Flashcards in 04a: Esophagus, Gastric Deck (36):
T/F: Squamous cell carcinoma is the most common esophageal cancer worldwide.
True - but incidence gradually decreasing
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
SCC of esophagus: Two most important risk factors in low-incidence areas.
EtOH and smoking
(X) cancer is associated with high risk of esophageal SCC.
X = SCC of head and neck
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
(Hyper/hypo)-calcemia occurs in up to 30% of patients with esophageal cancer. Why?
Hypercalcemia; PTHrP secretion
(SCC/AdenoCa) of esophagus is very locally invasive and may affect which structures?
Recurrent laryngeal n (hoarseness) or cause tracheoesophageal fistula
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
Preferred method of esophageal and gastric cancer diagnosis.
EGD (esophagogastroduodenoscopy) with biopsy
T/F: Screening for esophageal cancer has not proven useful for low-risk populations.
True - but benefit in screening high-risk pop
T/F: T1 stage of esophageal cancer has nearly 100% 5-year survival
False - only 46%!!
T/F: Metastasized esophageal cancer has under 5% 5-year survival
Esophageal and gastric cancer: (X) is the most accurate modality for staging.
X = endoscopic ultrasound
T/F: Surgery can be curative for esophageal cancer.
True - in early lesions (rarely seen in US)
#2 cause of cancer death worldwide
Gastric cancer (used to be #1 until 1930s)
(X) cancer was the most common cancer in US in 1930s, but is not no longer in top 10 US cancers.
X = gastric
Most common histological type of gastric cancer:
Intestinal type adenocarcinoma
Diffuse type gastric cancer is (more/less) common than intestinal type adenocarcinoma, associated with (better/worse) prognosis, and has "(X) cell" pathology.
X = signet
(Diffuse/intestinal) type gastric cancer is associated with cancer family syndrome.
H. pylori strains that are cagA (pos/neg) are associated with higher risk of atrophy and cancer.
T/F: Smoking is independent risk factor for gastric cancer, but alcohol is not.
True - 2-fold increased risk for smoking
T/F: Diet rich in fruits and veggies is protective against gastric cancer.
True - 30-50% risk reduction
T/F: Regular aspirin use increases risk of gastric cancer by about 1.5.
False - protective (relative risk is 0.5)
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
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)
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)
Gastric polyps: (common/uncommon), most (rarely/always) undergo malignant transformation, except for the 10% of them that are (X).
X = Adenomas (excision recommended for these due to high risk of malignant transformation)
T/F: Gastrectomy is protective against gastric cancer.
False - premalignant group of patients (maybe due to decreased acid production, bac, atrophy, etc)
List the most common physical signs of gastric cancer
2. Abdominal tenderness (and maybe a mass)
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)
(R/L) supraclavicular lymph node, called (X), is often associated with intra-abdominal malignancy, usually (Y) cancer.
X = Virchow's
Y = gastric
Blumer shelf can be a sign of (X), detected on (Y) exam. How do these come about?
X = gastric cancer
Y = digital rectal
Metastatic cells in peritoneum rest in pouch of Douglass and grow into mass lesions
Most common sites of gastric cancer metastasis.
Liver, lung, peritoneum, marrow
(X) are velvety black lesions in axilla and neck that are most often associated with (Y), but may be a sign of (Z).
X = Acanthosis nigricans
Y = metabolic syndrome
Z = internal malignancy (paraneoplastic syndrome)
You diagnose patient with gastric ulcer on EGD and the biopsy comes back negative for cancer. Can you rule out cancer in this case?
No! Repeat EGD after 12weeks to confirm ulcer is healing; biopsy may be initially false neg due to inflammation