The NCCPA™ Gastroenterology and Nutrition PANCE Content Blueprint gastrointestinal system neoplasms (PEARLS)
Esophageal Neoplasms | Patient will present as → a 62-year-old man with a history of alcoholism who complains of difficulty swallowing solids that has progressed to difficulty swallowing liquids. He has smoked 1-2 packs of cigarettes per day for the past 38 years. In addition, he reports occasional bouts of hematemesis and hoarseness, along with progressive weight loss and weakness. Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis
Adenocarcinoma:
Squamous cell:
DX: endoscopy + biopsy TX: Resection |
Gastric Neoplasms | Patient will present as → a 68-year-old man, who presents to your clinic with complaints of fatigue, loss of appetite, and abdominal pain/fullness. He reports a 15-pound weight loss over the last three months. Vital signs are within normal limits. On exam, you discover a firm, enlarged painless lymph node above the patient’s left clavicle. Upon further questioning, the patient reports the node has been present for the past 2 months. His stool is Guaiac positive Abdominal pain and unexplained weight loss are the most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool.
DX: upper endoscopy with biopsy; linitis plastica – diffuse thickening of stomach wall d/t cancer infiltration (worst type) Treatment: gastrectomy, XRT, chemo; poor prognosis |
Liver neoplasms (ReelDx) | ReelDx Virtual Rounds (Liver neoplasms)Patient will present as → a 52-year-old female with a history of cirrhosis secondary to long-standing alcohol abuse visits your office to discuss a 15-pound weight loss over the last 6 months. She reports early satiety, jaundice, and vague abdominal discomfort. Her ascites, generally stable and small, has worsened in the last 3 weeks. Abdominal pain, weight loss, right upper quadrant mass
DX:
TX: Resection, transplant - poor prognosis |
Pancreatic neoplasms (ReelDx) | ReelDx Virtual Rounds (Pancreatic neoplasms)Patient will present as → a 68-year-old smoker with a 25 lb weight loss over the last three months that is associated with a burning pain deep in the epigastrium after eating, diarrhea, and jaundice. Physical exam reveals a palpable non-tender gallbladder and clay-colored stool. Labs show total bilirubin of 8, alkaline phosphatase of 450, and an ALT of 150. Painless jaundice is pathognomonic
DX: Diagnose with abdominal CT scan - 75% show tumor at the head of the pancreas, 25% at the tail
Treatment: Whipple procedure: remove antrum of the stomach, part of the duodenum, head of pancreas, gallbladder |
Colon cancer | Patient will present as → a 65-year-old male with several months of weight loss, vague right upper quadrant pain, and thin-caliber stools. His medical history is notable for 50-pack-years of smoking and obesity. On exam, he appears chronically ill and has firm hepatomegaly. His labs reveal a hemoglobin of 10.7 g/dL and mildly elevated ALT and AST. Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age
Screening begins at 45 and continues until 75 y/o
Recommended intervals for colorectal cancer screening tests include
Selectively screen adults aged 76 to 85 years for colorectal cancer:
DX: Definitive diagnosis is with colonoscopy and biopsy, barium enema will classically show an "apple core lesion"
Treatment: Resect tumors and adjuvant chemotherapy |
Anorectal cancer | Patient will present as → a 69-year-old male who complains of rectal pruritus, bleeding with defecation, and a sensation of incomplete evacuation. A palpable mass is noted on digital rectal examination. Rectal bleeding + tenesmus (a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma
DX: Typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out TX: Treated with wide local surgical excision, radiation with chemotherapy for large tumors with metastases |