Gastrointestinal Cancer Quiz
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Questions and Answers

What is the relationship between decreased consumption of dietary carcinogens and gastric adenocarcinoma incidence?

  • It is responsible for the rise in gastric cardia cancer.
  • It leads to increased survival rates for cancer patients.
  • It contributes to the decline in incidence of gastric adenocarcinoma. (correct)
  • It has no significant influence on cancer rates.

Which condition is most commonly associated with Sister Mary Joseph’s nodule?

  • Advanced-stage abdominal malignancies. (correct)
  • Early-stage ovarian cancer.
  • Localized gastric adenocarcinoma.
  • Benign tumors of the gastrointestinal tract.

What type of cancer is primarily associated with Krukenberg tumors?

  • Lung carcinoma.
  • Melanoma from skin lesions.
  • Primary ovarian tumors.
  • Metastatic adenocarcinomas from the gastrointestinal tract. (correct)

What is a likely cause of the increase in gastric cardia cancer incidence?

<p>The prevalence of chronic GERD and obesity. (B)</p> Signup and view all the answers

What percentage of Sister Mary Joseph’s nodule cases are associated with primary gastrointestinal tract cancers?

<p>52% (B)</p> Signup and view all the answers

What characterizes diffuse gastric cancer at a cellular level?

<p>Presence of discohesive cells due to E-cadherin loss (B)</p> Signup and view all the answers

Which characteristic morphology is associated with gastric tumors that do not form glands?

<p>Mucin vacuoles expanding the cytoplasm (D)</p> Signup and view all the answers

What is the typical histological appearance of gastric MALToma?

<p>Dense lymphocytic infiltrate in the lamina propria (D)</p> Signup and view all the answers

Which type of gastric cancer is associated with atrophic gastritis and intestinal metaplasia?

<p>Intestinal-type gastric cancer (C)</p> Signup and view all the answers

What significant morphological change can be observed in advanced diffuse gastric cancer?

<p>Development of linitis plastica (D)</p> Signup and view all the answers

In what setting do extranodal marginal zone B-cell lymphomas typically arise?

<p>At sites of chronic inflammation (C)</p> Signup and view all the answers

Which morphological feature is least associated with gastric tumors having an intestinal growth pattern?

<p>Presence of inflammatory macrophages (C)</p> Signup and view all the answers

What histological characteristic is most indicative of intestinal-type gastric cancer?

<p>Glandular structures forming bulky tumors (D)</p> Signup and view all the answers

What type of lymphoma can MALTomas histologically resemble?

<p>Diffuse large B-cell lymphoma (A)</p> Signup and view all the answers

What is the typical appearance of the cut surface of a GIST?

<p>Whorled appearance (C)</p> Signup and view all the answers

Which cell marker is commonly expressed in MALTomas?

<p>CD43 (D)</p> Signup and view all the answers

From what type of cells do GISTs arise?

<p>Interstitial cells of Cajal (D)</p> Signup and view all the answers

What is the estimated percentage of GISTs that have oncogenic mutations in the KIT receptor?

<p>75% to 80% (B)</p> Signup and view all the answers

How are GISTs primarily categorized based on histology?

<p>Spindle cell and epithelioid type (D)</p> Signup and view all the answers

In which anatomical region do GISTs most frequently occur?

<p>Stomach (D)</p> Signup and view all the answers

What type of lesions do neoplastic lymphocytes create in gastric MALToma?

<p>Diagnostic lymphoepithelial lesions (C)</p> Signup and view all the answers

Which dietary factor is least associated with increased rates of colorectal cancer?

<p>Adequate intake of omega-3 fatty acids (C)</p> Signup and view all the answers

What role does reduced fiber content play in colorectal cancer risk?

<p>Decreases stool bulk, leading to prolonged contact with toxins (C)</p> Signup and view all the answers

What factor is most commonly associated with high-grade dysplasia in gastric adenomas?

<p>High cytologic atypia and irregular architecture (C)</p> Signup and view all the answers

What percentage of gastric cancers is comprised of adenocarcinomas?

<p>More than 90% (C)</p> Signup and view all the answers

Which pathway is characterized by accumulation of mutations in microsatellite repeat regions?

<p>Microsatellite instability pathway (B)</p> Signup and view all the answers

What is the main outcome of high fat intake in relation to colorectal cancer?

<p>Enhanced synthesis of cholesterol and carcinogens (A)</p> Signup and view all the answers

Which symptom is least likely to occur in advanced stages of gastric adenocarcinoma?

<p>Dyspepsia (C)</p> Signup and view all the answers

Which lymph node is typically associated with metastasis in gastric adenocarcinoma?

<p>Virchow node (D)</p> Signup and view all the answers

Which condition refers to the accumulation of mutations in microsatellite repeats?

