Esophageal cancer Flashcards
RF’s for esophageal squam
- diet high in nitrites
- smoking, drinking
- esophageal webs
- zenker’s
RF’s for esophageal adeno
- GERD
- barret’s (esophageal *metaplasia)
- obesity
TIa
Invasion of muscularis mucosa (*Mucosa not propria) or lamina propria
TIa management
EMR
T1b management
Surgery alone with esophagectomy
T1b esophageal
submucosa invasion
Anatomic boundary that defines squamous esophageal cancers as unresectable
Upper - Above aortic bifurcation (CONFIRM)
Perioperative systemic therapy options for gastric
- FLOT
- ECF (Magic) also an option but not used anymore
Adjuvant management of gastric patient undergoing upfront surgery
- IF D1 dissection (inadequate) → postoperative CRT + chemo (Sandwich)
- IF D2-D3 dissection (adequate lymphadenectomy) →
IF node negative,
IF T2NO
IF low risk, observation
IF high risk (hig grade, LVI, PNI), adjuvant chemo for 6 months
IF T3 or higher, Node negative, chemo alone
mFOLFOX for 6 months (Preferred)
CAPOX for 6 months (CLASSIC)
If node positive disease, chemoradiotherapy + chemo
2 cycles mFOLFOX vs. FLOT
then continuous 5 Fu-based chemoradiation (CALGB 80101)
then 4 additional cycles of mFOLFOX vs. FLOT
Lymph node boundary for nonregional in esophageal
Distal to celiac axis
CPS threshold for addition of immunotherapy in esophageal squam and adenocarcinoma
- squam is >1
- adeno is >5
Role for IO in esophageal
- First line
- IF not received first line, second line
Resectable esophageal cancer in terms of T staging
T2-T4a
Last line treatment for metastatic GEJ adeno
Lonsurf
Next step after T3N0 disease diagnosed for gastric cancer
Laparoscopic peritoneal evaluation
