(PA school Q3) CAM II > GI 6 highlights > Flashcards

GI 6 highlights Flashcards

(66 cards)

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1
Q

2nd leading cause of malignancy-related death worldwide is what?

A

Colorectal cancer (CRC)

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2
Q

Incidence & mortality of CRC is __________ (in U.S.)

A

decreasing

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3
Q

A risk factor for CRC is family history of GI neoplasia (CRC or adenomatous polyps) in a ____________ degree relative

A

first

(i.e. not grandparents)

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4
Q

90% of CRC cases are in persons >_____y/o

A

50

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5
Q

75% of all cases occur in people with ___________ predisposing factors

A

no known

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6
Q

What diet decreases risk of CRC?

(important)

A

Diet high in fruits, vegetables & fiber

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7
Q

True or false: There are no symptoms in most early-stage CRC

A

True

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8
Q

What type of cancer are the majority of CRCs?

A

Adenocarcinomas

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9
Q

Most accurate & versatile diagnostic test for CRC is what?

A

Colonoscopy

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10
Q

CRC: What is required for preoperative staging?

A

CT chest, abdomen & pelvis with IV/PO contrast

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11
Q

What are the 3 parts of the TNM staging system for CRC?

A

1) Tumor
2) Nodes
3) Metastasis

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12
Q

CRC: What is the treatment of choice for almost all patients who have resectable lesions & can tolerate general anesthesia?

A

Resection of the primary colonic or rectal cancer

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13
Q

You need at least _____ lymph nodes to be resected to determine staging of CRC

A

12

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14
Q

Most cases of CRC arise from ____________ or ___________polyps which progress to cancer

A

adenomatous; serrated

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15
Q

What prevents the majority of CRC?

A

Polyp removal (polypectomy)

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16
Q

______ is strongest risk factor for CRC & adenomatous polyps

(important)

A

Age

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17
Q

Men & women should be offered screening beginning at _______y/o

A

45 y/o

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18
Q

CRC screening: Patients with h/o ______________________ (ie, hyperplastic polyps) should have interval screening colonoscopy every 10 years (unless other risk factors for intermediate or high risk)

A

non-pre-cancerous polyps

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19
Q

CRC screening: Patients with h/o pre-cancerous polyps should have interval screening colonoscopy every ______ years

A

3- 5

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20
Q

What is super important with CRC screening?

A

Review pathology/biopsy report from most recent colonoscopy

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21
Q

What are 3 predicters of development of future advanced adenomas or cancers at baseline colonoscopy?

(important)

A

1) 3 or more adenomas
2) Adenoma size greater than 1 cm
3) Adenoma with high-grade dysplasia

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22
Q

What is the primary prevention for CRC?

A

Avoid or modify risk factors

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23
Q

What is secondary prevention for CRC?

