PANCE Blueprint GI and Nutrition (9%)

Gastrointestinal System Neoplasms (PEARLS)

Esophageal Neoplasms Progressive dysphagia to solid foods along with weight loss, reflux, and hematemesis

  • Squamous cell m/c worldwide and adenocarcinoma common in the US

Adenocarcinoma:

  • Complication of Barrett's esophagus (screen Barrett's patients every 3-5 years with endoscopy), affects distal (lower) 1/3rd of the esophagus

Squamous cell:

  • Associated with smoking and alcohol use
  • Affects proximal (upper) 2/3rds of the esophagus
  • Progressive dysphagia, weight loss, hoarseness
  • Diagnostic studies: Endoscopy + biopsy
  • Treatment: Resection
 Gastric Neoplasms Abdominal pain and unexplained weight loss are most common symptoms along with reduced appetite, anorexia, dyspepsia, early satiety, nausea and vomiting, anemia, melena, guaiac-positive stool.

  • Gastric adenocarcinoma in most cases worldwide
  • Virchow's node (Supraclavicular) (view image)
  • Sister Mary Joseph's node (Umbilical) (view image)
Liver neoplasms (ReelDx) Abdominal pain, weight loss, right upper quadrant mass

Etiology: Cirrhosis, Hepatitis B, Hepatitis C, Hepatitis D, Aflatoxin from Aspergillus

  • Tumor Marker: ↑ alpha-fetoprotein and abnormal liver imaging

Treatment: Resection, Transplant - Poor prognosis

Pancreatic neoplasms (ReelDx) Painless jaundice is pathognomonic

  • Most commonly ductal adenocarcinoma located at pancreatic head
  • Presentation:
    • Jaundice and palpable non-tender gallbladder (Courvoisier’s sign)
    • Trousseau sign of malignancy - migratory phlebitis
    • Virchow's node (or signal node) is a lymph node in the left supraclavicular fossa (the area above the left clavicle) that is associated with pancreatic cancer
  • Diagnose with abdominal CT scan - 75% show tumor at the head of the pancreas, 25% at the tail
  • Tumor Marker: CA 19-9

Treatment: Whipple procedure: remove antrum of stomach, part of duodenum, head of pancreas, gallbladder

Colon cancer Painless rectal bleeding and a change in bowel habits in a patient 50-80 years of age

Screening with colonoscopy begins at 50 then every 10 years until 75

  • Fecal occult blood testing – annually after age 50
  • Flexible sigmoidoscopy – every 5 years with FOB testing
  • Colonoscopy – every 10 years
  • CT colonography – every 5 years

Tumor Marker: CEA

  • More likely to be malignant: sessile, > 1 cm, villous
  • Less likely to be malignant: Pedunculated, < 1 cm, tubular

Treatment: Resect tumors and adjuvant chemotherapy

"Apple core" lesion on barium enema

"Apple core" lesion on barium enema

Anorectal cancer Rectal bleeding + tenesmus (a feeling of incomplete emptying after a bowel movement), the most common anorectal cancer is adenocarcinoma

  • Primarily adenocarcinomas.
  • Typically colonoscopy is done: whenever rectal bleeding occurs, even in patients with obvious hemorrhoids or known diverticular disease, coexisting cancer must be ruled out.
  • Treated with wide local surgical excision, radiation with chemotherapy for large tumors with mets.
Rickets (Prev Lesson)
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