Genes and Cancers

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In This post I will be adding most commonly associated genetic abnormalities and changes

MEN2 syndrome is caused by gain of function mutations in the RET  gene.

Li-Fraumeni syndrome is associated with mutation of P53.

Mutations in p16 is associated with melanomas, pancreas, esophagus, head and neck, stomach, breast, and colon.

BRCA1 is associated with breast and ovarian carcinoma. 

Gold Standard Investigations in GI Surgery and Onco Surgery

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Esophagus

Ambulatory pH monitoring is the gold standard for the diagnosis of GER. ( SKF 61)

Esophageal high-resolution manometry (HRM) is currently the gold standard for the evaluation of esophageal motility ( SKF 11)

The current gold standard for the operative treatment of GERD is the laparoscopic Nissen fundoplication. ( SKF 234)

Gastrinoma diagnosis

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Q) Gastrinoma false is (AIIMS GI 2020) 
a) Fasting serum gastrin levels are  1000 g/ml
b) Duodenotomy should be done in all cases
c) Diarrhea most common symptom
d) SRS can localize 80% cases

Ans  )  c -

Duodenotomy detects 25% to 30% of tumors not seen on preoperative imaging.

Gastrin  levels higher than 1000 pg/mL are strongly suggestive of gastrinoma, provided that the patient demonstrated increased gastric acid  secretion ( gastric secretion ph should be less than 2) 

Most common is abdominal pain ( 75%) In 10% to 20% of patients, diarrhea is the only symptom

 Saby page 954) 

SRS should be performed because almost all gastrinomas express somatostatin receptors.

2nd primary tumors

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Q) In buccal mucosa cancer after surgery and CRT, after 2 year patient developed cancer at base of tongue with N3 nodes positive. Best line of management

A Palliative RT
B. CTRT
c. Rehabilitation
D.  Surgery followed CTRT

There are two parts to this questions 

a) Second Primary tumor (SPM)

b) Management of Base of tongue tumors with N3

Both are discussed here ---