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GI Cancers/ksw

  1. The esophagus is divided into two sections called the _____ and the ______  and ____.Or, it can just be divided into the upper 1/3, middle 1/3 and lower 1/3.
    cervical and thoracic esophagus
  2. The esophagus is about _____cm long and starts at the base of the pharynx at level ______.
    25, C6
  3. The esophagus penetrates the diaphragm through an oopening called the _________ and is in close proximity to the ______ and the trachea.
    esophageal hiatus, aorta
  4. Lymphatic drainage of the esophagus is unpredictable so routes of spread are not ________. Spreads in a longitudinal fashion and _____ _____ are present at a significant distance from primary lesion. A distance of as much as ____ cm of normal esophagus may be interposed between the site of gross tumor and lymphatic metastasis. SUBMUCOSAL SPREAD
    orderly, skip lesions, 8
  5. Site of  a esophageal lesion is measured from the _______.
    incisors
  6. The junction between the esophagus and the stomach is called the _______________.
    GE junction (sometimes EG junction) for gastroesophageal junction
  7. ___%  of all cancers and _____%  of all cancer deaths in the US ar esophageal cancer.
    1%, 2%
  8. Esophageal Cancer:
    Men are __ to _____ times more affected than women.
    3, 4
  9. Are men or women more likely to get esophageal cancer?
    Men are 3-4 times more likely than women.
  10. African Americans have a  ___% her rate of esophageal cancer than whites.
    50%
  11. Are African Americans or whites more likely to get esophagel cancer?
    African Americans have a 50% higher rate
  12. Average age of diagnoses for esophageal cancer is ______.
    55-85 years old
  13. What countires havw a higher rate of esophageal cancer and why?
    N. China, N. Iran, & S. Africa   due to diet
  14. Esophageal cancer spreads locally and creates ______ and ______ fistulas.
    • trachoesophageal, bronchoesophageal
    • (passageways between trachea&esophagus, and bronchus&esophagus)
  15. The most likely place for esophageal cancer to metastasize to is the ________, as well as spreading to the ____, ____, ________, and ________.
    liver,lung, bone, adrenals, brain
  16. Most common pathology for esophageal cancer is ________.  In the lower third and the GE junction, however, ________, is the most likely pathology.
    squamous cell(for the upper two thirds), adenocarcinoma
  17. Staging for esophageal cancer is based on the TNM system on _______ outward
    extension.
  18. 5 year survival rate for esophageal cancer is ________.
    5 %
  19. What are the clinical presentations of esophageal cancer?
    • 1)žDysphagia(difficulty swallowing) and weight loss
    • 2)žChest pain
    • 3)Regurgitation and aspiration
    • 4)Odynophagia (severe pain on swallowing due)
    • 5)Hematemesis (vomiting blood.)
    • 6)Coughing
      7)žHoarseness
    • 8)hemoptysis (coughing up of blood).
  20. Treatment techniques for esophageal cancer is a ______ _______ approach. Surgery is reserved for ___________ only. Complications from surgery include:______________.
    • multimodality , middle and lower third
    • anastomotic leaks(leaks where two tubes are connected), PE, MI, strictures, GE reflux
  21. Chemotherapy fro esophageal cancer is used in conjuction with radiation therapy for better local control and distamt metastatic disease. Chemo drugs include: ______ & ______.
    5FU, and Cisplastin
  22. Most esophageal cancers are located in the _____ _______(______%)  ______% are in the _____ third and _______% in the _______third.
    • MIDDLE THIRD(40-50%), 25-50% lower third,
    • 10-25% upper third (which is a good thing because upper third lesions aren't resectable)




    ž
  23. Detection of esophageal cancer by barium swallow with __________, _________, and ____________.
    X-ray,Pet/Ct and Esophagoscopy
  24. Radiation therapy for esophageal cancer has a _____ cm border superior and inferior, and ____cm laterally.  The fields are very ______ and beams are ___ ______.
    5cm, 2-3cm, large,  AP PA
  25. Esophageal CA of the upper third are treated with a field that begins at the level of the ____ _____ and ends at the level of the _______ to include_____nodes, _____ ____ _____nodes, and _______ nodes.
    thyroid cartilage, carina, scv nodes, lower anterior cervical nodes, mediastinal nodes
  26. Esophageal lesions of the lower third are treated  with fields that include the ________ nodes a nd the ______ axis.
    mediastinal nodes, celiac axis
  27. Esophageal lesions of the middle third include __________ and ________ nodes
    perioesophageal and mediastinal nodes
  28. Radiation dose for esophageal cancer without chemo is ______ and with chemo________. Critical sturctures include the ______, _____, _______.
    • 6500cGy(3600-4500 offcord)
    • 5040cGy(3600-4500 offchord)
    • lungs, heart, cord

