Ugi, Pancr. Cancer; Colon And Rectal Cancer

Front 1

Predisposing factors for squamous cell carcinoma of esophagus

Back 1

alcohol, tobacco

HPV

Front 2

Predisposing factors for adenocarcinoma of esophagus

Back 2

Reflux disease, Barrett's esophagus

Front 3

T/F PPIs can help stop progression to cancer in Barrett's esophagus

Back 3

F.

Front 4

Presenting sx of esophageal cancer

Back 4

1) Dysphagia
2) Odynophagia
3) Regurgitation
4) Aspiration pneumonia
5) Cough

Front 5

What is connection between Esophageal Adenocarcinoma and Obesity

Back 5

positive correlation

Front 6

What does the presence of significant dysphagia mean for prognosis in esophageal cancer?

Back 6

Poor prognostic indicator. Means there is large occlusion of esophageal lumen.

Front 7

What does the presence of hoarseness mean for prognosis in esophageal cancer?

Back 7

Poor prognostic indicator

Front 8

What does the presence of Persistent substernal pain unrelated to swallowing
mean for prognosis in esophageal cancer?

Back 8

May indicate mediastinal disease.

Front 9

What does the presence of hiccups mean for prognosis in esophageal cancer?

Back 9

there is irritation of phrenic n, poor prognostic indicator, suggests involvement of diaphragm

Front 10

How is staging of esophageal cancer accomplished?

Back 10

Esophageal ultrasound (with or without FNA biopsy)

Front 11

T/F Surgery for patients with metastatic disease is a good idea.

Back 11

F! No need to do a huge surgery like esophagectomy if it's no chance of cure.

Front 12

What is the role of radiation and chemo in esophageal cancer?

Back 12

Combined with chemo as a preoperative tx. In 25-50% of these patients, may have no residual cancer.

Front 13

Resection is possible in _____% of patients with esophageal cancer

Back 13

50-60

Front 14

What are the results of treatment of esophageal cancer usually?

Back 14

Poor treatment except for early stage cancer.

Front 15

Most stomach cancer falls into what category?

Back 15

adenocarcinoma

Front 16

Symptoms of stomach cancer

Back 16

Epigastric discomfort – often vague
Indigestion – 70 - 80%
Ulcer-like symptoms – 10%
Dysphagia
Nausea
Vomiting
Anemia and/or weight loss
Occult or acute GI bleeding

Front 17

What are 4 types of gastric neoplasms?

Back 17

1) Adenocarcinoma

2) Adenomatous polyps

3) Gastrointestinal stromal tumors (eg leiomyoma)

4) Lymphoma (MALT) - mucosa associated lymphoid tumor

Front 18

T/F There is an increase in incidence of gastric cancer in US

Back 18

F. Decrease

Front 19

Risk factors for gastric cancer

Back 19

1) H. pylori infection (although most with this will never get it)

2) Pernicious anemia (atrophic gastritis)

3) Prior partial stomach removal for peptic ulcer

4) NOT past peptic ulcer

Front 20

What is Rectal shelf ?

Back 20

a shelf palpable by rectal examination, due to metastatic tumor cells gravitating from an abdominal cancer and growing in the rectovesical or rectouterine pouch.

Front 21

Physical findings in gastric cancer

Back 21

1) Neck nodes (indicates metastasis)

2) Abdominal mass

3) Hepatomegaly

4) Ascites

5) Ovarian mass

Front 22

In contrast to (duodenal, gastric) ulcers, all (duodenal, gastric) ulcers must be biopsied and must be re-examined and shown to heal completely to rule on malignancy

Back 22

duodenal; gastric

Front 23

Periampullary tumors can originate from where?

Back 23

1) Pancreatic acinar cell (85%)
2) Ampullary carcinomas (10%)
3) Duodenal carc (10%)
4) Carc of bile duct (5%)

Front 24

How do periampullary tumors present and why?

Back 24

Present similarly due to anatomic location:
jaundice
weight loss
ab. pain

Front 25

Risk factors/Genetic predisposition for pancreatic cancer

Back 25

Cigarette smoking
certain chemical exposure
red meat, dietary fat
DM, alcohol, chronic pancreatitis
(familial only in 5%)

Front 26

What is the most common cell type origin of pancreatic cancer?

Back 26

Ductal epithelial cells

Front 27

normal purpose of ductal epithelial cells

Back 27

secretion of electrolytes (bicarb) and pancreatic juice to the duodenum

Front 28

Where is ductal adenocarcinoma most common?

Back 28

Head of pancreas (60-70%)

Front 29

Symptoms of ductal adenocarcinoma

Back 29

Jaundice (obstruction)
Pruritus (jaundice complication)
Abdominal pain
Back pain - later
Nausea/vomiting - later - due to duodenal obstruction
Weight loss

Front 30

What is Courvoisier's sign?

Back 30

a palpable gallbladder that's distended because of obstruction of bile duct

Front 31

Differential diagnosis of jaundice

Back 31

Hemolysis

Biliary obstruction (stone, cancer, inflammation)

Intrahepatic causes (hepatocellular, cholestasis)

Front 32

What lab results will be abnormal in pancreatic cancer?

Back 32

Elevated bilirubin, especially conjugated

Elevated Alkaline Phosphatase

Prolonged Prothrombin time

Normal amylase, usually

Front 33

What is CA-19?

Back 33

Mucin-associated carbohydrate antigen, elevated in 75% of patients with pancreatic cancer.

Used more to follow patients, not sensitive or specific enough to be used as a method of screening.

Front 34

Imaging - what is first test to evaluate jaundice?

Back 34

ultrasound.

