Shared Flashcard Set

Details

Dr. Fish GI
GI
205
Medical
Graduate
10/13/2009

Additional Medical Flashcards

 


 

Cards

Term

Leukoplaqia

"White Plaques"

Definition

 

An asymptomatic white patch on the surface of a mucous membrane.  This is not a tumor, but can result in malignant transformation to squamous cell carcinoma.
Occurs with equal frequency in both sexes, mostly after the third decades of life.
Not a histologic diagnosis, but a descriptive clinical term.
Term
What other entities feature a white plaque on oral muscosa?
Definition
Candidiasis, Lichen Planus, and Psoriasis
Term
What are some common causes of Leukoplakia?
Definition

 Causes include use of tobacco products, alcoholism, and local irritation (cheek biting or malformed dentures) and HPV infection.

 These same causes also occur in the etiology of oral squamous cell carcinoma.
Term
In Leukoplakia what portions of mouth are affected?
Definition

 

Most often occurs on the buccal mucosa, tongue, and floor of mouth.
 The plaques may be solitary or multiple, vary in size from small to large patches, and usually cannot be removed by scraping.
Biopsies have revealed carcinoma in-situ in 10% of the cases and invasive carcinoma in 8%.
Eventually 20% becomes malignant, so all cases should clinically be considered precancerous.
Term
Erthroplakia
Definition

 

Much less common than Leukoplakia.
Considered red or dysplastic Leukoplakia.
Term
What is Eryhtroplakia represented within the oral cavity?
Definition

 

Represents a red, velvety and eroded area within the oral cavity mucosa.
The epithelial changes tend to be markedly atypical, incurring a much higher risk of malignant transformation, greater than 50%.
Term
What is the most common malignant tumor in the oral mucosa and could occur at any site?
Definition
Squamous Cell Carcinoma
Term

Squamous Cell Carcinoma frequenly involves what structures?

 

What would are the ratio for male to female?

Definition

Frequently involves tongue, followed by floor of mouth, palate, and buccal mucosa.

 

Male:Female ratio 2:1

Term
What is the average age of squamous Cell Carcinoma?
Definition
50-70 years old
Term
What are the predisoposing factors of Squamous Cell Carcinoma?
Definition

 

Predisposing factors includes the use of tobacco products, alcoholism, physical and chemical irritants, chewing of betal nuts, poor oral hygiene (ill-fitting dentures) and U-V light on the lips. (most of the same factors seen in leukoplakia and erythroplakia.
Term
Squamous Cell Carcinoma is associated with?
Definition

 

Some squamous cell cancers have also been associated with human papillomavirus.
Term
In squamous cell carcinomas where do oral carcinomas metastasize mainly?
Definition

 

Oral carcinomas metastasize mainly to the submandibular, superficial, and deep cervical lymph nodes.
Term
Invansive lesions are similiar to:
Definition
:the same tumor in other parts of the body, ranging from a well-differentiated lesion (grade I) with frequent keratinization to poorly-differentiated lesions which are difficult to distinguish as squamous.
Term
In SCC who die have distant blood borne metasis in what common areas?
Definition
most commonly to the liver, lungs, gastrointestinal tract or bone.
Term

Metasis lesions may take ____ to ____ to progress to invasive lesions.

 

What presentation does this have?

Definition

Months to Years

 

Raised, firm pearly-white lesions with central necrosis and rolled mucosal borders.
Term

Neoplasms of Salivary Glands consists of less than ___ of human cancers.

 

65-85% arise from ______

 

10-15% of tumours of the ____ are malignant, but 40% in the _________

Definition

2%

Parotid Gland

Parotid

Submandibular

Term
Neoplasms usually occur in?
Definition
Occur in adults with a slight female over male predominance.
Term
Benign tumors are seen in which decades? and what type of tumor is seen later?
Definition
5th and 7th Decades and Malignant tumors are later.
Term
What is the most common tumor of the salivary glands?
Definition

Pleomorphic Adenoma

(Mixed Tumor)

 

Term
Pleomorphic Adenoma is characterized by what?
Definition
Benign neoplasm are characterized by a biphasic appearance, with admixure of epithelial and stromal elements.
Term
Pleomorphic Adenoma is frequent in:
Definition
9 times, Parotid Gland, frequent in middle aged persons with females over males.
Term

Pleomorphic Adeonomas have a clinical presentation of:

Where is it typically seen:

Microsopically shows a mixture of:

Definition

 

A slow-growing, painless, moveable, firm en-capsulated mass, which has a smooth surface.
Usually seen at the angle of the mandible.
Microscopically, it shows a mixture of epithelial tissue intermingled with myxoid, mucoid, or chondroid areas. (mixed tumors).  The epithelial component consists of two types of cells: ductal and myoepithelial cells.
Term

Pleomorphic Adenoma cells form:

What type of exposure may increase the risk?