<p>Microsatellite instability (MSI) (D)</p> Signup and view all the answers

What percentage of sporadic colon cancers is accounted for by the classic adenoma-carcinoma sequence?

<p>Up to 80% (C)</p> Signup and view all the answers

Which environmental factor is linked to an increased risk of gastric cancer?

<p>Low socioeconomic status (C)</p> Signup and view all the answers

Which of the following is NOT a typical characteristic of sessile serrated adenomas?

<p>Result from increased refined carbohydrate intake (A)</p> Signup and view all the answers

What aspect of gastric cancer screening has been effective in regions like Japan?

<p>Endoscopic screening programs (B)</p> Signup and view all the answers

How does the incidence of gastric cancer in immigrants relate to their new country?

<p>It becomes similar to that of their new country (B)</p> Signup and view all the answers

What is a key factor in both genetic pathways involved in colorectal cancer?

<p>Stepwise accumulation of multiple mutations (D)</p> Signup and view all the answers

Which characteristic is NOT typical of early gastric cancers detected through screening?

<p>Detection at advanced stages (B)</p> Signup and view all the answers

What characterizes the metastatic potential of intramucosal carcinomas in the colonic mucosa?

<p>Absence of functional lymphatic channels (D)</p> Signup and view all the answers

Which factors are crucial in determining further therapy for patients with invasive adenocarcinoma?

<p>Histologic grade, vascular or lymphatic invasion, distance from resection margin (C)</p> Signup and view all the answers

What is the minimum number of polyps required for a diagnosis of classic Familial Adenomatous Polyposis (FAP)?

<p>100 (C)</p> Signup and view all the answers

What is the standard therapy for individuals with inherited APC mutations in FAP?

<p>Prophylactic colectomy (B)</p> Signup and view all the answers

What percentage of colorectal cancers are accounted for by Hereditary Non-Polyposis Colorectal Cancer (HNPCC)?

<p>2% to 4% (B)</p> Signup and view all the answers

What types of cancers tend to cluster in families with HNPCC?

<p>Colorectal, endometrial, and small bowel cancers (C)</p> Signup and view all the answers

Which genes are most commonly mutated in patients with Hereditary Non-Polyposis Colorectal Cancer (HNPCC)?

<p>MSH2 and MLH1 (D)</p> Signup and view all the answers

At what age do most untreated patients with Familial Adenomatous Polyposis (FAP) develop colorectal adenocarcinoma?

<p>By age 30 (C)</p> Signup and view all the answers

Flashcards

Gastric Adenomas

A benign growth of glandular cells in the stomach. They are often small and located in the antrum. Most gastric adenomas are composed of intestinal-type cells.

Gastric Adenocarcinoma

A cancerous tumor arising from the glandular cells of the stomach. It is the most common type of gastric cancer.

Gastric Dysplasia

A precursor lesion associated with gastric adenocarcinoma, characterized by abnormal cell growth and organization.

High-Grade Dysplasia

A type of dysplasia characterized by severe cellular changes and irregular architecture, indicating a higher risk of developing cancer.

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Symptoms of Gastric Adenocarcinoma

Symptoms of gastric adenocarcinoma often mimic those of other stomach conditions, leading to late diagnosis.

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Importance of Early Detection

Early detection of gastric cancer is vital. Mass screening programs, especially in areas with high incidence, can increase the chances of successful early diagnosis.

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Environmental and Dietary Factors in Gastric Cancer

Factors like diet and environment play a role in developing gastric cancer. Lifestyle changes can impact risk.

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Predisposing Factors for Gastric Cancer

Gastric cancer is more prevalent in specific populations, like individuals with multifocal mucosal atrophy and intestinal metaplasia.

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Sister Mary Joseph Nodule

A palpable nodule protruding into the umbilicus, often indicating advanced abdominal or pelvic cancer with multiple peritoneal metastases.

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Krukenberg Tumor

A rare subtype of ovarian cancer caused by metastasis from other primary sites, most commonly the gastrointestinal tract (stomach, colon, pancreas), and less frequently from the gynecologic organs (ovary, endometrium).

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Signet Ring Metastasis

Refers to the 'signet ring' type of metastatic tumor spreading to the ovary, often originating from the colon or stomach, followed by breast, lung, or the opposite ovary.

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Decreased Consumption of Dietary Carcinogens

A condition that contributes to the decreasing prevalence of gastric cancer. It is linked to reduced use of salt and smoking for food preservation due to the widespread adoption of refrigeration.

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Gastric Cardia Cancer

A type of gastric cancer that is on the rise despite the overall decline in gastric adenocarcinoma. It may be linked to Barrett's esophagus, GERD, and obesity.