    • *Technique described in book is to treat AP-PA to 30-40 Gy and then boost using  2 posterior obliques to spare the cord(3 field technique)
    • Alos, laterals or IMRT can be used
  29. What is the three field radiation therapy technique for esophageal cancer?
    Treat AP to 4000 cGy then 2 posterior obliques to 6500
  30. How is an esophageal ca patient positioned for RT ?
    • Supine with arms by side or over head(do not treat through arms)
    • or
    • Prone with arms over head(patients complain more and it's not as stable a position)
  31. RT for esophageal ca side effects:
    • #1)ESOPHAGITIS(usually after treatment)
    • 2)ulceration of the esophagus
    • 3)Decreased blood counts(BECAUSE IT'S A BIG FIELD)
    • 4)radiation pneumonitis
    • 5)perforation of the esophageal-trachea wall
    • 6)strictures
    • 7)TRANSVERSE MYELITIS
    • 8)Pericarditis
  32. Where is the  stomach ?
    under the diaphragm in the upper LEFT hand portion of the abdominal cavity.
  33. The stomach is divided into the ______, _______,______, and ________ portions.
    cardia, fundic, body, and pyloric
  34. The _____ portion of the stomach is the small portion near the esophageal opening.  The _______region, which balloons above the cardiac portion, acts as a temporary storage area and sometimes becomes filled with air. The dilated ____ region is the main part of the stomach and is loacated beween the fundic and the ______ portions. The _______ region narrows and becomes the _______ canal as it approaces the junction with the small intestine.  The stomach is _____ shaped.
    cardiac, fundic, body, pyloric, pyloric, pyloric, J
  35. What is the part of the stomach cloasest to the esophagus?
    the cardiac region
  36. What is the main part of the stomach that is located beween the fundic and the phyloric portions?
    body
  37. What is the part of the stomach closest to the small intestine?
    the pyloric canal of the pyloric region
  38. What is the valve that prevents  regurgitation of food from the small intestine back into the stomach?
    The powerful circular muscle called the pyloric sphincter
  39. What are the folds in the stomach that disappear when the stomach is full?
    rugae
  40. The stomach's main function is to mix the food into a paste called _______. One important digestive enzyme in the stomach is _________.  __________ waves push the ______ a little at a time towards the pyloric sphincter which begins to relax and allow it to move little at a time into the __________ where most of the actual digestion and absorption  of digestive products occurs.
    chyme, pepsin, peristalic, chyme, small intstine
  41. The curve at the top of the stomach is called the _____ _____, and the larger curve and the bottom is called the _________.
    lesser curve, greater curve
  42. The accessory organs that add their secretions to the chyme are the________,__________, and __________.
    pancreas, liver, gallbladder
  43. identify the structure at the red dot

    Image Upload 1
    right colic flexure
  44. identify the structure at the red dot

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    ascending colon
  45. identify the structure at the red dot

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    cecum
  46. identify the structure at the red dot

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    transverse colon
  47. identify the structure at the red dot

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    descending colon
  48. identify the structure at the red dot

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    jejunum
  49. identify the structure at the red dot
  50. Duodenum
    • C shaped
    • divided into 4 parts
  51. 1st part of duodenum
    • superior
    • runs upwards and backwards on right side of L1
  52. 2nd part of duodenum
    • descending
    • runs vertically downward along right side of L1-L3
  53. 3rd part of duodenum
    • inferior
    • runs horizontally in front of L3
  54. 4th part of duodenum ascendingruns upwards and to the left and ends at the duodenojejunal flexure
    • ascending
    • runs upwards and to the left and ends at the duodenojejunal flexure
  55. Identify the structure in red dot

    Image Upload 7
    major duodenal papillae
  56. Identify the structure in red dot

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    pancreosplenic nodes
  57. Identify the structure in red dot

    Image Upload 9
    CELIAC AXIS LYMPH NODES
  58. Identify the structure in red dot

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    SUPERIOR MESENTERIC LYMPH NODES
  59. Identify the structure in red dot

