GI

Question 1

When to give neoadjuvant or adjuvant chemo in gastric cancer

Answer 1

Neoadjuvant: If >T1 (T2=invading muscularis propia)

Adjuvant: If T3/T4 and N+

Question 2

High risk stage II colon cancer

Answer 2

T4 tumors, high grade or poorly differentiated histology (signet ring or mucinous histologies), close/inderminate positive surgical margins, hjigh preop CEA, <12 regional LNs assessed, perineural invasion, lymphovascular invasion, bowel obstruction, bowel perforation

Question 3

1st line metastatic anal cancer (squamous)

Answer 3

1st line: cisplatin/5-FU or carbo/taxol

2nd line: pembro or nivo

Question 4

CRM in rectal cancer

Answer 4

> 1mm

Question 5

1st line localized rectal cancer treatment if T1-T2 only, or N+ or T3 and above

Answer 5

T1-T2: surgery and observation
N+ or T3 and above:
chemoRT > re-stage > resection > adjuvant chemo for 12-16 weeks
OR
chemoRT > neoadjuvant chemo 12-16 weeks > re-stage > surgery

Question 6

Adjuvant therapy pancreatic cancer if not given neoadjuvant

Answer 6

FOLFIRINOX
or
Gem/Cap
or 
Gem alone if poor PS

Question 7

T4 pancreatic cancer

Answer 7

involves celiac axis, SMA, and/or common hepatic artery; regardless of size. Makes it stage 3. Chemo or chemoRT first.

Question 8

imaging of HCC

Answer 8

triple phase CT: arterial = increased enhancement; venous = decreased enhancement; delayed phase = persistent wash out

Question 9

Barcelona Clinic Liver Cancer Algorithm - early stage A

Answer 9

single or 3 nodules <3cm, PS 0, if transplantable - proceed with transplant and if not - locoregional therapy

Question 10

Milan Criteria

Answer 10

single tumor 5cm or less
3 tumors 3cm or less
no macrovascular invasion
no extrahepatic invasion

Question 11

Child-pughs Score

Answer 11

Encephalopathy
Ascites
Albumin
PT 
Bili

A: 5-6 points
B: 7-9 points
C: 10=15 points

Question 12

Neuroendocrine tumors - grade 1 versus grade 3

Answer 12

Grade 1: well differentiated AND <2 mitotic rate AND Ki-67 <2%
Grade 2: not 1 or 3
NEC (neuroendocrine CARCINOMA)
Grade 3: poorly differentiated OR >20 mitotic rate OR Ki-67 >20%

Question 13

Risk factors for cholangiocarcinoma

Answer 13

Risk Factors → chronic inflammation 
   Gallstones
   Porcelain gallbladder
   DM
   Obesity
   Smoking
   Women > Men
   Infections (HCV > HBV, Salmonella, Liver Fluke)

Question 14

Adjuvant Treatment for cholangiocarcinoma

Answer 14

T1a clear margins –> observation

Anything more –> adjuvant chemo; if R1 then post-op chemoRT

Question 15

T2 in gastric and colon cancer

Answer 15

invading muscularis propria

Question 16

Metastatic R sided versus L sided colon cancer treatment

Answer 16

R sided –> BRAF (worse prognosis)

L sided and KRAS WT –> EGFR inhibitor

Question 17

Colon cancer adjuvant therapy guidelines

Answer 17

T1-T2 –> none
T3N0 –> +/- chemo (no benefit if MSI-high)
T4N0 –> chemo
N1 (<3 LN) –> 3 months FOLFOX/CAPOX
N2 (>3LN) –> 6 months FOLFOX or CAPOX or 3 months CAPOX

If age > 70 - benefit of oxaliplatin unclear

Question 18

Metastatic gastroesophageal cancer treatment

Answer 18

folfox or capox + ICI if

+Nivolumab if CPS 5-9
+Pembrolizumab or Nivolumab if CPS ≧ 10)

Add HER2 agent if HER2+

Question 19

Chemotherapy for perioperative setting gastric cancer

Answer 19

FLOT (superior to ECF/ECX)

Can give FOLFOX to debilitated patient

Question 20

metastatic treatment BRAF mutated colon cancer - 2nd line

Answer 20

2nd line BRAFV600E Mutated
Encorafenib + cetuximab (2nd line)
Dabrafenib + trametinib (2nd line)

Question 21

DPYD versus UGT1a

Answer 21

DPD deficiency - mainly neutropenia and mucositis
UGT1a1 allele variants - diarrhea and neutropenia and are unlikely to have severe mucositis. UGT1a1 variant alleles can be associated with elevated baseline bilirubin levels

Question 22

Mutation seen in MSI tumors

Answer 22

BRAF V600E mutations are frequent in MSI tumors (~47% of cases)