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Gastric Cancer Flashcards

1
Q

T1 - GASTRIC CANCER

A

Invasion of mucosa and submucosa (a/b)

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2
Q

T2 - GASTRIC CANCER

A

Invasion of tunica muscualaris

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3
Q

T3- GASTRIC CANCER

A

Invasion of subserosa

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4
Q

T4a- GASTRIC CANCER

A

Penetrates into visceral peritoneum

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5
Q

T4b- GASTRIC CANCER

A

Invades surrounding tissue

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6
Q

N1- GASTRIC CANCER

A

1-2 LN

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7
Q

N2 - GASTRIC CANCER

A

3-6 LN

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8
Q

N3 - GASTRIC CANCER

A

More than 7 LN

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9
Q

M1- GASTRIC CANCER

A

Distant metastases

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10
Q

T1- ESOPHAGEAL CANCER

A

Invasion of mucosa and submucosa (a/b)

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11
Q

T2 - ESOPHAGEAL CANCER

A

Invasion of tunica muscularis

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12
Q

T3 - ESOPHAGEAL CANCER

A

Invades beyond muscularis into adventitia

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13
Q

T4 - ESOPHAGEAL CANCER

A

Invades surrounding tissue (a/b)

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14
Q

N1 - ESOPHAGEAL CANCER

A

2-3 LN

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15
Q

N2 - ESOPHAGEAL CANCER

A

4-6 LN

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16
Q

N3 - ESOPHAGEAL CANCER

A

More than 7 LN

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17
Q

M1 - ESOPHAGEAL CANCER

A

Visceral metastases

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18
Q

What the risk factors of esophageal cancer?

A
  • obesity
  • smoking and alcohol
  • GERD
  • Barrett’s Esophagus
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19
Q

What are the clinical features of EC?

A
  • dysphagia and odynophagia
  • pain in tumour location
  • weight loss
  • loss of appetite
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20
Q

Diagnosis of EC?

A
  • EGD with biopsy
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21
Q

Treatment of EC?

A
  • Limited disease = resection (T1-T2N0.M0)

Locally advanced
SCC
- either neoadj or definitive chemo
- resection after restaging
OR
- FU and salvage resection

ADC
- periop or neoadj chemo
- restage
- resection

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22
Q

ESMO treatment of metastatic disease?

A
  • assess its operability
  • inoperable = palliative chemo and check if HER2 +/- (trastuzumab)

Operable depends on stage
- varies from endoscopic resection
or
- surgery then adj chemo/chemradio
- pre-op chemo, surgey, post-op chemo

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23
Q

What are the risk factors of gastric carcinoma? Mention types?

A

90% adenocarcinoma

  • smoking
  • H.pyori
  • atrophic gastritis
    -male

Distal (asian) : h.pylori, low fruit and veg, high red meat and salt

Gastric - fundus (non-asian): GERD, Obesity and Barrett’s

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24
Q

What are the clinical features of gastric cancer?

