GI cancers Flashcards
what is the process of diagnostic tests in oesophageal-gastric cancers?
start with endoscopy (macroscopic)
do a CT to exclude metastatic disease
EUS should be next to stage, particularly the T stage
then PET if considering curative treatment.
what is the treatment of distal oesophageal ca? (broadly speaking)
if curative, surgery is the mainstay
there should always be either chemo or chemoRTX. It’s still unclear if pre, peri or post op treatment
what is the treatment of incurable gastro-oesophageal and gastric cancer?
chemo
there is now also evidence of role for trastuzamab (herceptin) for tumours that are HER2 over-expressors.
in the work up of painless jaundice, what are the investigations?
CT is most often. usually dual phase
if the patient is to proceed to surgery, there is no need for biopsy before hand
PET has no established role in management
what is the treatment of curative pancreatic Ca?
surgery (Whipple’s) and then adjuvant chemotherapy (5FU or gemcitabine)
what is the origin cell of GIST tumours?
interstitial cells of Cajal (the GI pacemaker cell)
they are often “spindle shaped”
they are OFTEN (>85%) driven by C-KIT mutation (CD117), which causes an uncontrolled downstream autophosphorylation and downstream signaling
what is the benefit of the faecal occult blood test?
it reduces mortality in randomised trials
if someone has microsatellite instability and BRAF mutations, what does that mean about their germline?
HNPCC is associated with microsatellite instability, but not the BRAF mutation.
therefore, BRAF and MSI means methylation and not germline mutation
What is the treatment of CRC?
stage 1?
stage 2?
stage 3?
stage 4?
stages 1 and 2 should be treated with resection
Resected stage III should be treated with 5FU +/- oxaliplatin
stage IV treatment should be bevacizumab plus some sort of chemo. Never stop bevacizumab (avastin - a VEGF ligand inhibitor)
what are the adverse events associated with bevacizumab?
this is a VEGF inhibitor
it has impact on vessels
therefore, we can think of the side effects as hypertension
epistaxis
proteinuria
GI perforation
wound healing interference - should not be used 6 weeks either side of surgery
MI/stroke can occur, but are rare
what is cetuximab?
this is a EGFR MAb (EGF-Receptor MAb)
that are active with chemo or as single agent
They ONLY WORK IN K-RAS WILD TYPE
what are the adverse events associated with cetuximab?
this can be associated with allergic reactions (chimeric antibody)
Rash is very common - this is PREDICTIVE of response - it looks like acne but is NOT acne
diarrhoea
low Mg
what is the treatment of carcinoid syndrome?
this shoudl be treated with somatostatin analogues (such as octreotide)
what are some ways to monitor carcinoid syndrome and carcinoid tumours?
24 hour urine 5HIAA is important
but
chromogranin A is also a useful marker and is probably more closely aligned to the tumour growth