In Infrrequent cases a carcinoma may arise can take the form of what?

Definition

 

The myoepithelial cells form well-defined cords and nests, separated by a cellular myxoid stroma that appears to be a product of the myoepithelial cells.
Radiation exposure may increase the risk.
Infrequently, (2-3% of cases) a carcinoma may arise, usually taking the form of an adenocarcinoma or an undifferentiated tumor.
Term

Pleomorphic Adenoma if large enough may protrude into:

If the recurrent tumor is removed what nerve maybe sacrificed?

Definition

 

These tumors, if large enough, may protrude into the surrounding tissue, making total resection difficult at surgery.  Residual tumor left behind continue to grow as recurrences in the scar tissue.
When the recurrent tumor is removed, the facial nerve may have to be sacrificed, due to the difficulty in dissecting off branches of the nerve embedded in the dense scar tissue. (this represents local regrowth of the tumor and not malignancy.
Term
Malignant Tumors Mucoepidermoid Carcinomas
Definition

 

A malignant salivary gland tumor composed of a mixture of neoplastic squamous cells, mucous secreting cells, and intermediate hybrid cells.
Term

Where do Malignant Tumors Mucoepidermmoid Carcinomas Originate?

 

Most tumors are seen in who and affect who?

Definition

 

Originate from ductal epithelium, and accounts for 5-10% of all salivary gland tumors, and over 70% arise from the parotid.
 Most tumors are seen in adults and are more common in women.
Term
Mucoepidermoid Carcinoma are common of what gland, and is induced by what?
Definition
Salivary Glands, radiation induced neoplasms of glands.
Term
Mucoepidermoid Carcinomas grow:
Definition

 

Grows slowly as a firm, painless mass with infiltrating margins, grey-white on section.
Term
Mucoepidermoid Carcinomas have what type of differentiation? and lined by how many types of cells?
Definition

 

Well-differentiated tumors form duct-like and cystic spaces, lined by the three cell types.  Poorly-differentiated tumors contain much more squamous cells in lieu of the other two cell types.
Term
Mucoepidermoid Carcinomas arise from and what is the common site?
Definition
Tumors arise from salivary glands and common site is palate.
Term

 

Pathologically, the metaplastic epithelium extends up the distal esophagus with thickened red-brown circumferential tissue.
Definition
Barrett Esophagus
Term
Barrett Esophagus carries a risk of malignant Transformation to what:
Definition
Adenocarcinoma
Term
What factors increase the risk of Carcinoma of the Esophagus:
Definition
Smoking and Drinking
Term

What types of foods could cause or increase the risk of cancers?

 

A Carcinogen found in the soil or food in highly endemic areas:

Definition

Smoked Foods

 

Nitrosamines

Term
Diets lacking in what increase the risk of carcinoma of the Esophagus:
Definition
Diets lacking in fresh fruit, vegetables, proteins, and trace metals.
Term
Plummer-Vinson Syndrome and Achalasia are associated with:
Definition
Squamous Cell Carcinoma
Term

In Esophagus Pathology what portion involve the lower third:

 

Definition

 

Half the cases involve the lower third, and the middle and upper thirds account for the remainder.
Term
Name grossly the tumor are of three different types:
Definition

 

Grossly the tumor are of three different types:

     1. Polypoid, which projects into the lumen.

     2. Ulcerating, a crater-like lesion which bleeds.

     3. Infiltrating, in which the principal plane of the tumor growth is in the wall.

Usually these features overlap.
Term

All Squamous Cell Carcinomas:

 

Definition

 

 

1.Can project into tissue.
2.Can cause bleeding

3. Infiltrating with aggressive carcinomas

Term
In bulky polpoid tumours that tend to obstruct early, also infiltrating tumors gradually narrow the lumen by:
Definition
Concentric Compression
Term
In Esophagus Pathology major problems involving the mediastinal structures of tumor are done by what type of extension?
Definition
Local
Term
Microscopically the tumors are squamous cells and range from:
Definition
Well-differentiated with keratin pearls to poorly-differentiated tumors.
Term
Lymphatic drainage into the esophagus provides a route for metastasis, so tumors of the upper 3rd metastasize what nodes:
Definition
Cervical, Internal Jugular, and supraclavicular nodes.
Term

Cancer of the mid-third metastisize to the:

 

 

Definition
peritracheal, hilar and nodes in the aortic and cardiac regions
Term
Lower 3rd metastasize involve which lymph nodes:
Definition

