GIT Cancer NM

Question 1

Esophageal cancer stage II

Answer 1

IIA - lower 1/3 T3
IIB - upper 2/3 T3

Question 2

Esophageal cancer unresectable

Answer 2

Aorta, vertebral body, trachea, bronchi, lung

Question 3

Esophageal cancer stage III

Answer 3

N1

Question 4

Esophageal cancer M

Answer 4

Liver
Lung
Bone

Question 5

Smoking + alco
Esophagus

Answer 5

SCC, middle 1/3

Question 6

Obesity, reflux

Answer 6

Adenocarcinoma, distal, GEJ within proximal 5 cm

Question 7

Esophageal cancer diagnosis

Answer 7

EUS - most sensitive for tumor depth
FDG - more sensitive than CT in LN

Question 8

Esophageal cancer FDG indication

Answer 8

Distant MTS
LN involvement
Response to neoadj treatment
Local recurrence - - dd fibrosis vs edema
False negative - - small T1-2, necrotic, mucinous
3-4 weeks after chemoradio
6 weeks after surgery

Question 9

FDG T staging esophageal cancer

Answer 9

T1-2 - asymmetric thickening
T3 - wall thickening >5 mm or mass causing luminal obstruction

Question 10

Esophageal cancer LN

Answer 10

> 1 cm in short axis or >5 mm supraclavicular
Upper esophagus - cervical and mediastinal
Lower esophagus - abdominal

Question 11

Esophageal cancer treatment

Answer 11

Chemo radio + surgery

Question 12

T3 dd esophageal vs gastric

Answer 12

Esophageal - no serosa - - adventitia - - easy to spread
Gastric - subserosa - serosa

Question 13

Gastric T4

Answer 13

Not duodenum or esophagus

Question 14

Gastric cancer LN

Answer 14

Sister Mary Joseph’s LN - Periumbilical
Celiac >6 mm
Perigastric >8 mm
Clustering >3 LN
Risk for LN:
T4, tumor >2 cm, ulcer, mucinous

Question 15

Gastric cancer M

Answer 15

Liver
Peritoneum - - Krukenberg
Lung
Bone

Question 16

Gastric cancer type

Answer 16

Adenocarcinoma 90%
Intestinal type - older, distal, pernicious anemia
Diffuse type (signet ring cell) - <50 y, cardia, linitis plastica (diffuse thickening), reflux, obesity, ILC breast ca

Question 17

Gastric cancer risk

Answer 17

H. Pylori, alco, salt, meat - - distal, antral
Obesity, dysphagia - - proximal, cardia
Reflux - - GEJ
Vomit - - pylorus
Menetrier disease (giant hypertrophic gastritis)
Peutz-Jeghers syndrome
Smoking

Question 18

Gastric cancer staging

Answer 18

EUS - local invasion
CT thorax+abdomen+pelvis - - wall thickening >5 mm, advanced T, LN
FDG detection rate of primary tumor 55% - - no role in T staging, higher accuracy in LN, not sensitive for detecting peritoneal involvement

Question 19

Gastric cancer low FDG uptake

Answer 19

Mucinous, signet ring cell, poorly diff

Question 20

Gastric cancer treatment

Answer 20

Surgery + post-op chemo radio

Question 21

RT hemicolectomy if appendix cancer

Answer 21

Involvement of colon or base of appendix
Periappendicular area
Tumor size >2 cm
High grade
LN
Invades through muscularis propria
Colonic-type adenocarcinoma

Question 22

Colon cancer type

Answer 22

Right - anemia, occult blood, polypoid
Left - bleeding, altered bowel habits, pain, obstruction
Distal - circumferential, apple core
Adenocarcinoma 90%
Mucinous - - peritoneal spread - - Krukenberg
Ascending/descending - - retroperitoneum
Rectosigmoid - - worse prognosis

Question 23

Premalignant colon polyp

Answer 23

Tubular
Tubulovillous
Villous
Sessile
Pedunculated
Depressed

Question 24

Anal carcinoma T

Answer 24

Question 25

Anal cancer N

Answer 25

Proximal - - perirectal along IMA Below dentate line - - inguinal, external iliac Above dentate line - - mesorectal, internal iliac

Question 26

Colon cancer FDG

Answer 26

Focal uptake malignant No diff radio necrosis vs recurrence At least 4 weeks after radio Any incidental focal Colonic uptake - - colonoscopy Mucinous - - calcification in liver MTS dd after chemo Response to chemo radio not superior than CT, except for rectal cancer

Question 27

Anal cancer FDG

Answer 27

98% avid Big role for staging Not for treatment response: min residual activity 1 month follow up

Question 28

Colon cancer M

Answer 28

Liver (portal vein) - - resection Lung (recto sigmoid through paravertebral venous) Bone Brain

Question 29

Colon cancer diagnosis

Answer 29

Colonoscopy CT MRI

Question 30

Anal cancer risk

Answer 30

HPV - - SCC Female > male

Question 31

Anal cancer imaging

Answer 31

Pelvic MRI not T1 or endo anal US FDG - LN staging, 20% change in staging FDG benefit - detect residual subclinical pelvic or extra pelvic /para aortic node involvement

Question 32

Anal cancer type

Answer 32

<2 cm above dentate line - - anal ca >2 cm above dentate line - - rectal ca Skin within 5 cm of anus - - perianal ca SCC 90% better prognosis Adenocarcinoma, melanoma, small cell carcinoma

Question 33

Answer 33

Liver MTS from colon cancer

Question 34

Answer 34

Recurrence of colorectal cancer in liver

Question 35

GIST T

Answer 35

Question 36

GIST M

Answer 36

Liver Peritoneum Retroperitoneum Lung

Question 37

Carney triad

Answer 37

GIST Pulmonary chondroma Extraadrenal paraganglioma

Question 38

GIST risk

Answer 38

Neurofibromatosis type 1 - - small bowel Anemia Pulpable mass, obstruction Exophytic growth, 2-30 cm Treatment - glivec

Question 39

GIST PET

Answer 39

Response grade based on changes in SUV

Question 40

Answer 40

GIST small bowel