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Solid Tumor Oncology > Gastroesophageal Cancers > Flashcards

Gastroesophageal Cancers Flashcards

1
Q

What is the most common location of esophageal squamous cell carcinoma?

A

Cervical esophagus.

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2
Q

For esophageal or GEJ cancer, when is a bronchoscopy needed for staging?

A

If tumor is at or above carina - to rule out posterior trachea invasion

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3
Q

When to do staging laparoscopy?

A

Gastric tumors that are cT1b or higher

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4
Q

T stage in GEJ or distal esophageal cancer?

A

T1a: mucosa
T1b: submucosa
T2: muscularis propria
T3: Adventitia
T4a: Adjacent structures, debatably resectable
T4b: Adjacent structures, unresectable

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5
Q

What is the treatment for T1aN0 distal esophageal or GEJ adenocarcinoma?

A

Endomucosal resection

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6
Q

What is the treatment for T1bN0 distal esophageal or GEJ adenocarcinoma?

A

Surgery

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7
Q

What is the treatment paradigm for locally advanced, resectable distal esophageal or GEJ adenocarcinoma?

A

ChemoRT and surgery

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8
Q

What classifies a distal esophageal or GEJ adenocarcinoma as locally advanced, resectable? (2)

A

T2-T4a N0
Tany N+ (mediastinal or celiac)

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9
Q

What classifies a distal esophageal or GEJ adenocarcinoma as locally advanced unresectable?

A

T4b Nany

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10
Q

What is the treatment paradigm for locally advanced unresectable distal esophageal or GEJ adenocarcinoma

A

ChemoRT

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11
Q

Preferred Neoadjuvant chemoradiation regimen for distal esophageal or GEJ cancer?

A

Carboplatin + Paclitaxel (CROSS regimen)

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12
Q

Patient with distal esophageal or GEJ cancer undergoes neoadjuvant chemoradiation and surgery. He has residual tumor at the time of surgery. What now?

A

Adjuvant nivolumab x1 year

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13
Q

Preferred treatment for locally advanced resectable esophageal squamous cell carcinoma?

A

Neoadjuvant Carbo+Taxol+RT then surgery

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14
Q

Preferred perioperative chemotherapy for GEJ adenoca, distal esophageal adenoca, or gastric adenoca

A

FLOT (5-FU+LV+Oxaliplatin+Docetaxel) for fit patients

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15
Q

What patient population do not benefit from perioperative chemotherapy without radiation?

A

esophageal SCC

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16
Q

Preferred treatment for locally advanced resectable gastric adenocarcinoma?

A

Perioperative FLOT and then surgery

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17
Q

patient with gastric adenocarcinoma has up front surgical resection and has a T2N0 tumor. He had a D1 dissection. What adjuvant treatment?

A

ChemoRT (5-FU+RT)

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18
Q

Patient with gastric cancer had up front surgery and had T3N0 disease. He had a D2 dissection. Adjuvant treatment?

A

Chemotherapy alone (CAPOX)

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19
Q

What is a D1 surgery in gastric cancer?

A

Removal of N1 nodes

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20
Q

You have a patient with esophageal SCC undergoing neoadjuvant chemoRT, but he didn’t tolerate therapy well and is a borderline surgical candidate. What can you do to feel better about avoiding surgery?

A

EGD/biopsy.
Negative EGD/biopsy and PET/CT means we can omit surgery

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20
Q

What is a D2 surgery in gastric cancer?

A

Removal of N1 and N2 nodes

21
Q

What is the preferred treatment for locally advanced unresectable adenocarcinoma or squamous cell carcinoms of Distal esophagus or GEJ?

A

Cisplatin + 5-FU + RT
FOLFOX + RT

22
Q

How does the local management of cervical esophageal cancer differ from other esophageal cancers?

A

Usually considered inoperable, even if not T4b.
-Hard to do anastomosis, usually SCC, generally treated with definitive chemoRT

23
Q

First line Management of metastatic GEJ and gastric adenocarcinoma That is HER2 negative?

A

FOLFOX (CAPEOX) + Nivo

24
First line management of HER2+ metastatic GEJ adenocarcinoma?
Platinum+5FU + Pembro + Trastuzumab
25
First line management of HER2+ metastatic gastric adenocarcinoma?
Platinum+5FU + Pembro + Trastuzumab
26
Second line therapy for HER2+ GEJ adenocarcinoma?
Enhertu
27
Second line therapy for HER2+ gastric adenocarcinoma?
ENhertu
28
Second line therapy for metastatic HER2- GEJ adenocarcinoma (2)
Ram +Paclitaxel (preferred) FOLFIRI +/- Ram
29
Second line therapy for metastatic HER2- gastric adenocarcinoma? (2)
Ram + Paclitaxel FOLFIRI +/- Ram
30
1st line for metastatic esophageal SCC (3)
Platinum+5FU + Pembro Platinum+5FU + Nivo Ipi + Nivo
31
Indication for pembrolizumab monotherapy in metastatic esophageal SCC?
2nd line, PD-L1 CPS >10
32
Indication for Nivolumab monotherapy in metastatic esopahgeal SCC?
2nd line, PD-L1 any
33
3rd line metastatic GEJ adenocarcinoma?
Trifluradine - Tipracil
34
3rd line metastatic gastric adenocarcinoma?
Trifluradine - Tipracil
35
When giving platinum in metastatic GEJ/gastric adenocarcinoma, what is the preferred platinum?
oxaliplatin
36
Treatment for Barrett's esophagus with low grade dysplasia?
PPI
37
Treatment for Barrett's esophagus with high grade dysplasia?
Ablation, endoscopic resection
38
Patient with mid esophageal adenocarcinoma is taken for up front surgery. pT1bN0 at surgery. What to do in adjuvant setting?
Observation
39
What is the minimum number of LNs to be removed for adequate nodal staging in esophageal cancer
15
40
1st line treatment for metastatic esophageal adenocarcinoma that is MMRd or MSI-H (5)
Pembro Dostarlimab Ipi/Nivo FOLFOX+Nivo FOLFOX+Pembro
41
What LN groups are considered regional for esophageal adenocarcinoma?
Celiac or mediastinal (NOT hilar)
42
What are three high risk features of an early (T1 or T2) esophageal cancer?
LVI >3 cm poorly differentiated
43
Five second line options for metastatic esophageal SCC?
Docetaxel or Paclitaxel Irinotecan FOLFIRI Pembro (CPS >10) Nivolumab
44
Indications for Taxol + Ramucirumab?
Second line EGJ or gastric ADENOCARCINOMA (Ram also indicated by itself)
45
MoA of Ramucirumab
VEGFR2 mAb
46
At what T stage of gastric adenocarcinoma should you consider adjuvant therapy?
T2
47
What is Siewert I classification?
Adeno of lower eso with epicenter located 1-5 cm above EGJ
48
What is Siewert II classification?
Carcinoma of the cardia at the EGF, with tumor epicenter within 1 cm above and 2 cm below EGJ
49
What is Siewert III classification?
Subcardial carcinoma with tumor epicenter between 2 and 5 cm below EGJ, which infiltrates EGJ and lower esophagus from below
50
How is the management different between Siewert classifications?
I and II are esophageal or EGJ III is treated like gastric

Solid Tumor Oncology (20 decks)

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