 

retroperitoneal, celiac and gastric nodes.  Visceral mets to the liver and lungs are also common.
Term
Most common presenting syptoms in dyspahgia, are not recognized until the diameter of the lumen is reduced to what:
Definition
30-50%
Term
Patients with advanced esophageal disease are usually:
Definition
Cachexic, owing to anorexia, difficulty in swallowing and when persistent, may suggest mediastinal extension.  Compression of the recurrent laryngeal nerve produces hoarseness
Term
Cancer of the Esophagus(Treatment)
Definition

 

Surgery and radiation therapy are useful for palliation, but prognosis remains dismal.
Only 40% of patients who undergo surgery have tumors that are potentially resectable, and of these, one-third die as a result of the operation.  Of the survivors, only 10% live for 5 years.
Overall, 95% of patients will die within 2 years of diagnosis.
Term
All Adenocarcinomas arise from:
Definition
Barrett Epithelium
Term

PUD:

Breaks in muscosa of stomach and proximal duodenum are produced by action of:

Definition
Gastric Secretions
Term
PUD afflicts what percentage of population
Definition
10%
Term
What common factor unites both gastric and duodenal ulcers:
Definition
Hydro-cholric acid
Term
What peak incidence of duodenal ulcer disease is in what ages:
Definition
30-60 y/o
Term

Dudoenal ulcers have a predominat to what sex:

 

Gastric Ulcers is:

Definition
Male Distribution
Term
What is the most common stereotype of PUD
Definition

 

The common stereotype of the patient with a peptic ulcer is that of a highly motivated executive operating in a stressful environment.
Term
In Africa dudoenal ulcers are:
Definition
Dudodenal ulcers are rare among blacks.
Term
What environmental factors are associated with PUD:
Definition
 High amounts of Alcohol and cirrhosis of the liver are associated with PUD.  Aspirin as well as NSAID’s and high-dose Corticosteroids have all been incriminated in the production of peptic ulcers.  Cigarette smoking is also a risk for PUD, particularly gastric ulcers, although the mechanism is controversial.
Term
PUD Genetics factors. 1st degree relatives of pt's with duodenal ulcers have a ____ fold increased in risk of duodenal ulcers.
Definition
3
Term

Identical twins have what percentage of concordance for PUD:

 

The risk of duodenal ulcers is about 30% higher in person with what blood type:

Definition

50%

 

Type O blood

Term

All patients with duodenal ulcers and most gastric ulcers are:

 

Hypersecrtion of acid is present in many of what type of ulcer:

Definition

Gastric Acid secetors

 

Dudodenal Ulcers

Term
What gastric secretion may play a role in the production of peptic ulcers, which also parallels that of Hydrochloric acid:
Definition
Pepsin
Term
This has been isolated from the gastric antrum of all pt’s with duodenal ulcers, and infection is important in the pathogenesis of gastric ulcers, because this organism is responsible for most cases of chronic gastritis.
Definition
Helicobacter Pylori
Term
What percentage of patients with gastric ulcers harbor H. pylori:
Definition
75%
Term
  What should be considered chronic when it does not heal readily and leads to scarring at the base of the ulcer, (point of NO RETURN)
Definition
Peptic Ulcer
Term
In the point of NO RETURN that precludes complete restoration of what structure(s)
Definition
submucosa (2nd layer) muscularis mucosae
Term
What portion of the stomach do PUD arise
Definition

 

Most arise in the lesser curvature of the stomach, in the antral and prepyloric regions, and the 1st part of the duodenum.
Term
In gross examination of PUD it may be difficult to distinguish what:
Definition
chronic peptic ulcer from ulcerating gastric carcinoma.
Term
What is the diameter of PUD
Definition
2-10 cm in diameter
Term
PUD edges tend to look like:
Definition
edges tend to be sharply punched out, with overhanging margins. The flat base is gray and indurated.  Deeply penetrating ulcers produce a serosal exudate which may cause adherence of the stomach to the surrounding structures.
Term
Duodenal Ulcers are located where:
Definition
on the anterior or posterior wall of the first part of the duodenum, within a short distance of the pylorus.
Term
Duodenal Ulcers are usually solitary, but not uncommon to find paired ulcers on both walls, which are called:
Definition
Kissing Ulcers
Term
Microscopic Examination of PUD have 4 Characteristics of lumen outward:
Definition

1.  A superficial zone of fibrinopurulent exudate

2.  Necrotic tissue

3.  Granulation tissue

4.  Fibrotic tissue at the base of the ulcer, which exhibits variable degrees of chronic inflammation.

Term
Duodenal ulcers are characterized by what:
Definition
Burning epigastric pain experienced 1-3 hours after a meal or that awakens them at night.
Term
What relieves duodenal ulcers:
Definition
Both Alkali and food
Term
What complication can arise from PUD
Definition

 

      1.  Hemorrhage:  the most common complication, occurring in up to 20% of pt’s.

       -In many cases, the bleeding is occult and the pt may manifest an iron-deficiency anemia, or as occult blood in the stools. (erodes into vein)

       -Massive life-threatening hemorrhage is a well-recognized danger in patients with active peptic ulcers. 

