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FRCR CO2A > GALL BLADDER AND BILIARY TREE CANCERS FRCR CO2A > Flashcards

GALL BLADDER AND BILIARY TREE CANCERS FRCR CO2A Flashcards

1
Q

MOST COMMON TYPE

A

ADENOCARCINOMA 80 %

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2
Q

MALE: FEMALE RATIO

A

2:3 (GB)
1: 1 (CHOLANGIOCARCINOMA)

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3
Q

DISTRIBUTION OF CANCERS

A

GB 40%
CHOLANGIOCARCINOMA 43 % (INTRA AND EXTRAHEPATIC)
PERIAMPULLARY 13 %
OTHERS 4 %

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4
Q

RFs for Ca GB

A

obesity

gallstones, > 3 cm

polyps

chronic typhoid and paratyphoid carriers

ulcerative colitis

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5
Q

RFs for cholangiocarcinoma

A

primary sclerosing cholangitis (10 %)
clonorchis sinensis

Polycystic liver disease, gall stones
caroli’s disease

chemicals like aflatoxins, vinyl chloride, methylene chloride

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6
Q

what is caroli’s disease

A

rare congenital disease of multiple saccular dilations of the intrahepatic bile ducts

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7
Q

commonest presentation

A

obstructive jaundice (GB, bile duct):

Fluctuating jaundice (periampullary carcinoma)

wt loss, anorexia, fatiguability

Hepatomegaly, RUQ pain

palpable non tender GB

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8
Q

Bismuth classification for perihilar tumors

A

type I : below confluence of rt and lt ducts

type II: confined to confluence

type III: extension into right or left heaptic ducts

type IV: extension into right and left hepatic ducts or multcentric

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9
Q

imaging for biliary tree cancers

A
  1. USG (IHBD)
  2. CT scan (regiona LNS) and metastasis
  3. ERCP and PTBD
  4. EUS
  5. Laparoscopoy rules out peritoneal mets before curative surgery
  6. MRI , MRCP
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10
Q

curative Rx

A

Surgery but only 20 % pts have resectable tumor at presentation

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11
Q

Sx for Ca Gb

A

radical cholecystectomy

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12
Q

radical cholecystectomy includes removal of:

A

nodal dissection and excision of adjacent liver tissue

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13
Q

surgical options for bile tree cancers

A

Bile Duct
1. Bismuth I and II: en bloc resection of the bile duct, gb, LNs, Roux-enxY hepatico-jejunostomy

  1. Bismuth III: as above and right or left hemi hepatectomy
  2. Bismuth IV: as above and exxtended right or left hemi hepatectomy
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14
Q

lower third bile duct cance surgeries

A

Pancreatico-duodenectomy

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15
Q

intrahepatic cholangiocarcinoma Surgery

A

resectio of involved segments/lobes

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16
Q

Adjuvant chemo for Ca Gb T1aN0 NCCN 2025

A

observation

17
Q

Adjuvant chemo for Ca Gb >T1aN0 NCCN 2025

A

Capecitabine
Gem Capecitabine
Gem Cisplatin

18
Q

M1 Ca Gb or un-resectable, systemic therapies
NCCN 2025

A

Durvalumab + gemcitabine + cisplatin
(category 1)

  • Pembrolizumab + gemcitabine + cisplatin
    (category 1)

others
Gemcitabine + cisplatin (category 1)
* Capecitabine + oxaliplatin
* FOLFOX
* Gemcitabine + albumin-bound paclitaxel
* Gemcitabine + capecitabine
* Gemcitabine + oxaliplatin
* Single agents:
5-fluorouracil
Capecitabine
Gemcitabine

19
Q

molecular therapy for metastatic disease

A

as per mutation

20
Q

MSI-H/dMMR tumors:

A

Pembrolizumab

21
Q

NTRK gene fusion-positive tumors

A

Entrectinib13,14
Larotrectinib15
Repotrectinib

22
Q

TMB-H tumors:

A

Nivolumab + ipilimumabg,h,o,21
Pembrolizumabg,h,l,1

23
Q

BRAF V600E-mutated tumors

A

Dabrafenib + trametinib

24
Q

CCA with FGFR2 fusions or rearrangements

A

Futibatinib28
Pemigatinib29
Erdafitinib

25
Q

CCA with IDH1 mutations

A

Ivosidenib (category 1)3

26
Q
  • For HER2-positive tumors:
A

Fam-trastuzumab deruxtecan-nxki (IHC3+)

Trastuzumab + pertuzumab (IHC3+/ISH+/NGS amplification)

Tucatinib + trastuzumab (IHC3+/ISH+/NGS amplification)35
Zanidatamab

27
Q

RET gene fusion-positive tumors:

A

Selpercatinib
Pralsetinib (category 2B)

28
Q
  • For KRAS G12C mutation-positive tumors:
29
Q

1 yr and 5 yr survival in biliary tract cancers

A

22 % and 5 to 10 %

30
Q

factors a/w poor prognosis in biliary tract cancers?

A
  1. LN mets
  2. PNI
  3. Margin +
  4. perihilar tumors

FRCR CO2A (35 decks)

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