Path GI neoplasia I esophagus & stomach

Question 1

5 factors associated with squamous cell carcinoma

Answer 1

EtOH
smoking
urban & lower SEC population
lye ingestion
red meat

Question 2

3 adenocarcinoma of esophagus risk factors

2 rare ones

Answer 2

Barrett’s esophagus
GERD
Truncal obesity

Rare: sclerdermerrrer, Zollinger Ellison syndrome

Question 3

SCCA vs adenocarcinoma male or female?

Answer 3

4: 1 SCCA
7: 1 Adenocarcinoma

Question 4

SCCA vs adenocarcinoma black or white?

Answer 4

black SCCA

white Adenocarcinoma

Question 5

SCCA vs adenocarcinoma location?

Answer 5

middle SCCA

distal Adenocarcinoma

Question 6

SCCA vs adenocarcinoma age?

Answer 6

65 SCCA

55 Adenocarcinoma

Question 7

SCCA vs adenocarcinoma risk factors?

Answer 7

EtOH, smoking SCCA

Barrett’s Adenocarcinoma

Question 8

barium swallow results for esophageal carcinoma

Answer 8

narrowing & irregularity

Question 9

staging of esophageal cancer 2

Answer 9

CT of chest (mediastinal spread)

EUS (depth of penetration, lymph node mets=bad)

Question 10

prognosis

Answer 10

bad. 55% unresectable. surg & XRT

5% 5-yr survival
37-3% 5ysurvival, depending on spread

Question 11

hyperplastic gastric polyps description

3 causes

Answer 11

<1 cm cystic masses, sessile/pedunculated

H pylori, atrophic gastritis, chronic inflammation

Question 12

epidemiology of gastric cancer

Answer 12

lower SEC
2:1 male:female
70s
declining incidence in US

Question 13

Risk factors for gastric cancer (6)

Answer 13

chronic atrophic gastritis
pernicious anemia
prior gastric surgery
dietary nitrates
gastric polyps
H pylori (5x risk)

Question 14

how nitrates cause gastric cancer

Answer 14

bacterial growth, nitrate reductase, nitrites, N-nitroso compound

Question 15

Types of gastric neoplasia (2 major)

Answer 15

gastric lymphoma 24%

gastric adenocarcinoma 74.6%

Question 16

symptoms in gastric cancer

Answer 16

weight loss 62%
abdominal pain 52%
nausea 34%
dysphagia 26%
melena 20%
early satiety 18%
ulcer-type pain 17%

Question 17

virschow’s node

Answer 17

left supraclavicular node, met of gastric ca

Question 18

sister mary joseph node

Answer 18

periumbilical nodule, met of gastric ca

Question 19

linitis plastic

Answer 19

diffuse, hard gastric carcinoma

agressive, 5%, bad

Question 20

only chance for cure of gastric carcinoma

Answer 20

surgery. chemo may help after surg.

Question 21

early mutation in esophageal SCCA

Answer 21

p53

no K-RAS or APC in SCC of esophagus!

Question 22

location of SCCA of esophagus

early appearance
late appearance (years)

Answer 22

upper 20%
middle 50%
lower 30%

small gray-white plaque thickenings
protruding (60%), flat (15%), excavated (25%)

Question 23

keratin pearls in SCCA of esophagus?

Answer 23

rarely

Question 24

early mutation (1) and later (5) in esophageal adenocarcinoma or Barrett’s epithelium?

Answer 24

p53 (early)

hypermethylation of p16/INK4a
RB
cERB-B2 (HER2)
Cyclin D1
Cyclin E

Question 25

goblet cells in adenocarcinoma of esophagus?

Answer 25

gets rarer as more malignant/dysplastic

Question 26

3 histology hallmarks of hyperplastic gastric polyps

Answer 26

excess of cells inflammation edema

Question 27

dilated corpus (body) oxyntic type glands

Answer 27

fundic gland polyp

Question 28

stratified columnar epithelium in edematous polyp

Answer 28

worst risk

Question 29

signet ring cells

Answer 29

indicates diffuse type gastric adenocarcinoma. (also possible in any adenocarcinoma)

Question 30

how does obesity lead to esophageal carcinoma?

Answer 30

fat > gerd > barrett's > dysplasia > p53 & others > adenocarcinoma

Question 31

What do EtOH and tobacco lead to in esophagus?

Answer 31

SCCA