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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
Q

First line management of HER2+ metastatic GEJ adenocarcinoma?

A

Platinum+5FU + Pembro + Trastuzumab

25
Q

First line management of HER2+ metastatic gastric adenocarcinoma?

A

Platinum+5FU + Pembro + Trastuzumab

26
Q

Second line therapy for HER2+ GEJ adenocarcinoma?

A

Enhertu

27
Q

Second line therapy for HER2+ gastric adenocarcinoma?

A

ENhertu

28
Q

Second line therapy for metastatic HER2- GEJ adenocarcinoma (2)

A

Ram +Paclitaxel (preferred)
FOLFIRI +/- Ram

29
Q

Second line therapy for metastatic HER2- gastric adenocarcinoma? (2)

A

Ram + Paclitaxel
FOLFIRI +/- Ram

30
Q

1st line for metastatic esophageal SCC (3)

A

Platinum+5FU + Pembro
Platinum+5FU + Nivo
Ipi + Nivo

31
Q

Indication for pembrolizumab monotherapy in metastatic esophageal SCC?

A

2nd line, PD-L1 CPS >10

32
Q

Indication for Nivolumab monotherapy in metastatic esopahgeal SCC?

A

2nd line, PD-L1 any

33
Q

3rd line metastatic GEJ adenocarcinoma?

A

Trifluradine - Tipracil

34
Q

3rd line metastatic gastric adenocarcinoma?

A

Trifluradine - Tipracil

35
Q

When giving platinum in metastatic GEJ/gastric adenocarcinoma, what is the preferred platinum?

A

oxaliplatin

36
Q

Treatment for Barrett’s esophagus with low grade dysplasia?

A

PPI

37
Q

Treatment for Barrett’s esophagus with high grade dysplasia?

A

Ablation, endoscopic resection

38
Q

Patient with mid esophageal adenocarcinoma is taken for up front surgery. pT1bN0 at surgery. What to do in adjuvant setting?

A

Observation

39
Q

What is the minimum number of LNs to be removed for adequate nodal staging in esophageal cancer

A

15

40
Q

1st line treatment for metastatic esophageal adenocarcinoma that is MMRd or MSI-H (5)

A

Pembro
Dostarlimab
Ipi/Nivo
FOLFOX+Nivo
FOLFOX+Pembro

41
Q

What LN groups are considered regional for esophageal adenocarcinoma?

A

Celiac or mediastinal
(NOT hilar)

42
Q

What are three high risk features of an early (T1 or T2) esophageal cancer?

A

LVI
>3 cm
poorly differentiated

43
Q

Five second line options for metastatic esophageal SCC?

A

Docetaxel or Paclitaxel
Irinotecan
FOLFIRI
Pembro (CPS >10)
Nivolumab

44
Q

Indications for Taxol + Ramucirumab?

A

Second line EGJ or gastric ADENOCARCINOMA
(Ram also indicated by itself)

45
Q

MoA of Ramucirumab

A

VEGFR2 mAb

46
Q

At what T stage of gastric adenocarcinoma should you consider adjuvant therapy?

A

T2

47
Q

What is Siewert I classification?

A

Adeno of lower eso with epicenter located 1-5 cm above EGJ

48
Q

What is Siewert II classification?

A

Carcinoma of the cardia at the EGF, with tumor epicenter within 1 cm above and 2 cm below EGJ

49
Q

What is Siewert III classification?

A

Subcardial carcinoma with tumor epicenter between 2 and 5 cm below EGJ, which infiltrates EGJ and lower esophagus from below

50
Q

How is the management different between Siewert classifications?

A

I and II are esophageal or EGJ
III is treated like gastric

Solid Tumor Oncology (20 decks)

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