GI Cancer Flashcards
Colon cancer stage 1
Describe T stage in descriptive terms
Describe management
Describe follow up after treatment
T1-T2 N0
T1 invades submucosa
T2 invades muscularis
N0 no nodes
Surgical resection and no hem-onc follow up after pathology review
1 year post-surgical colonoscopy
Colon cancer stage II
Describe T stage in descriptive terms
Describe high risk features
Describe management
- T3-T4 N0
- Invades through muscularis
- Surgical resection followed by discussion on risk stratification and benefit of adjuvant chemotherapy
- High risk features: poorly differentiated, lymphovascular invasion, perineural invasion, close or indeterminant margins, tumor budding, <12 nodes examined, bowel obstruction or perforation at presentation.
High risk features in stage II colon cancer
- High risk features: T4 tumors, poorly differentiated, lymphovascular invasion, perineural invasion, close/ indeterminant/positive margins, tumor budding, <12 nodes examined, bowel obstruction or perforation at presentation.
MOSAIC trial in colon cancer
FOLFOX vs 5-FU adjuvant therapy in
stage II and III colon cancers
- No overall benefit in OS for oxaliplatin addition for stage II
- OS stage III benefit of 4.5%
- There is a benefit of about 7% 5yr DFS of adding oxaliplatin in stage II high and stage III
- Grade 2 neuropathy 3%, grade 3 0.5%
- reduced neuropathy with 3 months in IDEA trial
IDEA trial in colon cancer
Stage III colon cancer adjuvant therapy non-inferiority trial for FOLFOX/CAPEOX 3 vs 6 mo
- Less neuropathy with 3 months
- Low risk stage II- can do CAPOX for 3 months as it was non-inferior to 6 months in 3yr DFS
- Low risk III and high risk II- try to do 6 months folfox or capox but 3 was ok
- High risk stage III- all should get 6 months of treatment as 3 months FOLFOX was inferior to 6 (3 mo capox might be ok)
QUASAR trial in colon cancer
F-FU vs surgery alone
3% 5OS for chemotherapy with F-FU in stage II disease (77 vs 80%)- no high vs low risk distinction
Stage II MSI high
Low risk
No adjuvant chemotherapy
Detriment from adjuvant chemotherapy in stage II disease
low risk stage II colon cancer management
surgery then discussion
- observation recommended
- maybe about 3% benefit of 5-FU/xeloda alone for 6 mo
high risk stage II colon cancer management
check MMR status–> normal
Age <70: CAPEOX 3 months or FOLFOX 3-6 mo
Rectal cancer neoadjuvant chemotherapy benefits
T3Nx
CAO/ARO/AIO-94
- downstaging
- improved chemo tolerance esp reduced GI side effects
- increased sphincter preserving surgery 39% vs 20%
- reduced local relapse
- no change in OS
stage III intermediate risk colon cancer management
NOT T4 or N2
6 mo FOLFOX or 3 mo CAPEOX
Stage II colon cancer follow up post-treatment
Labs and CEA 3 mo for 2 years, 6 months 3-5
CT chest abdomen pelvis every 6-12 months for 5 years
Colonoscopy in 1 year, 3 years, then every 5 years
Stage III high risk colon cancer management
T4 or N2
6 months FOLFOX or CAPEOX
Stage I colon cancer follow up post-treatment
Colonoscopy in 1 year
no adjuvant or hem-onc follow up
Stage III colon cancer follow up post-treatment
Labs and CEA 3 mo for 2 years, 6 months 3-5
CT chest abdomen pelvis every 6-12 months for 5 years
Colonoscopy in 1 year, 3 years, then every 5 years