Term
Perforations in PUD is seen with which ulcers?
Definition

Commonly seen with duodenal ulcers, on anterior wall than gastric. 

     -Results in luminal contents freely escaping into the peritoneal cavity, and continue to be associated with a high mortality (10-40%)

     -Can also penetrate into the pancreas, liver, and greater omentum, with shock, bleeding and pain

Term
Pyloric obstruction occurs in what percentage:
Definition
5-10%
Term
Narrowing of the Pyloric Lumen by adjacent peptic ulcers can be caused by:
Definition
Muscular spasm, edema, muscular hypertrophy, most commonly a combination of each.
Term
Complications of PUD with retention of gastric contents results in:
Definition
Epigastric distress, anorexia, and early satiety.
Term
True or False the only way to tell if Gastric or Malignant is a biopsy?
Definition
True
Term
Where is the highest amount of gastric cancer located?
Definition
Japan
Term

Complications of PUD:

 

Malignant Transformation:

Definition

 

 Malignant transformation:  It is difficult to distinguish a cancer arising  in a preexisting gastric ulcer from an ulcerated primary carcinoma.

     -Malignant transformation of a duodenal ulcer is virtually unknown

     -Those cancers that do arise from preexisting gastric ulcers make up only 1%.

Term
Carcinoma of the stomach account for _____ of cancer deaths in the U.S.
Definition
3%
Term
What potent carcinogen has been detected in smoked fish and also found in tobacco:
Definition
Benzpyrene
Term

Stomach Cancer- Pathogenesis

 

Dietary factors in what large amounts can cause stomach cancer:

Definition
Amounts of starch, smoke fish and meats, and pickled vegetables.
Term

Stomach cancer is uncommon in what age group but has a sharp incidence in people over___.

 

Definition
Younger than 30 and people older than 50 years.
Term
Nitrosamines:
Definition
Powerful animal carcinogens related to the development of gastric cancer in certain individuals.  High nitrate concentrations are also found in the soil and water in certain areas where gastric cancer is high, and processed meats and vegetables are high in nitrates.  The low incidence in the U.S. has been attributed to an increased use of refrigeration that inhibits the conversion of nitrates.
Term

Stomach Cancer - Pathogenesis

What strong heredity traits have been identified in most cases of gastric cancer, involving what blood type:

Definition
Blood type A is found in 38% of the general population, whereas half of the patients with gastric cancer display this blood type.
Term
What socieconomic settings is stomach cancer most affiliated with:
Definition
Low socioeconomic settings
Term
What other factors, illness, diseases are associated with stomach cancer pathogenesis:
Definition

 

Atrophic Gastritis, Pernicious Anemia(antibodies to insintric factors)  Subtotal Gastrectomy, Gastric Adenomatous Polyps, and Helicobacter pylori.

Term
Superficial Spreading Carcinoma
Definition
A tumor that is confined to the mucosa or submucosa
Term

What type of carcinoma accounts for 95% of malignant gastric tumors:

 

What portion of the stomach:

Definition

 

Adenocarcinoma accounts for more than 95% of all malignant gastric tumors.
Most common in the distal stomach, on the lesser curvature of the antrum, and in the pre-pyloric region.
Term
By the time most gastric cancers in the Western world are detected, they are advanced they penetrate into what:
Definition
Penetrated beyond the subumcosa and into the serosa
Term
Gastric Cancers are divided into three macroscopic types list the first:
Definition

 

       1.  Polypoid (fungating) adenocarcinomas: accounts for one-third of advanced cancers.  It is a solid tumor that projects into the lumen.  The surface may be partially ulcerated, and the deeper tissue may or may not be infiltrated.

Term
Gastric Cancers are divided into three macroscopic types list the second:
Definition

 

    2.  Ulcerating Adenocarcinoma:  constitutes another one-third and is visualized as a shallow ulcer of variable size with surrounding tissue that is firm, raised and nodular.  The lateral margins are irregular and the base is ragged.  This appearance is in contrast to the benign peptic ulcer, which exhibits punched-out margins and a smooth base.

