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GI Neoplasms Flashcards

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1
Q

Types of GI Neoplasms

A 
Esophageal CA
Carcinoma of the stomach
Pancreatic CA
Liver CA
Small bowel CA
Colorectal CA
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2
Q

Type of Benign Esophageal Tumors

A

Leiomyoma

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3
Q

Type of Malignant Esophageal Tumor

A

Esophageal CA

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4
Q

Types of Esophageal Carcinoma

A

SCC

Adenocarcinoma (more common in US)

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5
Q

Risk Factors for SCC

A 
Long-standing esophagitis
Achalasia
Smoking
Alcohol
Diet
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6
Q

Define Barrett’s Esophagus

A

Invasion of foreign cells into the lower esophagus

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7
Q

Epidemiology of Esophageal CA

A

Increased prevalence in northern China, India, & Iran
Higher in men
50-80 years old

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8
Q

Symptoms of Esophageal CA

A 
Progressive dysphagia
Odynophagia
Regurgitation
Heartburn
Anorexia
Vomiting
Weight loss
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9
Q

Diagnostics of Esophageal CA

A

UGI/barium swallow
Endoscopic US
EGD
CT for staging & mets

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10
Q

Treatment of Esophageal CA

A

Chemo (neoadjuvent, adjuvent)
Radiation (adjuvent)
Surgery

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11
Q

Type of Benign Stomach Tumors

A

Hyperplastic polyp
Leiomyomas
Lipomas

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12
Q

Type of Malignant stomach Tumors

A

CA
Lymphoma
Sarcoma
Carcinoid

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13
Q

Carcinoma Tumors

A

Epithelial cell origin

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14
Q

Lymphoma Tumors

A

Lymphatic system

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15
Q

Sarcomas

A

Connective tissue tumor

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16
Q

Carcinoids

A

Serotonin secreting

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17
Q

Gastric Neoplastic Polyps

A

Tubular

Villous: >2cm & malignant

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18
Q

Macroscopic Appearance of Gastric Polyps

A

In antrum
Pedunculate with malignant potential
Solitary, large, ulcerated

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19
Q

Treatment of Gastric Polyps

A

Endoscopic removal

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20
Q

Gastric Leiomyoma arises from what?

A

Smooth muscle of the GI tract

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21
Q

Gastric Leiomyoma Presentation

A

Possible bleeding

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22
Q

Treatment for Gastric Leiomyoma

A

Local incision with 2-3 cm margin

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23
Q

Adenocarcinoma of the Stomach Related to

A

Low dietary intake veggies & fruit
High dietary intake of starches
More common in males (3:1)
Increased incidence with pernicious anemia & blood type A