A
  • early = asymptomatic
  • stomach pain
  • anemia
  • dyspepsia
  • weight loss
  • vomiting
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25
How do you diagnose gastric cancer?
- EGD and biopsy
26
How can gastric cancer present as metastases?
- virchow's node - krukenburg tumour
27
Treatment of gastric cancer?
Operable (T1N0) - resection Operable (> T1N0) - surgery and adj chemo/chemoradio tx - Preop chemo, surgery and postop chemo Inoperable or Metastatic - palliative - check for HER2 +/- (Trastuzumab) - CF/CX -Platinum + fluoropyramindine based double/triple regimen
28
What are the risk factors of colorectal cancer?
- familial adenomatous polyposis (FAP) - Lynch syndrome - Peutz Jeghers Syndrome - Obesity - High red meat intake - Smoking - Hx of IBD
29
What are the do tests of colorectal cancer?
- fecal occult blood test - recommended age 50-74 at 2 year intervals - fecal immunochem test
30
What are the clinical features of colorectal cancer?
- sideropenic anemia - emptying rhythm changes - mucous and blood in stool - sudden onset of ileus - right sided is more severe than left *right is more common in females, has poorer outcomes , gives rise to M1c and is more chemoresistant
31
How do you diagnose colorectal cancer?
- colonoscopy and biopsy - Fecal immunohisto test is more sensitive (FIT) - Other emerging Dx using DNA from stool
32
TNM staging of colon cancer?
T1: invades submucosa T2: invades muscularis propriae T3: penetrates pericolorectal tissue T4: viscera peritoneum and surround organ involvement N1: 1-4 LN N2: 4-7 LN M1 a: 1 organ b: more organs c: peritoneal dissemination
33
Types of colon cancer?
- adenocarcinoma : grade 1, 2, 3 - mucinous - signet cell - neuroendocrine
34
ESMO treatment of primary colorectal cancer?
- colectomy: total, subtotal or hemi L or R - assess for Ras or BRAF mutation - Adj Tx stage II high risk or III FOLFOX 4/6 12 CYCLES and FU folfox4/6 = oxaplatin, leucovorin, fluoruracil
35
ESMO treatment of metastatic colorectal cancer?
- cytotoxic doublet (oxaplatin and fluoropyramdine) - bevacizuamb EGFR antibody may be given instead of bevacizumab (use aflibercept)
36
Why is FU important in colorectal cancer?
- 30-50% relapse - focus on CEA monitoring - US of liver or MCST - 50% relapses occur in liver, 20% in lungs and other organs
37
What is rectal cancer?
- defined as a tumour 15cm from anocutaneous line - can be low (5cm), medium (10cm) and high (15cm) - rectal cancer differ biologically and via etiology from Colorectal cancer
38
What are the risk factors of rectal cancer?
- obesity - abdominal obesity - T2DM - Crohn's disease - High red meat and processed food consumption - Smoking - High intake of alcohol
39
TNM staging of rectal cancer?
T1: submucosa T2: muscularis propia T3: subserosa/pericolic/perirectal fat tissue T4: perforation of visceral peritoneum and organ invasion N0 N1: 1-3 LN N2: more than 4 LN M0 M1 a: 1 organ b: more than 1 organ c: peritoneal metastases w or w/o visceral organs
40
How do you diagnose rectal cancer?
- DRE - Endoscopy *if distal extension < 15 cm from anal margin = rectal cancer * if distal extension > 15 cm from anal margin = colon cancer
41
Treatment of rectal cancer?
- depends on stage Transanal excision Microsurgery - local Low anterior resection Abdominoperineal resection Plus radiotherapy and chemo e.g. FOLFOX
42
Treatment of metastatic rectal cancer?
Curative: - systemic Chemo - short course preop radiotherapy (SCPRT) - metastasectomy Palliative: - SCPRT - Systemic chemo +/- targeted agents
43
Facts about pancreatic cancer?
- 4th leading cause of death with 5-OS 5% - same treatment for the past 20 years - median age 71-74 - most are locally advanced, unresectable cancer
44
Risk factors of pancreatic cancer?
Hereditary: -BRCA2 mutation - Li fraumeni syndrome - familial pancreatic carcnioma syndrome Non-hereditary: - tobacco smoking - heavy alcohol usage - DM - High intake of red meat
45
Types of pancreatic cancer?
- 95% adenocarcinoma (85% are ductal adenocarcinoma with very rich stroma = barrier against chemo - acinar cell carcinoma - adenosquamous carcinoma - neuroendocrine - undifferentiated carcinoma with osteoclast like cells
46
Diagnosis of pancreatic cancer
- CA19-9 not useful for primary diagnosis - preop ca19-19 high indicates poor outcome - CT scan - endoscopy and US biopsy - if metastatic = biopsy of metastasis
47
TNM staging of pancreatic cancer?