Term
Gastric Cancers are divided into three macroscopic types list the third:
Definition

 

    3.  Diffuse or Infiltrating Adenocarcinoma:  No true tumor mass is seen macroscopically, instead, the wall of the stomach is thickened and firm, and when the entire stomach is involved, the term Linitis Plastica(leather bottle stomach) is applied.  The invading tumor cells induce extensive fibrosis in the submucosa and muscularis, therefore, the entire wall is stiff and therefore does not stretch.

Term
Micoscopically the histologic pattern of the advanced gastric cancer varies from:
Definition
a well-differentiated adenocarcinoma with gland formation to a totally anaplastic poorly differentiated type.
Term
Polypoid type typically is:
Definition
well-differentiated whereas linitis plastica is poorly differentiated.
Term

Stomach Carcinoma - Pathology

 

Tumor cells may be arrange in:

Definition
Cords or papillary configurations
Term
Signet-Ring Cells
Definition
The tumor cells may also contain mucin that displaces the nucleus to the periphery of the cell, resulting in the so-called "Signet-ring cells" ONLY SEEN IN GATRIC CANCERS
Term
Other types of adenocarcinomas histologically are:
Definition
Colloid, Papillary, solid or medullary types
Term
What are the most frequent inital symptoms associated with stomach carcinoma:
Definition
Weight loss with anorexia and nausea.
Term
Chronic bleeding with obstructions of gastric outlet occur with large tumors, what are the possible findings:
Definition
Occult blood in stools and anemia.
Term
Tumors involve the G-E junction result in:
Definition
Dysphagia
Term
Patient with early gastric cancer may be asymptomatic but usually complain of:
Definition
Dyspepsia or epigastric pain.
Term

Carcino Embroynic Antigen (CEA) is increased in the blood of 1/4 of patient with:

 

The CEA is helpful in regards to:

Definition

Advanced Gastric Cancer.

 

Monitoring the course of metastatic disease. 

Term
Hematogenous spread may seed any organ such as:
Definition
Liver, lung, or brain
Term
If metastasize occurs to the ovary it elicits a reaction called:
Definition
Krukenberg Tumor
Term
10 year survival rate for surgically treated advanced gastric cancer is about ___, Compared to ____ for early gastric cancers.
Definition
20% , 95%
Term
IBD has a term used for 2 closesly related but different diseases name them:
Definition
Crohn's disease = (regional enteritis) and Chronic Ulcerative Colitis are both characterized clinically by recurrent inflammation of the intestines and a chronic, unpredictable course.
Term

IBD affect:

 

Both diseases peak in:

Definition

the same populations, more common in whites than blacks, and are especially more common among E. European Jews.

3rd Decade

Term
IBD show a:
Definition
a familial predisposition and in some families, some have both Crohn’s and CUC
Term
IBD in early stages Croh's and CUC have:
Definition

 

Have morphologic changes often indistinguishable from one another.

Term
Crohn's Disease involves what:
Definition
Terminal ileum and colon.  In 50% of cases, the disease affects both, in 30% it is limited to the ileum, and in 20% it is limited to the colon.
Term
Crohn's Disease also includes and in 1-2% of cases involves what other parts.
Definition
Appendix. Involves the esophagus, stomach or fallopian tubes.
Term
1/3 of Crohn's Disease patients have inflammatory lesions of:
Definition
Joints, skin or eyes.
Term
The Earliest pathologi changes involve the terminal ileum where there are shallow mucosal defects typically overlying lymphoid aggregates form the:
Definition
Peyer's Patches (Terminal End of the Ileum)
Term
Plasma cells secrete antibodies. What cells participate in cell immunity:
Definition
T-Cells
Term
In Crohn's Disease sharp demarcated non-caseating granuloms are located within what:
Definition
Muscosa and submucosa.
Term
Crohn's Disease also has fibrosis of muscularis and seros causing the wall to thicken and become rigid known as:
Definition
Rubber Hose Fibrosis with "Creeping Fat"
Term
Crohn's Disease has what type of appearance interspersed between normal mucosa (Skip Lesions)
Definition
Cobblestone
Term
The fibrotic intestines may be narrowed, causing intestinal stricture, and the inflammation of the serosa leads to adhesions with adjacent intestinal loops and the formation of:
Definition
Fistulas
Term
What type of involvement is often associated with formation of fissures as well as abscesses:
Definition
Anal Involvement
Term
Crohn's clinical features are nonspecific. The most common symptoms are:
Definition

are diarrhea, abdominal pain, and weight loss, characterized by exacerbations and remissions.

Bleeding is more common with rectal involvement, and fever occurs in 1/3 of patients
In later stages, constipation may be present due to intestinal narrowing or fistulas.
Dx:  Colonoscopy, X-rays, and  mucosal biopsies.

 

Term
Ulcerative Colitis
Definition

 

An intestinal inflammation of unknown etiology that most often involved the colon.
 