Front 35

What does a dilated common bile duct on ultrasound mean?

Back 35

There is extrahepatic biliary obstruction

Front 36

If the tumor is resectable, is there a need for a biopsy to confirm the malignancy of tumor?

Back 36

No, go ahead and just take it out.

Front 37

Where are most of the resectable pancreatic tumors located?

Back 37

head of pancreas

Front 38

____% of patients are resectable for cure of pancreatic cancer

Back 38

10-20

Front 39

What is the Whipple procedure?

Back 39

Removal of the head of pancreas and duodenum

Front 40

Palliative treatments for biliary obstruction

Back 40

biliary bypass, endoscopic stents, percutaneous stents

Front 41

Palliative treatments for gastric outlet obstruction

Back 41

gastrojejunostomy, stent

Front 42

Once the cancer has reached ANY lymph nodes, what is the staging (at least)

Back 42

III.

IV is metastases

Front 43

Most common endocrine neoplasm of pancreas

Back 43

Insulinoma

Front 44

What is the Whipple triad?

Back 44

collection of three criteria (called Whipple's criteria) that suggest a patient's symptoms result from hypoglycemia that may indicate insulinoma.

1) Symptoms known or likely to be caused by hypoglycemia
2) A low plasma glucose measured at the time of the symptoms
3) Relief of symptoms when the glucose is raised to normal

Front 45

2nd most common neoplasm of endocrine pancreas

Back 45

gastrinoma

Front 46

Symptoms of gastrinoma

Back 46

Diarrhea

abdominal pain due to peptic ulcer

GERD

Front 47

How is gastrinoma treated medically?

Back 47

Antisecretory treatment (omeprazole,other PPIs)

Front 48

3 organs that tumors develop in for MEN1

Back 48

parathyroid, pituitary, and pancreas.

Front 49

What is serous cystadenoma?

Back 49

benign tumor of the pancreas

Front 50

second most common cancer death

Back 50

colon cancer

Front 51

T/F Colon cancer is more common in the developed vs developing world

Back 51

T

Front 52

Dietary factors associated with colon cancer

Back 52

red meat, dietary fat, low fiber

Front 53

majority of colon cancer occurs after age ___

Back 53

50

Front 54

Symptoms of colon cancer

Back 54

Pain, nausea, vomiting, blood, constipation, diarrhea

Front 55

How does left vs. right colon cancer differ regarding bleeding?

Back 55

Right: tends to ulcerate and bleed, patients present with anemia, heart failure, occult blood in stool

Left: bleeding occurs but more often seen in stool, anemia is less common

Front 56

Lesions in the (left, right) colon more likely to cause obstruction

Back 56

Left

Front 57

What type of gene is APC?

Back 57

tumor suppressor

Front 58

Hyperproliferation: what role does it play in colon cancer?

Back 58

Hyperproliferation of the epithelium results from hypomethylation of DNA, and/or inactivation of tumor suppressor genes (APC) or DNA mismatch repair.

Front 59

Adenoma:what role does it play in colon cancer?

Back 59

Accumulation of more DNA mutations causes a raising of the epithelium aka polyp

Front 60

For the tumor to be carcinoma in situ, what must not be invaded?

Back 60

The muscularis mucosa

Front 61

Which of the following polyp morphology is most associated with development of colon cancer?

Tubular
Tubulovillous
Villous

Back 61

Villous > Tubulovillous > Tubular

Front 62

A + fecal occult blood test has about a ____% chance of having cancer

Back 62

7-14%

Front 63

T/F In office fecal occult blood test is a good screening tool.

Back 63

F. Essentially worthless. Patient must take them home.

Front 64

Detection of colon cancer: what are some screenings?

Back 64

Colonoscopy (best)

Proctosigmoidoscopy

Double contrast barium enema

CT scans (for mets in liver)

Labs (CBC for anemia, alk phos for liber mets)

Front 65

Carcinoembryonic Antigen (CEA): what is it used for?

Back 65

A non-specific test used to follow patients with colon cancer. Want to get a baseline and then monitor patients after resection for evaluations indicating recurrence.

Front 66

What role does molecular screening have in dxing colon cancer?

Back 66

In the future it will have a higher role. It will Detection of k-ras and other mutations in stool samples
Screening of rectal mucus for galactose-N-acetylgalactosamine

Front 67

What is the virtual colonoscopy?

Back 67

Not quite ready for prime-time, but may replace colonoscopies.

Three dimensional rendering of CT or MRI data
Breath holding and bowel prep required
Time consuming reconstruction creating a ‘virtual fly-through’

Front 68

Differential diagnosis of colon cancer

Back 68

1) Diverticular disease (confirm after resection of colon)

2) IBD

3) Ischemic colitis

4) Polyps - can be malignant or benign

Front 69

What are the surgical resections based on?

Back 69

The blood supply which parallels lymph drainage of colon - want to make sure enough is taken out.

Front 70

If anastomosis isn't feasible, what can be done to allow normal bowel function?

Back 70

Colostomy - proximal end of colon brought out as a stoma to allow normal bowel function.

Front 71

LYMPHATICS ARE LOCATED IN THE ____, THEREFORE CARCINOMA IN SITU DOES NOT METASTASIZE TO REGIONAL LYMPH NODES

Back 71

SUBMUCOSA

Front 72

What is a big difference between colorectal cancer and other GI cancers?

Back 72

there is effective chemo for colon cancer.

Front 73

Radiation therapy is more important in (colon, rectal) cancer. Why?

Back 73

Rectal. Because of greater risk of regional disease. It isn't clear if colon cancer is different from rectal cancer because of biology or just because of different anatomic constraints.