esophageal/gastric

Question 1

high grade displasia esophagus Tx

Answer 1

RFA

Question 2

esophageal approach

Answer 2

either period chemo followed by surgery or concurrent chemoRT +/- surgery

Question 3

staging of esophageal

Answer 3

endoscopic US

Question 4

T1 esophageal tumor

Answer 4

superficial not into submucosa–> endomucosal resection

Question 5

T1b esophageal

Answer 5

submucosa: surgery

Question 6

T2 or greater esophageal

Answer 6

need NA chemo

Question 7

GEJ cancer treatment

Answer 7

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

Question 8

cross trial

Answer 8

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%!

Question 9

SCC surgery?

Answer 9

data suggest that with surgery added to chemorad that OS is not benefited, maybe improved local control

Question 10

gastric cancer causes

Answer 10

salted/smoked food, high nitrates, low fruits/vege, low selenium, Hpylori (30% of worlds gastric)

Question 11

familial gastric cancer

Answer 11

CDH-1/E-cadherin, autosomal dominant, multifocal diffuse cancer, associated with lobular breast cancer; 75% penetrance

Question 12

FAP

Answer 12

APC gene, autosomal dominant

Question 13

HNPCC

Answer 13

MMR–> gastric, colon

Question 14

gastric surgeries

Answer 14

D2- greater/lesser curve, celiac, splenic nodes, etc. D2 survival benefit (Dutch trial)

Question 15

gastric adjuvant options

Answer 15

MAGIC approach, versus surgery and post-op 5-FU/RT, or post-op chemo with 1 year oral 5-FU following D2 resection

Question 16

gastric cancer with surgery, ET

Answer 16

only 5-FU needed

Question 17

metastatic gastric cancer therapies

Answer 17

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)

Question 18

DCF treatment for gastric

Answer 18

29% neutropenic fever, 3.6% toxic deaths, 21% stomatitis.

Question 19

second line chemotherapy for gastric

Answer 19

docetaxel or docetaxel/

Question 20

HER2 in esophagastric cancer

Answer 20

overexpressed in 10-25%. Test all pts ToGa trial: FC+T approved for FISH+ or IHC 3+

Question 21

subsets of EGJ cancers by genes

Answer 21

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

Question 22

ramicurimab - anti VEGF for gastric

Answer 22

approved for monotherapy for patients progressing on first-line therapy for gastric, or combined with paclitaxel for second line treatment