From initial rectal lesions, the inflammation spreads proximally, ultimately involving the entire colon.
Term
Backwash Ileitis:
Definition
Inflammation in the terminal ileum
Term
What is the contrast in Crohn's versus CUC.
Definition
In contrast to Crohn’s involvement of the colon, which is typically segmental, CUC is a diffuse disease, and it usually does not extend into the ileum
Term
CUC is a disease principally limited to:
Definition
Colonic mucosa and submucosa
Term
Ulcerative Colitis lesions seen by rectoscope and colonscope appear:
Definition
Flattened, edematous patches involving the entire circumference. The mucosa appears like sandpaper, is friable, and is prone to bleeding.  This fragile mucosa is edematous and inflamed on histology.
Term
Ulcerative Colitis progresses the mucossal lesions become prominent in that mucosa appears flattened and pitted like:
Definition
Surface of a football.
Term
Crypt Abscesses
Definition
the mucosa shows atrophy of the crypts with aggregates of lymphocytes in the base of the crypts
Term
Ulerative Colitis have what type of lesions? and bleeds?
Definition
Rectal lesions and ulcerated mucosa bleeds easily and is not often infected.
Term
Serpiginous Ulcerations:
Definition
colonic ulcerations spreads through the entire colon and become confluent leaving behind only small remnants of inflamed mucosa that appear to be elevated over the base of the surrounding ulcerations and are termed inflammatory.
Term
Pseudopolyps
Definition

(False Tumors) Due to Reddened, inflammed mucosa.

Inflammed mucosa is where malignant formation has a chance to occur.

Term
CUC begins with mild symptoms that evolve into:
Definition
Diarrhea, rectal bleeding, and pain.
Term
The significant late complication of CUC is:
Definition
Mucosal regeneration that may undergo malignant transformation
Term

 

20% of cases, the disease has a fulminant course, and is resistant to medical treatment what would happen next.  
Definition
Patients require surgery, and only colectomy-resection of the entire colon is life
Term
CUC predominatly affects which side?
Definition
The left side of the colon
Term
Crohn's tends to involve which side:
Definition
The Right side of colon and ileum
Term
The lesions in CUC are:
Definition
Diffuse
Term
The lesions in Crohn's are present with:
Definition
Skip areas
Term
CUC is limited to the
Definition
Mucosa and submucosa
Term
Crohn's is limited to:
Definition
Transmural
Term
Granulomas are not seen in CUC but:
Definition
Are diagnostic in Crohn's
Term
Mucosal ulcers of CUC are:
Definition
wide, leaving few small patches of uninvolved, inflamed mucosa that protrude as inflammatory pseudopolyps
Term
Mucosal Ulcers in Crohn's are:
Definition
linear and resemble cobblestones.
Term
The broad ulcers in CUC are:
Definition
more friable and tend to bleed more than in Crohn’s.
Term
Colonic wall in CUC is thinner and predispose patient to intestinal dilation and ____________ with a chance of _____.
Definition
Toxic Megacolon, Perforation.
Term
In Crohn's the transmural inflammation contribues to thickenig of entire wall with:
Definition
Peri-intestinal fibrosis, adhesions and fistulas.
Term
IBD extraintestinal complications include:
Definition
Arthritis, eye lesions, and skin lesions.
Term
IBD risk of cancer is higher in _____ than it is for ______.
Definition
CUC, Crohn's (1%)
Term
Lung cancer in men, breast tumors in women, what is the 3rd most common malignant disease?
Definition
Intestinal Neoplasm (Cancer)
Term
Benign intestinal tumors outnumber malignant tumors:
Definition
2 to 3 fold.
Term

Of the 95% of cases involve what type of tissue origin:

 

Tumors protrude into the lumen of the intestine and can be seen by:

Definition

Epithelial.

 

Endoscopy or X-ray with barium enema.

Tumors of the rectum can be reached by anal digital palpation.

Term
What type of surveillanec is an effective approach for early diagnosis of intestinal cancers:
Definition
Blood in Stool
Term
Intraluminal location of intestinal tumors makes them vulnerable to:
Definition
Mechanical trauma (fecal trauma) by the intestinal contents and accounts for frequent intestinal bleeding.
Term
Where are most tumors located?
Definition
Located in the large intestine and as stated before the small intestines are involved in only a small percentage of all GI tumors.
Term
Why is the colon much more affected to get cancer:
Definition
Due to an increase in transent time because of feces sitting in colon.
Term
What fraction of tumors invole the rectum and can be detected by digital exam.
Definition
1/3
Term
It has been estimated at ___ that intestinal cancers have a genetic basis.
Definition
20%
Term
What is the primary cause of dietary factors in colon tumors?
Definition
Red Meat:  Unknown as to the risk, but we do know that red meat barbecued on a charcoal grill contains more carcinogens than white meat cooked in the same manner.
Term
What is the secondary cause of dietary factors in colon tumors?
Definition

 

     2.  Fat:  Presumably can be degraded to potential carcinogens during intestinal digestion, which acts on the intestinal epithelial cells.  Fat in the food also stimulates the release of bile, which is a source of intestinal carcinogens, presumably derived from degraded bile acids.