T1: limited to pancreas, size < 2cm T2: limited to pancreas, size > 2cm T3: extended beyond pancreas w/o invasion of SM artery or celiac axis T4: extended beyond pancreas w invasion of SMA or celiac axis N1: regional metastasis of LN M1: distant metastases
48
ESMO treatment recommendation for pancreatic cancer?
resectable (potentially curative) stage I - resection and adj chemo tx borderline resectable (potentially curative) stage II - neoadj tx followed by resection locally advanced (usually palliative) stage III - combination chemo tx e.g. gemcitabine metastatic (palliative) - stage IV - combination chemo tx e.g. gemcitabine r FOLFIRINOX *FOLFIRINOX folinic acid (leucovorin), fluorouracil, irinotecan
49
What are the risk factors for liver cancer?
- chronic active HBV and HCV infection - liver cirrhosis - Aflatoxin A1 - alcoholic/non-alcoholic liver disease
50
Diagnosis of liver cancer?
- CT/MRI of abdomen - ESR, CBC, LFT - AFP - Liver biopsy
51
Hepatocellular carcinoma CC grades?
HCC Grade: 1, 2, 3 *important to distinguish HCC from intraductal cholangiocarcinoma or liver metastases originating from other tumours - Fibrolamelar carcinoma
52
TNM staging of HCC?
T1: tumour 2cm w/o vascular invasion T2: solitary tumour > 2cm w vascular invasion T3: multiple tumours (at least 1 is > 5cm) T4: multiple tumours of varying size invading portal vein or hepatic vein or infiltrates surrounding tissue N1: 1 LN positive at least M1: distant metastases
53
What is the Barcelona Clinic Liver Staging?
BCLS connects clinical stages and functional liver capacity with treatment modalities (0, A, B, C, D)
54
ESMO treatment HCC?
BCLC 0-A - resection or liver transplant then radiotherapy BCLC B - liver transplant or resection - or transarterial chemoembolisation (TACE) with systemic therapy and radiotherapy BCLC C - sorafenib - pembrolizumab BCLC D - best supportive care
55
What are the biliary carcinomas?
- very rare < 1% of human cancers - Cholangiocarcinoma intrahepatic or extrahepatic: perihilar (Klatskin tumor) and distal - Gallbladder carcinoma
56
Risk factors of biliary carcinoma?
Cholangiocarcinoma: - primary sclerosing cholangitis - liver fluke infection Gallbladder Carcinoma: - cholelithiasis (Chronic) - Chronic cholecystitits - Gallbladder polyps - primary sclerosing cholangitis - porcelain gallbladder - obesity
57
Clinical features of cholangiocarcinoma and gallbladder carcinoma?
Cholangiocarcinoma: - signs of cholestasis e.g. jaundice, pruritus, dark urine, pale stool - Courvoisier sign: painless obstructive jaundice, non-tender gallbladder Gallbladder carcinoma: - no specific symptoms - mostly asymptomatic diagnosed incidentally
58
Diagnosis of biliary carcinoma?
- US - Biopsy - CT/MRI - Raised CA19-9 and CEA - MRCP for definitive diagnosis
59
Biliary carcinoma local and systemic disease treatment recommendation by ESMO?
Early stage: surgery, adj chemoradio tx, adj chemo, surveillance * <10% cases are resectable Locally advanced & Metastatic: systemic chemotherapy and radiotherapy e.g. gemcitabin based or fluoropyramidine based regimen
60
What is GIST?
Gastrointestinal Stromal Tumour - very rare - 60% affects stomach 30% duodenum - 60-65 years of age onset - mainly men
61
ESMO treatment of localised GIST?
R0 with no expected major complications: surgery and follow R0 with expected major complications not feasible: - imatinib 6-12 months - then either surgery or follow metastatic protocol
62
ESMO treatment for metastatic GIST?
Imatinib - Exon 11 mutation then 400mg - Exon 9 mutation then 800mg follow up with this treatment and reassess for potential surgery of residual disease or no response, then change to sunitinib
63
What the histological types of Esophageal cancer and where are they located?
SCC (90%): proximal and thoracal AdC: distal Rare tumours: small cell carcinoma, neuroendocrine, signet-ring cell
64
What are the PH types of gastric cancer?
90% AdC: intestinal type (well differentiated) and diffuse type (poorly differentiated) "Signet-ring cell poorly cohesive" Mucinoous adenocarcinoma Anaplastic carcinoma Neuroendocrine carcinoma 10% other tumors (lymphoma, plasmocytoma, GIST, sarcoma)
65
What is anal carcinoma?
- mostly SCC with HPV infection - Rarely adenocarcinoma, melanoma, lymphoma or sarcoma - chemo-radiation with with 5FU or Mitomycin C is preferred method of treatment - Tx also to enable anal sphincter preservation - 10-20% disseminate
66
What is the Child Pugh Staging?
- HCC - a tool for functional assessment of cirrhotic liver - albumine, Total bilirubin, PT, ascites and hepatic encephalopathy

Clinical Oncology (11 decks)

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