General

Question 1

False negative rate of SLN m&s approach?

Answer 1

approx 3%

Question 2

MSI-H definition?

Answer 2

Cancers that at least 30% of microsatellites have mutations are called micro satellite instability high;

Loss of expression of MMR (mismatch repair) genes is found in 15% of sporadic CRC (biologic footprint => MSI-H); sporadic tumors don’t have mutation, they have epigenetic silencing (acquired hypermethylation of the promoters of both alleles if MLH1 gene)

Question 3

What % of pts with primary cancer will develop secondary cancer? What is mortality from secondary cancers related to?
SEER data 1992-2011 on 1.5 mln of at least 5 year survivors - mean 7.3 years

Answer 3

10% developed secondary primary cancers “SPC” during mean f/u of 7.3 years

25-50% of them were smoking related: lung, bladder, oral/pharynx

Mortality related to SPC:

• 30% lung cancer
• 22-26% were obesity related cancers: colorectal, pancreas, corpus uteri and liver

Implications for surveillance at 5y for uterine and HPV cancers?

Question 4

Risk of EAC in patients with EIN on preop bx ~ stripe thickness

N- 378

Devon Abt; Beth Deaconess Boston - SGO 2021

Answer 4

47% for stripe > 20 mm
38% for stripe > 15 mm - significantly associated with high risk Mayo criteria

21% for stripe < 15 mm

Question 5

High-intermediate EAC category per 2021 gESGO and impact on LND?

Answer 5

sI t1 + substantial LVSI

sIB, g3

s.II

This group “should” have LN staging and requires side-specific LND for negative mapping