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Clinical Oncology > Gastric Cancer > Flashcards

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
Q

How do you diagnose gastric cancer?

A
  • EGD and biopsy
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26
Q

How can gastric cancer present as metastases?

A
  • virchow’s node
  • krukenburg tumour
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27
Q

Treatment of gastric cancer?

A

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
Q

What are the risk factors of colorectal cancer?

A
  • familial adenomatous polyposis (FAP)
  • Lynch syndrome
  • Peutz Jeghers Syndrome
  • Obesity
  • High red meat intake
  • Smoking
  • Hx of IBD
29
Q

What are the do tests of colorectal cancer?

A
  • fecal occult blood test
  • recommended age 50-74 at 2 year intervals
  • fecal immunochem test
30
Q

What are the clinical features of colorectal cancer?

A
  • 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
Q

How do you diagnose colorectal cancer?

A
  • colonoscopy and biopsy
  • Fecal immunohisto test is more sensitive (FIT)
  • Other emerging Dx using DNA from stool
32
Q

TNM staging of colon cancer?

A

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
Q

Types of colon cancer?

A
  • adenocarcinoma : grade 1, 2, 3
  • mucinous
  • signet cell
  • neuroendocrine
34
Q

ESMO treatment of primary colorectal cancer?

A
  • 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
Q

ESMO treatment of metastatic colorectal cancer?

A
  • cytotoxic doublet (oxaplatin and fluoropyramdine)
  • bevacizuamb

EGFR antibody may be given instead of bevacizumab (use aflibercept)

36
Q

Why is FU important in colorectal cancer?

A
  • 30-50% relapse
  • focus on CEA monitoring
  • US of liver or MCST
  • 50% relapses occur in liver, 20% in lungs and other organs
37
Q

What is rectal cancer?

A
  • 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
Q

What are the risk factors of rectal cancer?

A
  • obesity
  • abdominal obesity
  • T2DM
  • Crohn’s disease
  • High red meat and processed food consumption
  • Smoking
  • High intake of alcohol
39
Q

TNM staging of rectal cancer?

A

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
Q

How do you diagnose rectal cancer?

A
  • DRE
  • Endoscopy
    *if distal extension < 15 cm from anal margin = rectal cancer
  • if distal extension > 15 cm from anal margin = colon cancer
41
Q

Treatment of rectal cancer?

A
  • depends on stage

Transanal excision Microsurgery - local

Low anterior resection

Abdominoperineal resection

Plus radiotherapy and chemo e.g. FOLFOX

42
Q

Treatment of metastatic rectal cancer?

A

Curative:
- systemic Chemo
- short course preop radiotherapy (SCPRT)
- metastasectomy

Palliative:
- SCPRT
- Systemic chemo +/- targeted agents

43
Q

Facts about pancreatic cancer?

A
  • 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
Q

Risk factors of pancreatic cancer?

A

Hereditary:
-BRCA2 mutation
- Li fraumeni syndrome
- familial pancreatic carcnioma syndrome

Non-hereditary:
- tobacco smoking
- heavy alcohol usage
- DM
- High intake of red meat

45
Q

Types of pancreatic cancer?

A
  • 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
Q

Diagnosis of pancreatic cancer

A
  • 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
Q

TNM staging of pancreatic cancer?

A

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
Q

ESMO treatment recommendation for pancreatic cancer?

A

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
Q

What are the risk factors for liver cancer?

A
  • chronic active HBV and HCV infection
  • liver cirrhosis
  • Aflatoxin A1
  • alcoholic/non-alcoholic liver disease
50
Q

Diagnosis of liver cancer?

A
  • CT/MRI of abdomen
  • ESR, CBC, LFT
  • AFP
  • Liver biopsy
51
Q

Hepatocellular carcinoma CC grades?

A

HCC Grade: 1, 2, 3

*important to distinguish HCC from intraductal cholangiocarcinoma or liver metastases originating from other tumours

  • Fibrolamelar carcinoma
52
Q

TNM staging of HCC?

A

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
Q

What is the Barcelona Clinic Liver Staging?

A

BCLS connects clinical stages and functional liver capacity with treatment modalities

(0, A, B, C, D)

54
Q

ESMO treatment HCC?

A

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
Q

What are the biliary carcinomas?

A
  • very rare < 1% of human cancers
  • Cholangiocarcinoma
    intrahepatic or extrahepatic: perihilar (Klatskin tumor) and distal
  • Gallbladder carcinoma
56
Q

Risk factors of biliary carcinoma?

A

Cholangiocarcinoma:
- primary sclerosing cholangitis
- liver fluke infection

Gallbladder Carcinoma:
- cholelithiasis (Chronic)
- Chronic cholecystitits
- Gallbladder polyps
- primary sclerosing cholangitis
- porcelain gallbladder
- obesity

57
Q

Clinical features of cholangiocarcinoma and gallbladder carcinoma?

A

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
Q

Diagnosis of biliary carcinoma?

A
  • US
  • Biopsy
  • CT/MRI
  • Raised CA19-9 and CEA
  • MRCP for definitive diagnosis
59
Q

Biliary carcinoma local and systemic disease treatment recommendation by ESMO?

A

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
Q

What is GIST?

A

Gastrointestinal Stromal Tumour
- very rare
- 60% affects stomach 30% duodenum
- 60-65 years of age onset
- mainly men

61
Q

ESMO treatment of localised GIST?

A

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
Q

ESMO treatment for metastatic GIST?

A

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
Q

What the histological types of Esophageal cancer and where are they located?

A

SCC (90%): proximal and thoracal
AdC: distal
Rare tumours: small cell carcinoma, neuroendocrine, signet-ring cell

64
Q

What are the PH types of gastric cancer?

A

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
Q

What is anal carcinoma?

A
  • 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
Q

What is the Child Pugh Staging?

A
  • 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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