    Image Upload 11
    pancreatico-duodenal lymph nodes
  60. Identify the structure in red dot

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    DUODENUM
  61. Identify the structure in red dot

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    JEJUNUM
  62. Identify the structure in red dot

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    ILIUM
  63. Identify the structure in red dot

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    superior mesenteric lymph nodes
  64. Identify the structure in red dot

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    mesenteric lymph nodes
  65. Identify the structure in red dot

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    CECUM
  66. Identify the structure in red dot

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    APPENDIX
  67. Identify the structure in red dot

    Image Upload 19
    ASCENDING COLON
  68. Identify the structure in red dot

    Image Upload 20
    TRANSVERSE COLON
  69. Identify the structure in red dot

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    DESCENDING COLON
  70. Identify the structure in red dot

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    SIGMOID COLON
  71. Identify the structure in red dot

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    RECTUM
  72. Identify the structure in red dot

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    ANAL CANAL
  73. Identify the structure in red dot

    Image Upload 25
    • R & L colic flexures
    • R: aka heptic flexure
    • L: aka spleenic flexure
  74. Identify the structure in red dot

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    DENTATE LINE (pectonate)

    • Above the dentate line:  columnar epithelium and adenocarcinoma
    • Below the line: squamous cell carcinoma
    • *Candice's memory aid :)  "poop is coming down the "column" and once it goes thru the "gate" ( dentate) it comes out and makes you squeamish (squamous)"
    • THANKS CANDICE!!
  75. Identify the structure in red dot:

    Image Upload 27
    AORTA
  76. Peyer's patches are _______ _______ follicles present in the mucous membrane of the lower _____ along the anti mesenteric border
    • lymphoid follicles
    • ileum
  77. Large intestine extend form the ileum to anus & divides into 8 parts:
    • cecum
    • appendix
    • ascending colon
    • transverse colon
    • descending colon
    • sigomoid colon
    • rectum
    • anal canal
  78. Ascending colon:
    • extends upward from cecum to the inferior surface of the R lobe of the liver ends at R colic flexure
    • retroperitoneal
  79. Ascending colon:
    extends across abdomen occupying the umbilical region hangs downward on pancreas
  80. Descending colon:
    • extends form L colic flexure to pelvic brim
    • retroperitoneal
  81. Sigmoid colon:
    • extends from pelvic brim to front of S3
    • attached to posterior abdominal wall by sigmoid mesocolon
  82. Rectum:
    • beings in front of S3 and ends 1 inch in front of tip of coccyxouter
    • longitudinal muscle surrounds entire circumference of rectum
  83. Rectum lymph drainage:
    inferior half internal iliac lymph nodes
  84. 3 part of the small intestine:
    • duodenum
    • jejunum
    • ileum
  85. Duodenum lymphatic drainage:
    drains to the pancreatoduodenal nodes then to the celiac nodes and superior mesenteric nodes
  86. Jejunum & Ileum:
    • freely mobile
    • attached to posterior abdominal wall of mesentery of small intestine
  87. Jejunum and ileum lymph drainage:
    mesenteric nodes then superior mesenteric nodes to intestinal lymph trunk to cisterna chyli
  88. Cecum lymph drainage:
    • mesenteric nodes to
    • superior mesenteric nodes
  89. Rectum beings in front of_____ and ends 1 inch in front of tip of _______. Outer longitudinal muscle surrounds entire circumference of rectum.
    S3, coccyx
  90. Rectum lymph drainage:
    • superior half pararectal lymph nodes to
    • inferior mesenteric nodes
  91. Rectum lymph drainage inferior half:
    internal iliac lymph nodes
  92. The anal canal has involuntary _________ sphincter and a voluntary _____ sphincter
    internal, external
  93. Anal canal lymph drainage:
    upper half internal iliac nodes
  94. anal canal lymph drainage:
    lower half superficial inguinal nodes
  95.  Looking at the picture below to help answer the following questions: Another name for the tracheal bifurcation is the _______. The place where the esophagus enters the stomach is called the _______. The place where the aorta makes a U turn is called the ______ ______.  What is the large vein that corresponds to the aorta called which is near the esophagus? Why do you think trachoesophageal and bronchoesophageal fistulas can be a side effect of radiation therapy from esophageal cancer?
    Image Upload 28
    • carina, gastresophageal junction or esophageal gastric junction(GE or EG junction), aortic arch, pu
    • lmonary trunk, The esophageal tumor may be blocking a passageway(fistula), and as it is shrunk by radiation it now longer blocks the place where it was, which leaves a fistula. The fistulas are likely to be formed between the esophagus and trachea or bronchus because they are so close together in the chest.
  96. What are the causes(etiology) of esophageal ca?
    • 1)alcohol and tobacco use
    • 2) chemical exposure
    • 3) Barrett's esophagus(GERD changes lower 1/3 of esophagus from squamous to columnar epithelium which makes it more supceptible to adenocarcinoma)
    • 4) Achalasia(lower 2/3 loses normal peristalic activity
    • 5)Plummer-vision Syndrome(iron deficient anemia)
  97. What kind of cells line the GI tract?
    • The esophagus is lined with squamous cells (except there can be columnar epithelium in the lower 1/3 with Barrett's esophagus.) After that it's
    • columnar epithelium from the stomach until the dentate line in the anal canal where it turns back to squamous cell again.
    • Squamous is squamous cell carcinoma and columnar is adenocarcinoma.
    • Candice's memory trick for the dentate line: "poop is coming down the "column" and once it goes thru the "gate" ( dentate) it comes out and makes you squeamish (squamous)"
  98. Name the structure at the red dot:

    Image Upload 29
    greater curvature
  99. Name the structure at the red dot:

    Image Upload 30
    fundus
  100. Name the structure at the red dot:

    Image Upload 31
    lesser curvature
  101. Name the structure at the red dot:

    Image Upload 32
    fundus
  102. Name the structure at the red dot:

    Image Upload 33
    body(of stomach)
  103. Name the structure at the red dot:

    Image Upload 34
    pylorus
  104. __% of lesions are found in the distal portion, __% in the cardiac region,__% in the greater curvature, and ____% in the entire stomach.
    50%(distal), 25%(cardia), 5%(greater curvature), 10-15%(entire stomach)
  105. Stomach ca incidence is  greater in which ountries other than the US?
    Japan, Chili, Iceland
  106. Stomach ca incidence is higher in which ethnic groups?
    African Americans & Native Americans
  107. Is stomach ca more common in men or women?
    men- 2:1
  108. Peak age for stomach ca is_________.
    50-70
  109. What is the pathology of most stomach cancers?

    (*hint-think about what kind of cells line the stomach)
    • ADENOCARCINOMA(stomach is lined with columnar epithelium)
    • REMEMBER:The esophagus is lined with squamous cells (except there can be columnar epithelium in the lower 1/3 with Barrett's esophagus.) After that it's columnar epithelium from the stomach until the dentate line in the anal canal where it turns back to squamous cell again. (Squamous is squamous
    • cell carcinoma and columnar is adenocarcinoma.)
    • Besides Candice's memory trick "poop is coming down the "column" and once it goes thru the "gate" ( dentate) it comes out and makes you squeamish (squamous)"
    • I like to remember that the cells are "squishy at the top and bottom"(the esophagus and below the dentate line is squamous cell epithelium).
  110. What are the causes(etiology) of stomach cancer?
    • 1)diet (esp. red meat)
    • 2) coal mining
    • 3) Blood type "A"
    • 4) Rubber working
    • 5)Asbestos exposure
    • 6)Gastric ulcers/polyps
    • 7)Alcohol/tobaco
    • 8)Poor nutrition
    • 9)Inadequate sanitation of consumables
    • 10) H. pylori (a bacteria)
  111. What are the symptoms of stomach cancer?
    • 1)persistent indigestion
    • 2)Epigastric pain or distress
    • 3)Loss of appetite
    • 4)N&V
    • 5)Dsyphagia(difficulty swallowing)- she had dysphasia(which means difficulty speaking)  on the PP but I think it was a typo)
    • 6)Jaundice(from liver mets)
    • 7)Abdominal mass or bloating(from ascites fro liver mets)
  112. How are stomach tumors diagnosed?
    • 1)physical exam
    • 2)Upper GI series
    • 3)CT
    • 4)endoscopy
  113. After stomach cancer has been diagnosed, a workup to discover the pathology and extent of the disease includes the following tests:
    • 1)CBC(to check for anemia)
    • 2)Guaiac stool test
    • 3)upper GI
    • 4)Endoscopy with biopsy
    • 5)CT scan of chest and abdomen
    • 6)Laparoscopy
  114. Staging of stomach cancer is with the ______system. _____ of patients have distant mets at diagnoses. Spread can occur through the lymphatics including the splenic, celiac and hepatic nodes. Direct spread can occur to the  bowel, _____, _____, ______, and regional nodes. Spread throught the blood to the _____ most often and also the ______.
    • TNM, 1/3,
    • (direct spread): omenta, pancreas, colon
    • LIVER, lungs
  115. 5 year survival rate from stomach cancer is _____%.
    10%
  116. The treatment of choice for stomach cancer if no mets are present is __________. Complications include: _________.Chemotherapy is used __________.
    • surgery.
    • COMPLICATIONS:#1 ANASTAMOSIS LEAK(when two tubes are reconnected and they leak), infection, hemorrhage, anemia,and PE

