esophageal/gastric Flashcards
high grade displasia esophagus Tx
RFA
esophageal approach
either period chemo followed by surgery or concurrent chemoRT +/- surgery
staging of esophageal
endoscopic US
T1 esophageal tumor
superficial not into submucosa–> endomucosal resection
T1b esophageal
submucosa: surgery
T2 or greater esophageal
need NA chemo
GEJ cancer treatment
preop chemo: magic trial ECF period, however multiple negative trials: meta-analysis Sjoquist Lancet 2011–> adeno had benefit with pre-op chemo. chemorad though likely better
cross trial
modern chemo carbo/taxol weekly well tolerated with concurrent rad 41.2Gy, 74% adenoma; R0 resection improved from 70-92%, OS 47 v. 34% 5-yr survival; benefit for both squamous and adeno. squamous path CR 49%!
SCC surgery?
data suggest that with surgery added to chemorad that OS is not benefited, maybe improved local control
gastric cancer causes
salted/smoked food, high nitrates, low fruits/vege, low selenium, Hpylori (30% of worlds gastric)
familial gastric cancer
CDH-1/E-cadherin, autosomal dominant, multifocal diffuse cancer, associated with lobular breast cancer; 75% penetrance
FAP
APC gene, autosomal dominant
HNPCC
MMR–> gastric, colon
gastric surgeries
D2- greater/lesser curve, celiac, splenic nodes, etc. D2 survival benefit (Dutch trial)
gastric adjuvant options
MAGIC approach, versus surgery and post-op 5-FU/RT, or post-op chemo with 1 year oral 5-FU following D2 resection
gastric cancer with surgery, ET
only 5-FU needed
metastatic gastric cancer therapies
modest benefit with chemo- cape=5-FU, 5-FU=oxali. then you can use FOLFOX; validated regimens are DCF/ECF–>reserve for younger pts, doublet regimens perform just as well. (epirubicin may not add any more based on FOLFIRI v. ECX)
DCF treatment for gastric
29% neutropenic fever, 3.6% toxic deaths, 21% stomatitis.
second line chemotherapy for gastric
docetaxel or docetaxel/
HER2 in esophagastric cancer
overexpressed in 10-25%. Test all pts ToGa trial: FC+T approved for FISH+ or IHC 3+
subsets of EGJ cancers by genes
genomically unstable (50%)-p53 mut, RTK amplification; 22%-MSI high, genomically stable-20%-diffuse histology CDH1/RHOA, 9% EBV associated- high PIK3CA, high PD-L1/2
ramicurimab - anti VEGF for gastric
approved for monotherapy for patients progressing on first-line therapy for gastric, or combined with paclitaxel for second line treatment
