Gastro-oesophageal Cancer

Question 1

Annual risk of oesophageal cancer in non-dysplastic Barretts?

Answer 1

0.3% (1 in 300)

Question 2

When is neoadjuvant FLOT recommended?

Answer 2

T2-T4 (at least muscle invasive) or node positive adenocarcinoma of stomach or GOJ

Question 3

How many lymph nodes should be taking with gastrectomy?

Answer 3

Aim for at least 15

Question 4

When is CRT recommended in oesophageal SqCC?

Answer 4

T3-4 disease or node positive. Some centres will have surgery following, variable practice.

Question 5

Indications for adjuvant nivolumab in oesophageal cancer?

Answer 5

One year of adjuvant nivolumab post CRT and surgery in residual disease. No PDL1 selection. Can be adenoca or SqCC.

Question 6

What are the PDL1 cut offs for first line chemo IO in oesophageal adenocarcinoma

Answer 6

CPS >10 can have pembrolizumab
CPS >5 can have nivolumab

Question 7

What are PDL1 cut offs for first line immunotherapy in oesophageal SqCC?

Answer 7

CPS >10 can have pembro (as in adenoca)
CPS <10 and PDL1 expression >1% can have nivolumab

Question 8

Second line treatment option in SqCC?

Answer 8

Nivolumab where fluoropyridamine and platinum based chemotherapy given in the first line

Question 9

Second line treatment options in adenocarcinoma?

Answer 9

Docetaxel or FOLFIRI

Question 10

Third line options in adenocarcinoma?

Answer 10

Lonsurf

Question 11

Which types of stent should be used to palliate dysphagia?

Answer 11

Partially covered self expanding metal stents, avoid plastic and uncovered stents.

Question 12

What is the most common cause of Trastuzumab resistance in gastric cancer?

Answer 12

Activation of the PI3K/AKT pathway

Question 13

What is the percentage of GOJ cancers that express HER2 vs gastric cancers.

Answer 13

32% vs 21%