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
Indication for nivo in metastatic esophageal squam per boards
irrespective of CPS
