Gastric cancer Flashcards
Clinical presentation?
Dysphagia Weight loss Loss of appetite Abdo pain Iron def
Which virus is associated with gastric cancer?
Epstein barr virus
Which host factors predispose?
Barretts
CDH1 mutation (hereditary diffuse gastric cancer)
Lynch
Polyposis syndromes (FAP, Peutz-Jeghers)
How is peritoneal disease ruled out?
Laparoscopy
Is neoadjuvant chemo given?
Yes in Aus/Europe
No in Asia
What pre-op chemo is used in Aus?
FLOT x 4 - docetaxel, 5-FU, and oxaliplatin
What adjuvant chemo is used in Aus?
Also FLOT if it can be tolerated
What toxicities of FLOT are seen?
Diarrhoea
Neutropenia - grade 3 + 4
Peripheral neuropathy
What palliative chemo is given?
1st line
Cisplatin + 5FU/capecitabine
FOLFOX (oxaliplatin + 5FU/capecitabine)
+/- trastuzumab (if HER2 overexpressing)
2nd
Irinotecan + paclitaxel +/- ramucirumab
When is ramucirumab?
If VEGFR2 positive
What is the advantage of combining chemo with pembro?
There is none
Which patients benefit most from pembro?
High PDL-1 staining
High microsatellite
