GI Cancers -Rajurkar

Question 1

***What are the common locations and risk factors for Squamous Esophageal Cancer and Adenocarcinoma of the Esophagus?

Answer 1

Squamous: MIDDLE esophagus.

• smoking and alcohol
• HPV
• poor nutritional status
• Plummer-Vinson Syndrome
• Black people

Adenocarcinoma: DISTAL esophagus

• GERD and Barrett’s
• high BMI
• White people

Question 2

***What is required for definitive diagnosis of esophageal cancer? What is the staging based off of?

Answer 2

Endoscopic biopsy (endoscopy often shows stricture but not mass)

staging=TEE =tells you the depth of the cancer (more important than the size) –> determines treatment

Question 3

How does a PET scan find cancer?

Answer 3

cancer consumes more glucose than normal cells

PET scan will light up cancer (and brain –> use MRI for brain cancer)

Question 4

***What is the prognosis of most esophageal cancer? Treatment?

Answer 4

poor

Tx: Esophagectomy (early tumors); Palliative care w/ chemo (Stage IV)

Question 5

Where is the highest occurrence of gastric cancer?

Answer 5

Japan =lots of smoked fish

Question 6

*What is Menetrier disease? What is this a risk for?

Answer 6

• protein-losing hypertrophic gastropathy
• precancerous* for gastric cancer
• protein loss–> hypoalbuminemia
• hypertrophy
• parietal cell atrophy
• inc mucosal epithelial cells

Question 7

What is the pathophysiology of Menetrier disease?

Answer 7

↑TGF-alpha → bind & activate EGFR → ↑EGFR activivty → ↑proliferation of gastric mucosal epithelial cells → giant mucosal folds

TGF-alpha also inhibit parietal cells → parietal atrophy → ↓ gastric secretion

Question 8

What are some paraneoplastic manifestations of Gastric Cancer?

Answer 8

• Acanthosis nigricans
• Leser-Trelat sign: Multiple pigmented skin lesions
• Trousseau’s syndrome
• Hypercoagulable state –> migratory thrombophlebitis

Question 9

***What are the 2 types of gastric adenocarcinoma (most common gastric cancer)? What are their key features and which one is associated with H. pylori?

Answer 9

1. Intestinal
   - associated with H. pylori
   - irregular ulcer with raised margins
2. Diffuse
   - Signet ring cells
   - Linitis plastica

Question 10

***What is a predisposing condition for Gastric Lymphoma?

Answer 10

H. pylori

stomach is most common extranodal site of lymphoma

Question 11

***How is gastric cancer diagnosed? Staged? Treatment?

Answer 11

• diagnosed by endoscopy with biopsy
• staged with abd CT scan
• Tx: sx resection w/ adjunct chemo

Question 12

Any pt with iron deficiency has _____ until proven otherwise

Answer 12

colon cancer (or gastric or esophageal)

Question 13

***How will colon cancer on the left side present? What about the right side?

Answer 13

left=anemia (more common in the ascending colon)

left=obstruction

Question 14

***What is the most common colon and rectum cancer?

Answer 14

adenocarcinoma

Question 15

***What is Familial Adenomatous Polyposis (FAP)? What is the mutation? What is recommended?

Answer 15

• thousands of polyps at a young age
• Autosomal dominant mutation of APC gene (Chromosome 5q)–> inc proliferation

-prophylactic colectomy is recommended (100% progress to CRC by age 40)

Question 16

***What is the mutation associated with Hereditary Nonpolyposis Colorectal Cancer (Lynch syndrome)? What other malignancies are these patients at increased risk for?

Answer 16

-DNA mismatch repair (MMR) gene mutation

• endometrial cancer*
• ureter cancer

Question 17

If a pt presents with ureter cancer, what should you suspect?

Answer 17

think Lynch syndrome bcasuse ureter cancer is very uncommon

Question 18

***What is Peutz-Jeghers Syndrome? What PE finding will be seen?

Answer 18

Multiple nonmalignant hamartomas throughout GI tract

Hyperpigmentation at mouth, lips, hands, genitalia

Question 19

***What is Gardener’s Syndrome?

Answer 19

• Polyps + osseous and soft tissue tumors

- Osteoma of skull & mandible

Question 20

***What is Turcot’s Syndrome?

Answer 20

Polyps + CNS tumors (cerebellar medulloblastoma or glioblastoma multiforme)

Question 21

What is the most sensitive and specific test for colon and rectum cancer?

Answer 21

colonoscopy

Question 22

***Can CEA tumor marker be a useful diagnostic screening tool?

Answer 22

NO! Not sensitive or specific

goof for treatment assessment and suspicion of reoccurrence

Question 23

***How should you screen for colon and rectum cancer? What age range should be screened?

Answer 23

• adults 50 – 75 year-old. (or 10 years earlier than age of family member’s cancer)
• Sigmoidoscopy + sensitivity fecal occult blood testing every 5 years

OR

-Colonoscopy at intervals of 10 years.

Recommends against screening for adults > 76 year-old

Question 24

***How often should colonoscopies be performed on a pt who has a history of colon cancer?

Answer 24

Colonoscopy at 1 year after resection, then 3 years, then every 5 years

Question 25

***At what age should FAP pts be screened for colon cancer?

Answer 25

Sigmoidoscopy or colonoscopy at age 12 every year

Question 26

What is the only curative modality for treatment of localized colon cancer?

Answer 26

Surgical resection

Question 27

***What is the most common type of anal cancer (anal canal and anal margin)? Risk factors? How are these treated?

Answer 27

-squamous cell carcinoma -risk factors: similar to genital malignancies so anal sex, HPV, HIV -*treated with chemo and radiation (anal cancer is rare)

Question 28

***How is adenocarcinoma of the anal canal treated?

Answer 28

Surgery

Question 29

What are the clinical features of hepatocellular carcinoma? (2nd leading cause of cancer-related death in the world)

Answer 29

- Abdominal pain - Hepatomegaly - Weight loss, anorexia, fatigue - Symptoms of chronic liver disease: (Portal HTN, Ascites, Jaundice , Splenomegaly) - Paraneoplastic syndrome: (Erythrocytosis, hypercalcemia, hypoglycemia, Severe watery diarrhea)

Question 30

***What tumor marker will be elevated in HCC?

Answer 30

AFP

Question 31

***If you have a AFP >500 and a known liver mass, do you need a biopsy to diagnose HCC?

Answer 31

NO!

Question 32

What is Trousseau's Syndrome? What can this be a sign of?

Answer 32

- Migratory thrombophlebitis | - Pancreatic cancer (Adenocarcinoma= Most common; most are from endocrine pancreas)

Question 33

***If pancreatic cancer is suspected, what test should be done first? What does it mean if this is negative?

Answer 33

CA19-9 if negative, does not rule out cancer check CEA

Question 34

***What does the prognosis of pancreatic cancer depend on?

Answer 34

the SIZE of the cancer, not the depth

Question 35

What is the treatment for pancreatic cancer?

Answer 35

``` Whipple procedure (pancreaticoduodenectomy) -super poor prognosis, most present in stage III or IV ```