Term
What is the third cause of dietary factors in colon tumors?
Definition

 

3.  Foods rich in refined carbohydrates: (and low in vegetable fibers) produce low volume waste.  Because colonic peristalsis depends on the volume of feces in the lumen, the transit time in the large intestines is prolonged and this allows for longer contact between the carcinogens in the intestinal contents and the intestinal mucosal cells.

Term
What is the most common site of large intestinal cancer?
Definition
Rectosigmoid area, where feces is retained the longest.
Term
Food that passes through the small intestines much faster than large intestine accounts in part for the ____ times lower incidence of tumors in the jejunum and ileum than the colon and rectum.
Definition
50
Term
Pathology of colonic tumors are subdivided into three groups:
Definition
Non-neoplastic polyps, benign polyps, and malignant tumors (Adenocarcinomas)
Term
What type of tumors develop from epithelial cells lining the crypts and villi
Definition
Intestinal Tumors
Term

Proposed that the epithelial cells undergo malignant transformation through the action of

Definition
Oncogenes and environmental factors.
Term
Non-Neoplastic polyps. Hyperplastic Polyps are:
Definition

 

Over 80% are located in the rectosigmoid area, and grossly they appear as small, dew-droplet like protrusions on the mucosa measuring less than 5mm in diameter. Histologically, they are composed of hyperplastic glands rich in goblet cells and mucin.  They do not progress to cancer
Term
Hamartomas:
Definition

Benign collection of normal cells and tissue that are indigenous to that area but within a tumor mass. 

developmental abnormalities in which the normal components of the tissue aggregate in an abnormal manner.

Most are found in children less than 5 yrs.

Most are solitary, 1-3 cm, and are located in the rectum as lobulated, sessile lesions, that can become inflamed and ulcerated, giving symptoms of bleeding and rectal irritation

Term
Juvenile Polyps:
Definition

 Histologically, they are composed of glands lined by normal epithelium with a well-differentiated stroma.

The glands tend to dilate cystically because of the obstructed flow of mucus, hence the other name of “retention polyp”.
Have no malignant potential.
Term
Neoplastic polpys are:
Definition
are composed of neoplastic epithelium that shows no evidence of normal differentiation
Term
Neoplastic Polyps are classified as:
Definition
Tubular,(Begnin) Tubulovillous(middle road) and Villous Adenomas.(Worst)
Term
These polyps can lead to adenocarcinoma:
Definition

 

Tubular adenoma: the risk is about 20%

-Tubulovillous adenoma: the risk is 30-35%

-Villous adenoma: the risk is over 50%

Term
Common to Benign Neoplastic Polyps are:
Definition

 

1.  Their incidence increases with age.

 2.  They are more common in males (2:1)

 3.  They are more often multiple.

 4.  Seventy percent (70%)of the large polyps are located in the rectosigmoid area.

Term
The most common benign tumor accounting for 75% of all neoplastic polyps are:
Definition
Tubluar Adenomas
Term
Tubular Adenomas occur:
Definition
 in any part of the intestine, small or large, but one half are located in the rectosigmoid area
Term
Tubular Adenomas are usually attached to the:
Definition
the mucosa by a stalk (pedunculated) and have a lobulated head.  Some can also be sessile.
Term
Tubular Adenoma histologically are lined by:
Definition

cuboidal epithelium with no obvious nuclear or cytoplasmic atypia.  Malignant transformation can be recognized by nuclear atypia, abnormal mitotic figures and the malignant glands are more crowded and show a back to back arrangement.

Invasive cancer can be detected by its tendency to invade the stalk.

 

Term
Tubulovillous Adenoma:
Definition

 Defined as predominantly tubular tumors that appear villous on at least 25% of their surface.

Tends to be sessile and larger than the typical tubular adenoma.
Histologically, the tumors contain tubular and villous elements, and malignant disease is found in 25-35% of tubulovillous adenomas.
Term
Villous Adenomas
Definition

BAD ONE:

 Sessile, large, broad-based tumors, composed of epithelial cells aligned into elongated villi.

