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?

The prevalence of chronic GERD and obesity. Signup and view all the answers

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

52% Signup and view all the answers

What characterizes diffuse gastric cancer at a cellular level?

Presence of discohesive cells due to E-cadherin loss Signup and view all the answers

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

Mucin vacuoles expanding the cytoplasm Signup and view all the answers

What is the typical histological appearance of gastric MALToma?

Dense lymphocytic infiltrate in the lamina propria Signup and view all the answers

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

Intestinal-type gastric cancer Signup and view all the answers

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

Development of linitis plastica Signup and view all the answers

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

At sites of chronic inflammation Signup and view all the answers

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

Presence of inflammatory macrophages Signup and view all the answers

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

Glandular structures forming bulky tumors Signup and view all the answers

What type of lymphoma can MALTomas histologically resemble?

Diffuse large B-cell lymphoma Signup and view all the answers

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

Whorled appearance Signup and view all the answers

Which cell marker is commonly expressed in MALTomas?

CD43 Signup and view all the answers

From what type of cells do GISTs arise?

Interstitial cells of Cajal Signup and view all the answers

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

75% to 80% Signup and view all the answers

How are GISTs primarily categorized based on histology?

Spindle cell and epithelioid type Signup and view all the answers

In which anatomical region do GISTs most frequently occur?

Stomach Signup and view all the answers

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

Diagnostic lymphoepithelial lesions Signup and view all the answers

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

Adequate intake of omega-3 fatty acids Signup and view all the answers

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

Decreases stool bulk, leading to prolonged contact with toxins Signup and view all the answers

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

High cytologic atypia and irregular architecture Signup and view all the answers

What percentage of gastric cancers is comprised of adenocarcinomas?

More than 90% Signup and view all the answers

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

Microsatellite instability pathway Signup and view all the answers

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

Enhanced synthesis of cholesterol and carcinogens Signup and view all the answers

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

Dyspepsia Signup and view all the answers

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

Virchow node Signup and view all the answers

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

Microsatellite instability (MSI) Signup and view all the answers

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

Up to 80% Signup and view all the answers

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

Low socioeconomic status Signup and view all the answers

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

Result from increased refined carbohydrate intake Signup and view all the answers

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

Endoscopic screening programs Signup and view all the answers

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

It becomes similar to that of their new country Signup and view all the answers

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

Stepwise accumulation of multiple mutations Signup and view all the answers

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

Detection at advanced stages Signup and view all the answers

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

Absence of functional lymphatic channels Signup and view all the answers

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

Histologic grade, vascular or lymphatic invasion, distance from resection margin Signup and view all the answers

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

100 Signup and view all the answers

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

Prophylactic colectomy Signup and view all the answers

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

2% to 4% Signup and view all the answers

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

Colorectal, endometrial, and small bowel cancers Signup and view all the answers

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

MSH2 and MLH1 Signup and view all the answers

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

By age 30 Signup and view all the answers

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.