04a: Esophagus, Gastric Flashcards Preview

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Flashcards in 04a: Esophagus, Gastric Deck (36)
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1

T/F: Squamous cell carcinoma is the most common esophageal cancer worldwide.

True - but incidence gradually decreasing

2

In high-incidence areas, how might diet be increasing Squamous cell carcinoma of esophagus?

Nutritional deficiency; high level nitrosamines or aromatic hydrocarbons; drinking hot tea

3

SCC of esophagus: Two most important risk factors in low-incidence areas.

EtOH and smoking

4

(X) cancer is associated with high risk of esophageal SCC.

X = SCC of head and neck

5

Pt with Barretts has (X)% yearly risk of cancer, which is (Y)x that of general population

X = 0.1-0.5
Y = 30-60

6

(Hyper/hypo)-calcemia occurs in up to 30% of patients with esophageal cancer. Why?

Hypercalcemia; PTHrP secretion

7

(SCC/AdenoCa) of esophagus is very locally invasive and may affect which structures?

SCC;
Recurrent laryngeal n (hoarseness) or cause tracheoesophageal fistula

8

List two key reasons why esophageal cancer is advanced at time of diagnosis in most cases.

1. Absence of serosa in esophagus
2. Rich lymphovascular network in LP and submucosa

9

Preferred method of esophageal and gastric cancer diagnosis.

EGD (esophagogastroduodenoscopy) with biopsy

10

T/F: Screening for esophageal cancer has not proven useful for low-risk populations.

True - but benefit in screening high-risk pop

11

T/F: T1 stage of esophageal cancer has nearly 100% 5-year survival

False - only 46%!!

12

T/F: Metastasized esophageal cancer has under 5% 5-year survival

True

13

Esophageal and gastric cancer: (X) is the most accurate modality for staging.

X = endoscopic ultrasound

14

T/F: Surgery can be curative for esophageal cancer.

True - in early lesions (rarely seen in US)

15

#2 cause of cancer death worldwide

Gastric cancer (used to be #1 until 1930s)

16

(X) cancer was the most common cancer in US in 1930s, but is not no longer in top 10 US cancers.

X = gastric

17

Most common histological type of gastric cancer:

Intestinal type adenocarcinoma

18

Diffuse type gastric cancer is (more/less) common than intestinal type adenocarcinoma, associated with (better/worse) prognosis, and has "(X) cell" pathology.

Less; worse
X = signet

19

(Diffuse/intestinal) type gastric cancer is associated with cancer family syndrome.

Diffuse

20

H. pylori strains that are cagA (pos/neg) are associated with higher risk of atrophy and cancer.

Pos

21

T/F: Smoking is independent risk factor for gastric cancer, but alcohol is not.

True - 2-fold increased risk for smoking

22

T/F: Diet rich in fruits and veggies is protective against gastric cancer.

True - 30-50% risk reduction

23

T/F: Regular aspirin use increases risk of gastric cancer by about 1.5.

False - protective (relative risk is 0.5)

24

Patient's father died of gastric cancer. He's worried about his risk of also developing gastric cancer. What do you tell him about his risk?

2-3x increased risk

25

Which genetic syndromes/mutations are associated with high risk of gastric cancer?

1. FAP (10-fold increased risk; screen via EGD every 3-5y)
2. HNPCC (11% risk)
3. E-cadherin gene mutation (diffuse type with high penetrance)

26

List causes of chronic atrophic gastritis, which carries (X)x risk of gastric cancer. Star the cause that carries highest risk.

X = 6

1. H. pylori*
2. Pernicious anemia (anti-parietal cell Ab)

27

Gastric polyps: (common/uncommon), most (rarely/always) undergo malignant transformation, except for the 10% of them that are (X).

Uncommon;
Rarely
X = Adenomas (excision recommended for these due to high risk of malignant transformation)

28

T/F: Gastrectomy is protective against gastric cancer.

False - premalignant group of patients (maybe due to decreased acid production, bac, atrophy, etc)

29

List the most common physical signs of gastric cancer

1. Cachexia
2. Abdominal tenderness (and maybe a mass)

30

Patient with abdominal pain and weight loss has a hard, purple nodule at the umbilicus. What is this nodule formally called and what is toward the top of your differential?

Sister Mary Joseph nodule;
Advanced Gastric cancer (metastatic deposit)