GI Neoplasms Flashcards
(30 cards)
Esophageal tumors:
- Benign Type
- Malignant Type
Benign: Leiomyoma
malignant: esophageal carcinoma
Esophageal Carcinoma:
- what are the 2 types? which is MC?
- mortality rate?
- Age
- sx
Types:
- squamous cell carcinoma
- adenocarcinoma (MC) (distal 1/3 of esophagus, occurs in barretts esophagus)
Moratlity: very high.
Age: 50-80YO
Sx:
- progressive dysphagia
- odynophagia (painful swallowing)
- regurgitation
- heartburn
- anorexia
- vomiting
- weight loss
Esophageal cancer:
- dx
- Tx
Dx:
- UGI/barium swallow
- endoscopic US
- EGD (good for getting bx) GOLD STANDARD
- CT (for staging and r/o mets)
- esophageal US (often done in combo w/ EGD to help appreciate the extent of tumor invasion of esophageal wall)
Tx:
- Chemo, radiation, surgery
- combined modality tx leads to best outcome*
Stomach Cancer:
-what are the benign and malignant types?
- Benign:
- -polyps
- -Tumors: Leiomyomas, lipomas
- Malignant:
- -Tumors:
- –Carcinoma (epithelial cell)
- –Lymphoma (lymphatics); sensitive to radiation
- –Sarcoma (CT)
- –Carcinoid (Serotonin secreting) (neuroendocrine tumor)
Gastric Polyps:
- types
- macroscopic appearance
- tx
Types: tubular, villous (greater than 2cm & malignant)
Macroscopic appearance:
- MC in antrum
- pedunculated (stalk)
- solitary, large, ulcerated
Tx:
-endoscopic removal if no malignancy identified, then period surveillance.
Gastric Leiomyoma:
- appearance
- tx
appearance: large protruding lesions with central ulcer, usually presents with bleeding if at all.
Tx: local excision with 2-3cm margin
Adenocarcinoma of Stomach
- cause
- histological typing
Cause: H. pylori d/t chronic atrophic gastritis
- low dietary intake of vegetables and fruit, high dietary intake of starches
- increased incidence with pernicious anemia and blood group A.
Histological typing:
-ulcerated carcinoma: deep penetrated ulcer with shallow edges, usually through all layers of stomach
- polipoid carcinoma: intraluminal tumors, large size, late mets
- superficial spreading: confinement to mucosa and sub mucosa, best prognosis*
- Lintis Plastica: involves all layers of the stomach,, “leather bottle” appearance on xray
Adenocarcinoma of the stomach
- signs and sx
- tx
vague discomfort difficult to distinguish from dyspepsia
anorexia
- meat aversion
- pronounced weight loss
Late stage:
- epigastric mass
- hematemesis: coffee grounds
Metastasis: Virchows Node (L supreclavicular)
Tx:
- surgical resection is the only cure
- prognosis; 12% 5 year survival
Routes of Gastric Carcinoma spread
Local infiltration (through the wall of stomach to peritoneum, pancreas, etc)
- lymphatic; local and regional LN
- blood; liver, lungs
- transcoelomic (across peritoneal cavity; often involves ovaries)
Dx of Gastric Cancer
anemia in 40% Elevated CEA UGI Endoscopy CT for mets
Pancreatic Cancer:
- age and gender affected
- prognosis
- cause
- risk factors
- pathophysiology
Age: 60-70YO, Males
Prognosis: less than 20% live longer than one year.
Cause: unknown
Risk factors:
- smoking
- high fat, high protein, high alcohol diets
Pathophys:
-arise from epithelial cells of pancreatic ducts, discovered in late stage so has spread throughout pancreas. MC site is HEAD OF PANCREAS!!!*
Pancreatic Cancer:
- signs and sx
- dx
Signs and Sx:
- vague, dull, abd pain
- painless jaundice
- weight loss, weakness
- anorexia, n/v
- glucose intolerance
- flatulence
- GI bleeding
- ascities
- leg/calf pain
- jaundice (if head of pancreas is involved; clay colored stools)
Dx:
- elevated amylase, lipase, alk phos, bilirubin, CEA C19-9
- CT US
- ERCP** most definitive dx test
Pancreatic Cancer:
-clinical management
- chemo or radiation
- pain control (opiods)
- distal resection
- whipple procedure
What is a whipple procedure? when is this used?
surgeon removes the head of the pancreas, the gallbladder, part of the duodenum, a small portion of the stomach called the pylorus, and the lymph nodes near the head of the pancreas.
