GI cancers Flashcards
GEJ adenocarcinoma type of treatment
multimodality approach chemoradiation f/b surgery even if lymph nodes (mediastinal and celiac). Not if RP. Also even if extends to other organs.
Adenocarcinoma is treated with chemoradiation f/b surgery.
SCC sometimes try to avoid surgery (especially MSKCC)
nasopharyngeal carcinoma staging
MRI given the anatomic location of the nasopharynx, this tumor has a propensity for skull base invasion, bone destruction and parapharyngeal space involvement, and involvement of retropharyngeal lymph nodes which have treatment and prognostic implications.
Recurrent symptomatic CLL after treatment with fludarabine?
Can do fludarabine again if greater than 12 months. Alemtuzumab is approved for use in patients with disease refractory to fludarabine. In such patients, the response rate was 33%, including a 2% rate of complete response. Response rates varied with a number of clinical factors, and were markedly lower in patients with enlarged lymph nodes. Bendamustine is a bifunctional alkylator that provides responses in 70-80% of patients with recurrent CLL, including those with enlarged lymph nodes.
surgery in mesothelioma
good performance status and the pulmonary reserve to tolerate surgery, an extrapleural pneumonectomy should be attempted. Patients with negative mediastinal nodes and an epithelial histology are most likely to benefit from surgery.
indolent HL
Nodular lymphocyte-predominant
Breast cancer under 30 genetics?
BRCA1 or TP53 TP53 is associated with leukemia and sarcoma
When to do RPLND for residual mass in seminoma?
complete a PET scan at least 6 weeks after completion of chemotherapy, and proceed with surgical resection only if there is a residual mass ≥ 3 cm that is FDG avid consistent with persistent viable seminoma
when do you use in anthracycline in APL?
when patient is defined as high risk with wbc >10 are at risk for potentially fatal differentiation syndrome and benefit from cytoreduction using anthracycline or gemtuzamab.
criteria for multiple myeloma
MM Clonal BMPC ≥10% or biopsy proven bony or extra-medullary plasmacytoma, AND ≥1 of the following myeloma defining events (MDE): - Evidence of end organ damage attributed to PC proliferative disorder: serum Ca ≥ 11 mg/dL, renal insufficiency (creatinine ≥ 2mg/dL/creatinine clearance ˂ 40mL/min, anemia (Hb ˂10 g/dL), lytic bone lesions - ≥ 1 of the following Clonal bone marrow plasma cell percentage ≥ 60% Involved:un-involved serum free light chain ratio ≥ 100 ˃1 focal lesion on MRI
smoldering multiple myeloma criteria
SMM Must meet both of the following criteria: - Serum monoclonal protein ≥ 3g/dL or urine monoclonal protein ≥ 500 mg/24 hour, and/or BMPC 10 to 60% - Absence of MDEs and amyloidosis
MGUS definition
-Serum monoclonal protein <30 g/L Bone marrow plasma cells <10% Absence of myeloma defining events or amyloidosis (or Waldenström macroglobulinemia in the case of IgM MGUS)
Older head and neck patients:
Surgery, radiation, and chemoradiation appear to be equally efficacious in older and younger patients The available data suggest that patient-reported quality of life is not significantly reduced after treatment in older patients with HNC. However, we do not recommend using these data to inform patient counseling and treatment decisions. Older patients with HNC require more supportive care. We recommend prophylactic feeding tubes. We also recommend coordinating care with the patient’s other general practitioners and specialists.
HPV related oropharyngeal cancer in unresectable cancer treatment?
Randomized phase III studies comparing sequential chemotherapy and RT to concurrent chemotherapy RT alone are ongoing and have not demonstrated a convincing survival benefit with incorporation of induction chemotherapy. Cisplatin based induction chemotherapy followed by high-dose every 3 weeks cisplatin chemoradiation is not recommended due to toxicity concerns. After induction chemotherapy, multiple options can be used for RT based portion of therapy including carboplatin or cetuximab.
capecitabine and anticoagulation
increased anti-coagulant activity of warfarin
second line chemo for advanced gastric cancer
phase III Rainbow trial found that the addition of ramucirumab to paclitaxel improved response rate, progression-free survival and OS among patients who had previously received a platinum and fluoropyrimidine. Neither cetuximab nor bevaziumab improve survival in metastatic gastric cancer and are not part of routine care.
Patient on CAPEOX with significant myelotoxicity and, to a lesser extent, GI toxicity
highly suspicious for him being homozygous for the germline UGT1A1*28 polymorphism. educed clearance of SN-38 (the active metabolite of irinotecan), resulting in excessive neutropenia and, possibly to a lesser extent, diarrhea.
Patient receives 5FU and develops myelotoxicity and GI toxicity
DPYD
Lobular breast cancer, particularly under the age of 50, and diffuse gastric cancer (also known as signet ring carcinoma, linitus plasticus) should b tested for??
CDH1, located on 16q22.1, with autosomal dominance inheritance, codes for the E-Cadherin protein, involved in cellular adhesion
head and neck cancer receiving moderate dose radiation therapy (up to 50 Gy),
Benzydamine mouthwash
grade 3 mucositis
prevents the patient from eating any solids
Palifermin
has been shown to improve oral mucositis symptoms in patients undergoing hematopoietic cell transplantation.
Hemicolectomy for Incidentally found carcinoids of the appendix?
recommended for patients with tumors over 2 cm in maximum dimension. For small (< 1) cm lesions the risk of recurrence is so small as to not warrant additional follow-up testing or surveillance.
Pathway has shown activity in the treatment of low-grade ovarian cancer
MAP-kinase with selumetinib