    in combination with radiation therapy
  117. Radiation therapy fields for stomach cancer are ______ and extend from ____to ______ including ____ and regional lymph nodes.
    • AP/PA
    • diaphragm to L3 including duodenal loop(and regional lymph nodes)
  118. Stomach cancer radition therapy doses are:
    ______ cGy  for curative.
    ______cGy for palliative
    ______cGy  for Gastric Lymphomas
    • Curative: 5000-5500 cGy
    • Palliative: 3500-4000 cGy
    • Gastric Lymphoma: 4000 cGy   (Lymphomas are more radiosensitive)
  119. Side effects to radiation therapy for stomach cancer include:
    • 1)ulcers
    • 2)fistula
    • 3)decreased blood count
    • 4)bowel obstruction
    • 5) transverse myelitis
  120.  RT for stomach cancer includes which critical structures?
    kidneys, liver, bowel, cord
  121. This is a portal for treating what kind of cancer?

    Image Upload 35
    stomach cancer
  122. Small intestine cancer is a rare form of cancer and is not treated with radiation therapy because ______________.
    Tumors are usually located in the ______ or the first few ______ loops. ______  50% of the lesions are ________.
    • it's always moving. duodenum, jujunal
    • Adenocarcinoma

    (the rest are lymphoma, carcinoids, and sarcomas)
  123.  The small intestine absorbs food nutrients through finger like ______.
    villa
  124. žTumors of the small intestine  are usually
    discovered via____________________, and symptoms  of small intestine cancer include:_____________.


    upper GI and small bowel follow through or endoscopy

    Obstruction, rectal bleeding, weight loss, weakness, bloating, abdominal pain, N&V, fever, or change in bowel habits
  125. Disorders that predispose towards small bowel cancer  include:

    polyposis, Crohn disease, and Gardner syndrome
  126. Small intestine cancer can spread via direct extension, lymph or blood system to the _____, ______, and _______.
    LIVER, lungs, and bone
  127. Treatment option for small bowel cancer includes surgery and chemo(with _____), but NOT radiation therapy due to the motion of the organ and _____________. The 5 year survivval rate for small bowel cancer is < __%.
    • 5FU
    • bowel sensitivity(the small intestine is extremely sensitive to radiation)
    • 20%
  128. Colon cancer is žranked ___ in the US for men
    and women in incidence and ____ for overall death rate. žPeak age is ___ or older and _____ lesions are most common.
    • 3rd
    • 2nd
    • 50
    • Rectal
  129. Causes of colon cancer include:
    • diet high in fat and low in fiber
    • obesity
    • smoking
    • alcohol  
    • minimal physical activity
    • familial polyposis
    • chronic ulcerative colitis
  130. Symptoms of colon cancer include:
    • Blood in stool
    • žRectal bleeding (hematochezia)
    • žChange in bowel habits
    • žPencil stools
    • žTenesmus (ineffectual and painful straining for an extended time)
    • žN & V
    • Obstruction
  131. Colon cancer is detected via _______, ______ and ____________.

    ž______ _____ and ___________ determines the size, mobility, location from the anal verge, and rectal wall involved.

    Chest X-ray, ž______, ____, ______, and _________, are done to evaluate metastatic disease

    žCEA (carcinoembryonic antigen)  is a _____ _______.
    physical exam, radiographic and endoscopic studies

    Digital exam, proctosigmoidoscopy

    •  CT, MRI, Pet/CT, Lab studies,
    • tumor marker
Author
RadTherapy
ID
181015
Card Set
GI Cancers/ksw
Description
GI Cancers ksw
Updated

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