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24
Q

Histological Typing of Adenocarcinoma of the stomach

A 
Ulcerated carcinoma (25%)
Polipoid carcinoma (25%)
Superficial spreading carcinomas (15%)
Linitis plastica (10%)
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25
Ulcerated Carcinoma of the Stomach
Deep penetrating ulcer with shallow edges | Usually through all layers of the stomach
26
Polipoid Carcinoma of the Stomach
Intraluminal tumors Large in size Late mets
27
Superficial Spreading Carcinoma of the Stomach
Confined to mucosa & sub-mucosa Mets 30% at diagnosis Best prognosis
28
Linitis Plastica Adenocarcinoma of the Stomach
All layers of stomach Poor prognosis "Leather-bottle" appearance on Xray
29
Signs/Symptoms of Adenocarcinoma of the Stomach
``` Vague discomfort Anorexia: meat aversion Epigastric mass (late) Hematemesis (late) Mets: Virchow's node ```
30
Spread of Gastric Carcinoma
``` Through wall of stomach to peritoneum Pancreas Local/regional nodes Liver Lungs Across peritoneal cavity (Ovaries) ```
31
Diagnosis of Gastric Cancer
``` Anemia Elevated CEA UGI Endoscopy CT for mets workup ```
32
Treatment of Adenocarcinoma of the Stomach
Resection
33
Less Common Gastric Neoplasms
Lymphoma Gastrointestinal stromal tumor (GIST) Neuroendocrine (carcinoid) tumors
34
Gastric Lymphoma
MALT
35
Treatment of Gastric Lymphoma
Radiation
36
Gastrointestinal Stromal Tumors (GIST)
Mesenchymal neoplasms | Stomach most common
37
Neuroendocrine Tumors
Tumors of resident neuroendocrine cells in gastric glands
38
Gastric Sarcomas
Leiomyosarcoma Leiomyblastoma GIST
39
Pancreatic CA Epidemiology
Leading causes of CA mortality Incidence increases with age Usually 60-70 y/o Men > Women
40
Etiology of Pancreatic CA
Smoker high risk High fat, protein & alcohol diets May be genetic
41
Pathophysiology of Pancreatic CA
Arises from epithelial cells of the pancreatic ducts Discovered in late stages Rapidly growing Mainly in head of pancreas
42
Signs/Symptoms of Pancreatic CA
``` Vague, dull, abdominal pain "Painless jaundice" Weight loss, weakness Anorexia, N/V Glucose intolerance Flatulence GI bleeding Ascites Leg/calf pain Jaundice: clay colored stools, dark urine ```
43
Diagnostics of Pancreatic CA
Elevated amylase, lipase, alkaline phosphatase, bilirubin, CAE 19-9 CT, US ERCP
44
What is the most definitive diagnostic test for pancreatic CA?
ERCP
45
Clinical Management of Pancreatic CA
``` Prevent spread of tumor Chemoradiation Pain control (opiods) Distal resection Whipple procedure ```
46
Define Whipple Procedure
Excision or all or part of the pancreas together with the duodenum & usually the distal stomach
47
Define Zollinger-Ellison Syndrome
Islet cell tumor of the pancreas or of the duodenum
48
Gastrinoma (Z-E Syndrome)
Hypergastrinemia to gastric acid hyper secretion to PUD/GERD with or without complications
49
Signs/Symptoms of Zollinger-Ellison Syndrome
``` Pain + diarrhea Pain without diarrhea Diarrhea without pain Hearburn + dysphagia MEN-1 features ```
50
Epidemiology of Z-E Syndrome
Any age group | Male > Female 3:2
51
Diagnostics of Z-E Syndrome
Clinical suspicion | Fasting serum gastrin measurement
52
Management of Z-E Syndrome
PPIs over tumor search Prognosis excellent w/o mets CT Scan for tumor search
53
Other Pancreatic Tumors
Insulinoma | Glucagonoma
54
Most Common Type of Liver CA
Hepatocellular carcinoma
55
Epidemiology of Liver CA
Twice as common in men than women
56
Causes of Liver CA
Chronic infection with HBV & HBC Cirrhosis due to ETOH, hepatitis Tobacco use Aflatoxins from a fungus
57
Prevention of Liver CA
Minimize HBV transmission Avoid ETOH abuse Minimize HCV
58
How does HBV get transmitted?
``` Blood Saliva Semen Mucus Vaginal fluid Breast milk Sexual activity Sharing needles, toothbrushes, or razors From mom to baby at birth ```
59
Ways to reduce HBV transmission?
Wash hands after touching body fluids Avoid sharing personal hygiene items Cover all cuts/sores with bandage Practice safe sex
60
Prevention of HBV
HBV vaccination | Avoid alcohol abuse
61
Transmission of HCV
``` Blood to blood contact only Sharing of needles Unsterile tattooing Body piercing Sharing razor blades & toothbrushes Certain sexual activities Mother to baby No vaccine ```