These project into the lumen of the intestines, forming finger-like protrusions.
On gross examination, they have a velvety appearance, and most measure more than 2 cm in diameter.
Term
histologically Villous Adenoma is:
Definition

lined with a single cell type that does not show signs of differentiation.

Invasive carcinoma is found in over 50% of these tumors.  Because of their large size and broad-base, these tumors cannot be resected through an endoscope.  A segmental resection of the involved intestine is curative if performed before the malignant transformation takes place.

 

Term
Adenocarcinoma of the Colon:
Definition

 

Accounts for 95% of malignant tumors of the intestines, the remainder consisting of Lymphomas, Carcinoids, and Sarcomas.
Term
Adenocarcinoma of the colon is ___ times common in the large intestines than the small intestines.
Definition
50
Term
Tumors are 10 times more common in the US and western countries than in:
Definition
Asia and Africa
Term
What is the age for basline age for testing of Adenocarcinoma?
Definition
50 years
Term
45% of intestinal cancers develop in the rectosigmoid area, what other ares of the colon are affected:
Definition
24% Cecum, 15% tranverse colon, and 15% descending colon.
Term

Adeonocarcinoma of Rectosigmoid Colon likes to evade:

Patients have a constriction of rectus sigmoid will C/O:

Definition

Mucous and goes out and surrounds the colon.

 

Red blood, stool is thin and stringy pencil like.

Term
Adenocarcinoma of the Cecum tend to be more exophotroic but also called what type of lesion?
Definition
Califlower lesion
Term
Established invasive carcinoma can present itself as:
Definition
as mucosal plaques, ulcerations, or exophytic protruding masses.
Term
Tumors of the right side of the colon tend to grow:
Definition
Fungating masses or ulcerated, shallow like craters.
Term
Napkin Ring lesions:
Definition
Adenocarcinomas of the sigmoid and rectum tend to infiltrate the intestine circumferentially
Term

Because of long transit time what would you expect blood in the stool to look like.

 

Definition
Dark red, black, purple, tary = Melema more common on right sided lesions.
Term
What are the classifications of the Dukes colorectal cancer? 
Definition
Duke A, B, C, and D.
Term
Adenocarcinomas of the right side of the colon and cecum tend to be clincally silent producing only non-specific signs such as:
Definition
Weakness and Fatigue. Weakness is due to anemia due to chornic bloodloss with dark red feces (melena) may cause the anemia.
Term
A positive tests for occult blood in the feces predicts the presence of a cancer or an adenoma in:
Definition
40-50% of cases
Term
What diagnostic measures are used to detect / visualize Colon cancer.
Definition

 

colonoscopy or rectoscopy, X-ray studies combined with barium enema, and CT scans
The final diagnosis depends on the histologic examination of the tissue.
Term
What is the glycoprotein created by adenocarcinomas called:
Definition
CEA (carcinoembryonic antigen) normally produced by the fetal, but not the adult intestine.
Term
Colorectal cancer invades ____________ and initially involves the _______ immediately underling the tumor.
Definition
lympatic channels, lymph nodes.
Term
Venous invasion leads to metastasis going most commonly which organ first and then secondly.
Definition
Liver first and the lungs second.
Term
Which classification criteria is used today:
Definition
Astler-Coller Classification.
Term
Astler-Coller Classification is based on the:
Definition

Extent of local invasion and the presence of lymph node metastasis (stages A to C) and distant visceral metastaes (stage D).

Similar to Dukes ( Stages A to D also) but has numeral subtypes based on the extent of tumor or lymp node metastasis.

Term
Astler-Coller System:
Definition

Stage A:  Tumor confined to the mucosa.

Stage B1:  Extending into the muscularis propria but not penetrating through it; uninvolved nodes.
Stage B2:  Penetrating through the muscularis propria; uninvolved nodes.
Stage C1:  Extending into the muscularis propria, but not penetrating through it; involved nodes.
Stage C2:  Penetrating through the muscularis propria; involved node.
Stage D:  Distant metastatic spread (liver, lungs).
Term
Dukes Classification:
Definition

 

Dukes A: (15%) Confined to the bowel wall and does not penetrate into the muscularis propria.
Dukes B: (40%) Tumor has penetrated the muscle wall and pericolic fat, but does not involve the lymph nodes.
Dukes C: (25%) Stage B with Lymph node mets
Dukes D: (20%) signifies distant metastases.
Term
Prognosis Based on Stage:
Definition

 

Patients with Stage A are usually cured by surgical resection with an 85% 5 yr survival
Patients with Stage B cancers overall have about a 60% 5 year survival.
Patients with Stage C overall, have a 40% 5 year survival.
Patients with disseminated disease (Stage D) have about a 5% 5 year survival rate.
Supporting users have an ad free experience!