A

Screening at appropriate time for determined risk

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24
Q

___________ prevention of CRC is less effective: no early detection

A

Primary

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25
Most common **primary** malignant tumor of the liver is what?
Hepatocellular carcinoma (HCC)
26
HCC incidence increases progressively with advancing _____ in all populations
age
27
What are the 3 major risk factors for HCC?
Chronic hepatitis B Chronic hepatitis C Cirrhosis
28
HCC clinical features: Arterial phase enhancement of the lesion followed by delayed ____________ (“washout”) is most _____________ for hepatocellular carcinoma
hypointensity; specific
29
What is the standard screening/ surveillance approach for HCC?
U/S liver & AFP every 6 months
30
Most common benign liver tumor is what?
Cavernous hemangioma
31
What should you NOT do when diagnosing cavernous hemangioma?
Do not biopsy
32
What is the only physical feature of cavernous hemangioma
Hepatomegaly
33
Hepatocellular adenoma: 1) What are 2 important parts of epidemiology? 2) What is an important clinical feature?
1) Benign; linked to OCP use 2) Often superficial tumors may rupture (often while menstruating)
34
Hepatocellular adenoma: 1) What is an important lab value when diagnosing? 2) What is a key part of management?
1) Normal AFP 2) **Discontinue OCPs**
35
Infantile hemangioendothelioma: 1) What are 2 important aspects of its epidemiology? 2) **What is an important clinical feature?**
1) Rare, but most common liver tumor in infants; high incidence of HF & resulting 70% mortality rate 2) **High-output cardiac failure**
36
Benign liver lesions: Focal nodular hyperplasia (FNH) are benign, solitary lesion composed of nodules of benign hyperplastic hepatocytes surrounding a __________
central scar
37
What is an important part of treating Focal nodular hyperplasia (FNH)?
Stop OCPs
38
Liver nodularity without fibrosis that's associated with RA describes what?
Nodular regenerative hyperplasia
39
Macroregenerative nodules occur in advanced ___________
cirrhosis
40
Most pts symptomatic & have advanced, incurable disease at presentation of what?
Gastric cancer
41
What type of gastric cancers have infrequent detection?
Surgically curable early cancers; usually asymptomatic
42
List 3 important features of gastric adenocarcinoma
1) Usually asymptomatic until advanced 2) Early satiety 3) Weight loss
43
When do you usually see hepatocellular adenomas? (important)
Long-term OCP use
44
What is a key part of gastric adenocarcinoma management?
Surgical resection
45
What is a key part of gastric lymphoma management? (important)
Tx of H. pylori in positive patients
46
What is the most common stromal or mesenchymal neoplasm in GI tract?
Gastrointestinal stromal tumor (GIST)
47
Gastrointestinal stromal tumor (GIST): What is the most common location?
Most common location is stomach & jejunum/ileum
48
Gastrointestinal stromal tumor (GIST): 1) What is a key part of diagnosis? 2) What is possible in most cases? 3) What is an important feature?
1) Histopathology 2) Complete resection 3) EGISTs
49
Enteric neoplasms: List the 2 main groups of malignant ones
Adenocarcinomas, neuroendocrine (carcinoid) tumors
50
The most common small bowel tumor AND most common malignancy **affecting the ileum** is what? (probs don't need to know)
Neuroendocrine tumor (type of enteric neoplasm)
51
What is the most common malignancy affecting the duodenum? (probs don't need to know)
Adenocarcinoma (type of enteric neoplasm)
52
Intermittent & crampy abdominal pain is the most common symptom of what?
Enteric neoplasms
53
True or false: Depending on the location, different types of enteric neoplasms are more common
True
54
Adenocarcinoma as an enteric neoplasm: 1) What is unique abt Crohn's pts? 2) What may management involve?
1) Most common in ileum 2) Wide resection
55
Neuroendocrine tumors (NET): What are some important features?
SB NETs most commonly found in ileum; watery diarrhea & flushing m/c symptoms of carcinoid syndrome
56
Where is pancreatic CA most common? (important)
Head
57
Most common neoplasm of pancreas (85%) is what?
Adenocarcinoma
58
Pancreatic cancer: 1) Only _______% of patients are candidates for pancreatectomy 2) **>____% expected to die from the disease**
1) 15-20 2) 90%
59
List some important risk factors for pancreatic cancer
1) heavy alcohol use, 2) Smoking 3) Chronic pancreatitis 4) family history
60
Pancreatic cancer: Pain occurs in 70% of cases (usually ________or LUQ) & often radiates to the ______
epigastric; back
61
Pancreatic cancer: 1) Possible relief of pain with what? 2) What Sx is less common? 3) What can occur due to biliary obstruction (usually by mass of pancreatic head)?
1) Sitting up & leaning forward 2) Weight loss common 3) Jaundice
62
Hard periumbilical (Sister Mary Joseph’s) nodule is a Sx of what?
Advanced pancreatic cancer
63
Pancreatic cancer: 1) What imaging is important? 2) What is not useful due to interference from intestinal gas?
1) CT (multi-phase, thin-cut) detects mass in >80% 2) U/S not useful
64
Pancreatic CA Dx/Tx: 1) Normal _____ excludes pancreatic cancer 2) What can you do with ERCP? 3) What is comparable to ERCP in diagnosing cancer?
1) EUS 2) place stent 3) MRCP
65
Pancreatic CA Dx/Tx: 1) What is indicated for cancers limited to the head of the pancreas? 2) What is used for surgically resectable tumors of body or tail?
1) Radical pancreaticoduodenal (Whipple) resection 2) Distal subtotal pancreatectomy
66
Pancreatic CA mgmt: Should do _________________ to relieve jaundice in unresectable cases
endoscopic stenting
(PA school Q3) CAM II
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