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Flashcards in GI neoplasms Deck (77)
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1

Esophageal Tumors
1. Benign?
2. Malignant?

1. Benign
Leiomyoma

2. Malignant
Esophageal carcinoma

2

Esophageal carcinomas
Squamous cell carcinoma
1. More prevalent where?
2. Risk factors? 5

1. More prevalent worldwide
2. Risk factors:
-long-standing esophagitis,
-achalasia,
-smoking,
-alcohol,
-diet

3

Esophageal carcinomas
Adenocarcinoma
1. More common where?
2. Occurs in what disease?
3. What part of the esophagus?

Adenocarcinoma
1. More common in USA
2. Occurs in Barrett’s esophagus
3. More in distal 1/3

4

Cancer of the Esophagus
Symptoms?
7

1. Progressive dysphagia
2. Odynophagia
3. Regurgitation
4. Heartburn
5. Anorexia
6. Vomiting
7. Weight loss

5

Diagnosis of esophageal cancer?
4

1. UGI/barium swallow
2. Endoscopic ultrasound
3. EGD…tissue is the issue
4. CT for staging and r/o mets

6

Treatment for esophageal cancer?
3

1. Chemo (preop and post-op protocols)
2. Radiation (post-op)
3. Surgery (best cure)

Combined Modality Treatment leads to the best outcome

7

Benign stomach tumors?
1. Polyps?
2. Tumors? 2

1. Polyps
-Hyperplastic

2. Tumors
-Leiomyomas (smooth muscle)
-Lipomas

8

Malignant stomach cancers
1. Tumors? 4

1. Carcinoma (epithelial cell origin)
2. Lymphoma (lymphatic system)
3. Sarcoma (connective tissue tumor)
4. Carcinoid (serotonin secreting)

9

Gastric Polyps: Neoplastic polyps?
1. Types? 2
2. Macroscopic appearance more often where?
3. What do they look like? 4
4. Treatment?

1.
-Tubular
-Villous (often larger …> 2cm and malignant)
2. More often in antrum
3.
-Pedunculated with malignant potential
-Solitary,
-large
-ulcerated

4. Treatment
-Endoscopic removal if no malignancy identified… the periodic surveillance

10

Gastric Leiomyoma: Pathology?
1. Arise from where?
2. What is it difficult to distinguish from?
3. More benign or malignant?
4. Differentiatied how?
5. What do they look like?

1. Arise from smooth muscle of the GI tract
2. Difficult to distinguish from
Gastrointestinal stromal tumor
3 75% benign
4Differentiation only on mitotic index
5. Large protruding lesions with central ulcer

11

1. Gastric Leiomyoma
usually present how?

2. Treatment?

1. Usually presents with bleeding if at all

2. Treatment is local excision with 2 – 3cm margin

12

Adenocarcinoma of the Stomach
1. What bug is associated with this and why?

2. Also related to what? 4

1. HP associated due to chronic atrophic gastritis

2. Also related to
-Low dietary intake vegetables and fruit
-High dietary intake of starches
-More common in males ( 3 : 1 )
-Increased incidence with pernicious anemia and blood group A

13

Adenocarcinoma of the Stomach
Histological typing? 4

1. Ulcerated carcinoma (25%)

2. Polipoid carcinoma (25%)

3. Superficial spreading carcinomas (15%)

4. Linitis plastica (aka Brinton’s disease or leather bottle stomach) (10%)

14

1. Ulcerated carcinoma (25%) looks like what?
-Usually through what layers of the stomach?

2. Polipoid carcinoma (25%) look likw what?
-Metastasis?

3. Superficial spreading carcinomas (15%) are confined to where?
-Prognosis?

4. Linitis plastica (aka Brinton’s disease or leather bottle stomach) (10%) involves what layers of the stomach and what is the prognosis?
-what kind of appearance on XRAY?

