUSE SX’S OF FLUSHING, STOMACH CRAMPS/PAIN, DIARRHEA, SOB, PALPS (AKA CARCINOID SYNDROME)


CUSHING’S SYNDROME

16

Signs & symptoms: GASTRIC CARCINOID TUMOR

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

17

DIAGNOSTIC TESTING: GASTRIC CARCINOID TUMOR

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