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Diffuse Gastric Cancer

Gastric tumors with an infiltrative growth pattern that spreads throughout the stomach lining, often appearing as clusters of cells or infiltrating the mucosa individually resembling macrophages.

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Intestinal-Type Gastric Cancer

A type of gastric cancer characterized by the formation of glands resembling those found in the intestines.

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Intestinal Metaplasia

A precursor lesion associated with intestinal-type gastric cancer, characterized by abnormal growth and organization of cells.

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Exophytic Gastric Tumor

A type of gastric tumor that grows outwards, often forming a bulky mass or an ulcer.

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Intestinal-Type Gastric Cancer: High-risk Areas

A type of gastric cancer that is more common in areas with high rates of Helicobacter pylori infection and is associated with atrophic gastritis and intestinal metaplasia.

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Linitis Plastica

A type of gastric tumor that forms a thick and rigid stomach wall, giving it a 'leather bottle' appearance.

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Extranodal Marginal Zone B-Cell Lymphoma (MALT)

A type of lymphoma that often arises at sites of chronic inflammation, particularly in the stomach due to chronic gastritis.

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Gastric MALT Lymphoma: Morphology

A dense lymphocytic infiltrate in the lamina propria, a layer of tissue beneath the stomach lining, often taking the form of numerous small nodules.

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What is a Gastrointestinal Stromal Tumor (GIST)?

The most common type of mesenchymal tumor in the abdomen. It originates from interstitial cells of Cajal and is often found in the stomach.

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What is the most common genetic change found in GISTs?

GISTs with mutations in the KIT gene account for 75-80% of all GISTs.

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How do GISTs typically appear in the stomach?

Large, well-defined masses in the stomach, often covered by ulcerated or intact mucosa.

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Where do GISTs commonly spread to?

GISTs can metastasize to the peritoneum, liver, and rarely to other organs.

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How are GISTs classified based on their microscopy?

GISTs can be classified based on their cell appearance: spindle cell type has elongated cells, epithelioid type has epithelial-like cells, and some have a mix of both.

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What is the most frequent cause of gastric MALT lymphoma?

The most common inducer of gastric MALT lymphoma. It is associated with most cases.

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Can MALT lymphoma transform into a more aggressive type?

MALT lymphomas can progress from a low-grade to a more aggressive form, resembling a diffuse large B-cell lymphoma.

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What are lymphoepithelial lesions and how are they formed in MALT lymphoma?

MALT lymphomas often infiltrate the gastric glands, creating lymphoepithelial lesions. These lesions are a characteristic feature.

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Adenocarcinoma of the Colon

A type of colorectal cancer that arises from glandular cells in the colon. It is the most common malignancy of the digestive tract.

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Dietary Factors in Colorectal Cancer

Dietary factors like low fiber intake and high consumption of refined carbohydrates contribute to increased risk of colorectal cancer.

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Microsatellite Instability Pathway

A condition where the cells have accumulated multiple mutations, leading to the development of colorectal cancer.

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APC/β-catenin Pathway

One of the key pathways in colorectal cancer development. Characterized by activation of the APC/β-catenin pathway.

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DNA Mismatch Repair Deficiency

A condition characterized by a defect in DNA mismatch repair. As a result, mutations accumulate in microsatellite repeat regions.

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Microsatellite Instability (MSI)

A condition where microsatellite repeat sequences in the genome have accumulated mutations.

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Sessile Serrated Adenomas

Colon cancers that arise from these adenomas are frequently found to have microsatellite instability.

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Classic Adenoma-Carcinoma Sequence

The traditional sequence of events that lead to colorectal cancer involves the accumulation of genetic mutations.

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Hereditary Non-Polyposis Colorectal Cancer (HNPCC) or Lynch Syndrome

A genetic disorder characterized by inherited mutations in genes that encode proteins involved in detecting and repairing errors during DNA replication. These mutations increase the risk of developing colorectal and other cancers.

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Familial Adenomatous Polyposis (FAP)

An autosomal dominant disorder characterized by the development of numerous colorectal adenomas, often starting in adolescence. This condition is caused by mutations in the APC gene, which regulates cell growth.

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Adenoma to Carcinoma Sequence

A progression from benign adenomas to invasive adenocarcinoma within the colon. This sequence involves the accumulation of multiple genetic mutations, including KRAS, TP53, APC, and beta-catenin.

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HNPCC-associated Colorectal Cancers

A type of colorectal cancer that is typically found in the right colon and often occurs at a younger age than sporadic colon cancers. It is characterized by the accumulation of mutations in microsatellite regions of DNA.

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Absence of Lymphatic Channels in Colonic Mucosa

A condition where the mucosal lining of the colon lacks functional lymphatic channels, limiting the spread of intramucosal carcinomas. Therefore, complete polypectomy can often cure these early-stage cancers confined to the mucosa.