1. Deep penetrated ulcer with shallow edges
-Usually through all layers of the stomach

2. Intraluminal tumors, large in size
-Late metastasis

3. Confinement to mucosa and sub-mucosa
-Metastasis 30% at time of diagnosis (Best prognosis)


4. involves all layers of stomach
(poor prognosis)
-“leather-bottle” appearance on X-ray



15

1. Adenocarcinoma of the Stomach
signs and symptoms? 3

2. At late stages? 3

1.
-Vague discomfort difficult to distinguish from dyspepsia
-Anorexia
-Pronounced weight loss

2. At late stage
-Epigastric mass
-Hematemesis usually coffee ground
-Metastasis...Virchow’s node (L supraclavicular)

16

What kind of anorexia is specific to adenocarcinoma?

Meat aversion

17

Spread of Gastric Carcinoma

4

1. Local infiltration (through wall of stomach to peritoneum, pancreas etc)
2. Lymphatic – local and regional lymph nodes
3. Blood – liver, lungs
4. Transcoelomic (across peritoneal cavity).

18

Transcoelomic (across peritoneal cavity) often involves what?

1. Often involves ovaries (esp. signet ring cancer) – Krukenberg tumour (ovarian tumor that metastasized from a primary site…colon or stomach

19

Diagnosis of Gastric Cancer
5

1. Anemia in 40%
2. Elevated CEA in 65%
3. UGI
4. Endoscopy…..tissue is the issue
5. CT scans for metastatic work up

20

Adenocarcinoma of the Stomach
1. Whats the only cure?
2. Prognosis? 2
3. What offers little benefot for treatment?

1. Surgical resection only cure
2.
-Prognosis overall…. 12% 5 year survival
-90% for stage I disease
3. Radiation and chemo offer little benefit

21

Adenocarcinoma of the Stomach
1. What often makes surgery futile?
2. Palliation controversial for what? 2

1. Late presentation makes surgery often futile

2.
-Hemorrhage
-Gastric outlet obstruction

22

Less Common Gastric Neoplasms
3

1. Lymphoma
2. Gastrointestinal stromal tumour (GIST)
3. Neuroendocrine (carcinoid) tumours

23

Gastric Lymphoma
1. Whats the lymphoma called?
2. treatment?

1. (MALT…mucosa associated lymphoid tissue)

2. Treatment….sensitive to radiation

24

1. Gastrointestinal Stromal Tumors (GIST)?
2. most common site?

1. Mesenchymal neoplasms

2. Stomach most common site

25

Neuroendocrine Tumors
1. What are the tumors of resident neuroendocrine cells in gastric glands?

carcinoids

26

Gastric Sarcoma
Includes a variety of tumors such as? 3

1. Leiomyosarcoma
2. Leiomyoblastoma
3. GIST

27

Pathophysiology of Pancreatic Cancer
1. Arises from where?
2. Tumor usually discovered when?
3. Describe its progression?
4. Whats the most common site for it on the pancreas?

1. Usually arises from epithelial cells of the pancreatic ducts

2. Tumor typcially discovered in late stages so has spread throughout pancreas

3. Rapid growing with spread to surrounding tissue

4. Most common site is head of pancreas

28

Signs and Symptoms of pancreatic cancer
10

1. Vague, dull, abdominal pain
2. “Painless jaundice”
3. Weigh loss, weakness
4. Anorexia, nausea, vomiting
5. Glucose intolerance
6. Flatulence
7. GI bleeding
8. Ascites
9. Leg/calf pain
10. Jaundice (if head of pancreas involved)
-Clay colored stools
-Dark urine

29

Diagnostics of pancreatic cancer?4

1. No specific blood tests to diagnose
2. Elevated amylase, lipase, alkaline phosphatase, bilirubin, CEA (carcinoembryonic antigen) C19-9
3. CT, Ultrasonography
4. ERCP – most definitive diagnostic test

30

Clinical Management of pancreatic cancer?
5

1. Goal is to prevent spread of tumor
2. Chemotherapy or radiation
3. Pain control (opioids)
4. Distal resection
5. Whipple procedure