2nd most common type of GI cancer

Hereditary colorectal cancer syndromes typically inherited in an ________ fashion

Germline mutation in the adenomatous polyposis coli (APC) gene located on chromosome 5 --> Loss of this genetic material results in the absence of tumor-suppressor genes

In typical _______, numerous colonic adenomas appear during childhood

•Extracolonic cancers are very common

--Endometrial carcinoma, may occur in up to 60% of female mutation carriers in some families

_______ is more common than ______; accounts for ≈ 3 to 5% of all colonic adenocarcinomas

Associated with germline mutations of several genes

Risk factors for Colorectal cancer

Risk factors for Colorectal cancer

Colorectal Cancer may present in 3 ways

simultaneous onset of two or more distinct tumors separated by normal bowel

non-anastomotic new tumors developing at least six months after the initial diagnosis

Typical sx from local tumor CRC

Less common sx from local tumor CRC

Change in bowel habits more common in

_________________ commonly ulcerate leading tochronic blood loss without change in bowel habits

Hematochezia is more often caused by

Abdominal pain can occur with tumors arising at

Tenesmus most commonly seen with

Most common sites for CRC metastatic disease are

Laboratory studies for CRCs

-Carries prognostic value for CRC

--Obtained preoperatively

--If highly elevated may indicate more advanced disease

[CRC] Useful first step in the evaluation of patients presenting with complications (i.e., bowel obstruction or perforation)

[CRC] used to distinguish between layers of the rectal wall and thus detect depth of tumor penetration and perirectal spread, staging accuracy superior to CT

[CRC] Staging before surgery, assessing and staging recurrent disease, detecting the presence of distant metastases

--Inadequate bowel preparation and/or distention, flat lesions, and small polyps are causes for missed lesions (false negatives)

Has a definite role in staging of rectal tumors

--Limited accuracy in determining nodal involvement

[CRC] Calculates a semiquantitative measure of uptake, known as standard uptake value (SUV)

--Used in pretreatment staging, post-treatment follow-up, and surveillance

gold standard screening for CRC ***

Average risk for CRC > 50 years with negative family history has the screening option to get a colonoscopy

Average risk for CRC > 50 years with negative family history has the screening option to get a fecal-based test

Histology: Hyperplastic on polyp screening

Adenomatous (malignant potential) polyps on screening can have histology of

[CRC surgery] lesions in cecum and right colon

[CRC surgery] : lesions in proximal or middle transverse colon

[CRC surgery]: lesions in splenic flexure and left colon

[CRC surgery]: Lynch syndrome, FAP, metachronous cancers in separate colon segments

[CRC] Curative intent for localized disease (stage I-III)

[CRC]

•Not standard of care

•Consider if positive surgical margin

•Palliation of symptoms

Standard of care for rectal cancer ***

--Lesions in the middle and upper third of the rectum

--Will not have a permanent colostomy; temporary colostomy or ileostomy may be necessary

--Very distal rectal cancers that are located just above the sphincter

--Increased frequency and urgency of bowel movements, as well as some incontinence to flatus and stool are possible

--Lower-third rectal cancers

--Performed in patients in whom negative margin resection will result in loss of anal sphincter function

Risk factors for squamous cell esophageal cancer

Risk factors for adenocarcinoma esophageal cancer

How deeply the cancer has grown into the wall of the esophagus or into nearby structures

Only in the epithelium (the top layer of cells lining the inside of the esophagus)

Growing into the tissue under the epithelium

Growing into the thick muscle layer (muscularis propria)

Growing into the outer layer of the esophagus (the adventitia)

Growing into nearby structures

Esophageal cancer: most common presenting symptom ***

Allows direct visualization and biopsy of the tumor [esophageal cancer]

Gold standard for diagnosis of esophageal cancer ***

Assesses both morphology and motility [esophageal cancer]

Most sensitive test for determining depth of tumor penetration (T staging) and presence of enlarged periesophageal lymph nodes (N staging) [esophageal cancer]

Evaluate extent of local tumor as well as presence of lymph nodes and distant metastases (M staging) to the lungs and liver [esophageal cancer]

Increasingly becoming standard in staging *** [esophageal cancer]

Targeted therapy for HER2 overexpressing available in

Average risk for CRC > 50 years with negative family history has the screening option to get a flexible sigmoidoscopy

Average risk for CRC > 50 years with negative family history has the screening option to get a flexible CTC

Adjuvant chemotherapy for CRC, survival benefit in

Only 20% of patient who survive a total resection live 5 years

Only in the top layer of cells of the mucosa

Growing from the top layer of cells of the mucosa into the next layers below such as the lamina propria, the muscularis mucosa, or submucosa

Growing into the muscularis propria

Growing into the subserosa layer

Growing into the serosa and may be growing into a nearby organ (spleen, intestines, pancreas, kidney, etc.) or other structures such as major blood vessels

Germline truncating mutations of the E-cadherin gene (CDH1) are detected in 50% of diffuse-type _________

Smoking risk factor is Dose-dependent; both number of cigarettes and duration of smoking

Pernicious anemia (B12 Deficiency) is a risk factor for

radiation exposure -- particularly survivors of atomic bomb blasts, is a risk factor for

Gastric cancer risk factors

Enlarged lymph nodes in left supraclavicular ***

Enlarged lymph nodes in anterior axillary

palpable nodule bulging into the umbilicus ***

malignancy in the ovary that metastasized from a primary site other than the ovary

metastasis to the peritoneal cul-de-sac palpable on rectal or vaginal exam

Tumor markers such as CEA and CA 19-9 can be used as a lab study in

Primary method to obtain tissue diagnosis in gastric cancer

[gastric cancer]

--Staging tool

--Assess depth of tumor penetration or involvement of adjacent structures

[gastric cancer]

Helpful in delineating the extent of disease when obstructive symptoms are present or when bulky proximal tumors prevent passage of the endoscope to examine the stomach distal to an obstruction

[gastric cancer] Assess local disease and evaluate for metastases

Esophagogastroduodenoscopy: Biopsy of any ulcerated lesion should include at least ___ specimens taken from around the lesion because of variable malignant transformation

mainstay of gastric cancer tx ***

immunotherapy -- pembrolizumab (Keytruda) for gastric cancer expressing

Esophageal cancer tx: chemotherapy and radiation therapy

gastric cancer tx: _______ after surgery does not improve survival, used primarily for palliation of pain

Primary Gastric Lymphoma: 95% are ________ B cell lymphoma

Primary Gastric Lymphoma risk factor

Primary Gastric Lymphoma tx for high grade lesions

______ far more treatable than _______