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Invasive Adenocarcinoma in Colon

Invasion of the colonic mucosa beyond the muscularis mucosae, including the submucosal stalk of a pedunculated polyp. This indicates invasive adenocarcinoma and carries a higher risk of spread to other sites.

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Study Notes

Gastrointestinal Tract Tumors

  • The gastrointestinal tract encompasses several organs with potential tumor development.
  • This section focuses specifically on esophageal and gastric tumors.

Esophageal Tumors

  • Adenocarcinoma: Originates from Barrett esophagus; increased incidence due to obesity and gastroesophageal reflux. Risk factors include tobacco use and radiation exposure. More common in Caucasians and men. Typically occurs in the distal third of the esophagus.
  • Squamous Cell Carcinoma: Commonly develops in the upper and middle esophagus. Smoking and alcohol are major risk factors. More prevalent in males.

Gastric Tumors

  • Gastric Polyps: Many forms exist, including hyperplastic, fundic gland, and gastric adenomas. Hyperplastic polyps are usually multiple, smaller than 1 cm, and typically associated with chronic gastritis (often H. pylori related).
  • Gastric Adenomas: Precursor lesions for gastric adenocarcinoma in the stomach antrum that can increase in risk of becoming cancerous with size larger than 2cm. Often found incidentally.
  • Gastric Adenocarcinoma: Highly prevalent stomach malignancy, comprising over 90% of gastric cancers. Early symptoms often mimic chronic gastritis or peptic ulcer disease, leading to late diagnosis.
  • Gastric Lymphoma: Arises from mucosa-associated lymphoid tissue (MALT) and is often induced by chronic inflammation (particularly from H. pylori).
  • Gastrointestinal Stromal Tumor (GIST): The most frequent mesenchymal tumor in the GI tract. About 75-80% possess a gain-of-function mutation in the receptor tyrosine kinase KIT.
  • Morphology of Gastric Tumors: Gastric tumors can be polypoid, ulcerated, or infiltrative. Diffuse gastric cancer often creates a "signet ring" cell morphology due to large mucin vacuoles.

Colon Tumors

  • Hyperplastic Polyps: Benign epithelial proliferations, typically multiple, smaller than 5mm, and located predominantly in the left colon.
  • Sessile Serrated Adenomas: Found more frequently in the right colon, characterized by serrated architecture throughout crypt length and crypt dilation. High risk for progression to colorectal cancer.
  • Traditional Serrated Adenomas: Precursor lesions to colorectal cancer, often located in the rectosigmoid colon, are characterized by prominent eosinophilic cytoplasm, elongated nuclei, and tubulovillous architecture.
  • Tubular Adenomas: Neoplastic colon polyps often asymptomatic. Microscopically, tubular adenomas feature closely packed tubular structures. With size >1cm, increased risk for cancer.
  • Adenomas - Epithelial Dysplasia: Low or high grade dysplasia in the epithelium, may be a precursor to carcinoma. Invasion of the lamina propria constitutes intramucosal carcinoma and has low/no metastatic potential if confined to the mucosa.
  • Histologic and Molecular Progression in the Colon: The adenoma to carcinoma sequence involves mutations in genes such as APC, KRAS, TP53, and beta-catenin.
  • Familial Adenomatous Polyposis (FAP): Autosomal dominant disorder causing numerous colorectal adenomas in adolescence/young adulthood often leading to colorectal cancer. APC gene mutation is characteristic.
  • Hereditary Non-Polyposis Colorectal Cancer (HNPCC): Often linked to mutations in mismatch repair genes (e.g., MLH1 or MSH2). Usually results from the accumulation of mutations in microsatellite repeats in the genome.
  • Colon Morphology: Tumors in the proximal colon tend to be polypoid, while those in the distal colon are often annular with "napkin ring" constriction. Stromal desmoplastic response creates a firm consistency in tumors.
  • Colon Cancer Staging: Different stages (0-IV) based on tumor depth, lymph node involvement, and metastasis. Depth of invasion and lymph node involvement are important prognostic factors in colon cancer.

Appendix Tumors

  • The most common tumor type in the appendix is the well-differentiated neuroendocrine (carcinoid) tumor, generally benign.
  • Mucocele (dilated appendix with mucin) is a possible finding in the appendix.
  • Appendiceal adenomas and adenocarcinomas can cause obstruction.

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Description

Test your knowledge on the relationship between dietary factors and gastric adenocarcinoma, as well as the significance of Sister Mary Joseph’s nodule. Explore key associations and statistics related to gastrointestinal cancers including Krukenberg tumors. This quiz covers essential concepts in oncology and clinical symptoms.

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