62
Symptoms of Liver Carcinoma
``` Anorexia Weight loss Jaundice Swelling of the abdomen Pain in the abdomen ```
63
Diagnostics of Liver CA
``` LFTs AFP: detect & diagnose CA of the liver, testicles, and ovaries Hep B & C blood tests US of liver CT/MRI of liver Biopsy Angiogram of liver Laparoscopy ```
64
Liver CA Treatment
Surgery | Chemotherapy
65
Types of Surgery for Liver CA Treatment
Liver wedge resection Liver lobectomy Liver tranplantation
66
Ways chemo is given for liver CA treatment?
Hepatic artery infusion | Chemo embolization
67
Types of Benign Small Bowel Tumors
``` Leiomyoma Adenoma Lipoma Brunner's gland hematoma Hemangioma Nodular lymphoid hyperplasia ```
68
Types of Malignant Small Bowel Tumors
``` Adenocarcinoma Lymphoma Leiomyosarcoma Other sarcomas Ampullary adenocarcinoma ```
69
Types of Neuroendocrine Small Bowel Tumors
``` Carcinoid Gangliomeuroma Gastrinoma Somatostatinoma Vipoma ```
70
Conditions Associated with SB Tumors
``` Peutz-Jeghers syndrome Celiac disease IPSID Crohn's disease Neurofibromatosis AIDS Hereditary multiple polyposis syndromes ```
71
Mets of Small Bowel Tumors
Malignant melanoma Bronchogenic Breast CA
72
Types of Small Bowel Malignancies
Adenocarcinomas (30-50%) Carcinoids (25-30%) Lymphomas (15-20%) Gastrointestinal stromal tumors (10-20%)
73
Risk Factors for Small Bowel Adenocarcinoma
``` Pre-existing adenoma Crohn's Celiac disease IgA deficiency Alcohol abuse Neurofibromatosis Urinary diversion procedures Red meat ```
74
Clinical Presentation of Small Bowel CA
``` Abdominal pain N/V Bleeding/anemia Weight loss Gastric outlet obstruction Diarrhea ```
75
Diagnostics of Small Bowel Malignancies
UGI/SBFT (small bowel follow through) Single contrast flouroscopy: mass, mucosal defect CT Capsule endoscopy
76
Prognosis & Treatment of Small Bowel Malignancies
Pretty good with surgery
77
Colorectal CA
Common in both sexes 3rd leading cause of CA death in both sexes Preventable disease
78
Colorectal CA Screening
Colonoscopy
79
Adenoma Carcinoma Sequence
``` Normal epithelium Adenoma Late adenoma Early CA Late CA ```
80
2 Main Types of Colorectal Polyps
Adenomas | Hyperplastic polyps
81
Screening Tests for Colorectal CA
FOBT/FIT Flexible sigmoidoscopy Colonoscopy
82
Why has colonoscopy become the screening test of choice?
Looks at entire colon Polyps can be removed Abnormalities can be identified
83
Risk Factors for Colorectal CA
``` Polyps Age IBD Diet high in saturated fats Personal or family Hx. of CA Obesity Smoking ```
84
Hereditary Colorectal CA Syndromes (HNPCC)
Accounts for 5-10% of all CA cases | Usually diagnosed at average age of 45
85
Hereditary Colorectal CA Syndromes (FAP)
Develop hundreds to thousands of colon polyps Polyps initially benign but 100% chance will develop into CA Usually
86
Symptoms of Colorectal CA
Change in bowel habits: diarrhea or constipation Bright red or dark blood in stools Abdominal discomfort
87
Treatment for Colorectal CA
Surgery: resection Chemo: fluorouracil (5-FU), oxaliplatin (Eloxatin), irinotecan (Camptosar), capecitabine (Xeloda) Radiation: neoadjuvent or adjuvent, external beam Antiangiogenesis: disrupts its blood supply; Bevacizumab (Avastin)
88
Staging of Cancer
TNM system
89
Stage 1 Colorectal CA
CA grown through mucosa & invades muscularis
90
Treatment of Stage 1 Colorectal CA
Surgical resection
91
Stage 2 Colorectal CA
CA grown beyond the muscularis but hasn't spread to lymph nodes
92
Treatment of Stage 2 Colorectal CA
Surgery | Adjuvent chemo
93
Stage 3 Colorectal CA
CA has spread to regional lymph nodes
94
Treatment of Stage 3 Colorectal CA
Surgery | Chemo
95
Stage 4 Colorectal CA
CA spread outside of colon to other areas of the body
96
Treatment of Stage 4 Colorectal CA
+/- surgery | Chemotherapy
97
Follow-Up Care of Colorectal Surgery
Serial CEA measurements Colonoscopy 1 year post resection of colorectal CA Surveillance colonoscopy every 3-5 years
98
Colon vs. Rectal CA
``` Rectal better prognosis Radiation not beneficial for colon DRE/Hemocult CEA Surgery ```
99
Anal Cancer
SCC Women > Men HPV association
100
Signs/Symptoms of Anal CA
Bowel changes | Bleeding
101
Treatment of Anal CA
Surgery | Chemoradiation

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