Only used for CA of the pancreas head.
Zollinger-Ellison Syndrome
- what is this?
- pathophys
- sx
- MC gender
- dx
WHat; islet cell tumor of pancreas or duodenum, gastrinoma.
Pathophys: hypergastrineimia, gastric acid hypersecretion leading to PUD, GERD.
Sx:
-diarrhea, malabsorption, pain, heartburn
MC in men.
Dx: begins with clinical suspicion
-fasting serum gastrin measurement = highly sensitive.
Zollinger-ellison syndrome:
-management
PPI (nexium)
tumor search via CT
resection if surgical candidate.
Cancer of liver:
- MC type
- causes
- can cancer of liver be prevented?
- how do we prevent liver cancer?
MC is hepatocellular carcinoma
Causes:
- chronic infection w/ Hep B and Hep C.
- cirrhosis d/t alcohol, hepatitis
- tobacco use
- aflatoxins from a fungus that can contaminate peanuts, wheat, soybeans, groundnuts, corn, rice.
Well ideally yes, if you could just cut down on the transmission.
Prevention:
- Hep B vaccine
- avoid alcohol abuse
Hep B transmission? Ways to reduce transmission??
Hep B transmission:
- blood, saliva, semen, mucus, vaginal fluid, and breast milk.
- sharing needles, toothbrushes, razors, sexual activity
- mother-child (verticle)
Reduce transmission:
- wash hands after touching blood/bodily fluids
- avoid sharing personal hygiene items that may come into contact with body fluids
- cover all cuts and open sores with bandage
- safe sex.
Hep C transmission?
Transmission:
- blood to blood only
- sharing needles, unsterile tattooing, body piercing, sharing razor blades, and toothbrushe
- mother to baby
Liver Ca:
- sx
- dx
- tx
- prognosis
Sx:
- loss of appetite and weight
- jaundice
- swelling of abd
- pain in abdomen
Dx:
- LFTs
- AFP (alpha fetoprotein)
- blood tests for hep B and C
- US of liver
- CT or MRI
- Bx
- angiogram
- laparoscopy
Tx:
- surgery is curative in stages I and II;
- -liver wedge resection
- -liver lobectomy
- -liver transplantation
-chemo; via hepatic artery infusion of chemo embolization
Prognosis:
survival rate at 5 years = 10-40% depending upon stage.
Small Bowel Cancers
- MC type?
- risk factors
- clinical presentation
adenocarinoma
Risk factors:
- pre-existing adenoma
- crohns
- celiac dz
- IgA deficiency
- alcohol abuse
- neurofibromatosis
- red meat
Presentation:
- -abd pain
- n/va
- bleeding/anemia
- wt loss
- gastric outlet obstruction
- diarrhea
Small bowel CA:
- dx
- tx
Dx:
- Upper GI series/ SBFT
- Single contrast flouroscopy looking for mass, mucosal defect
- CT
- capsule endoscopy
Tx:
-surgery
Colorectal Cancer:
- purpose of colorectal screening?
- arise from what?
- how long does dysplastic tissue take to progress to CA?
- what are the two main types of colorectal polyps? how do you differentiate between the two?
Purpose: catch dysplastic cells in their tracts, resect them, and prevent the development to colon CA.
Most arise from adenomatous polyps, but may also arise from flat adenomas (can be missed by inexperienced practitioners)
progression takes at least 10 years in most people. The larger the polyp the more likely to progress to CA.
Two main types are adenomas or hyperplastic polyps, require bx for dx.
Colon CA:
-screening tests
Fecal Occult Blood
Flexible SIgmoidoscopy
Colonoscopy**(screening and therapeutic)
