GI Oncology Flashcards
Where does colorectal cancer rank among amount of deaths and new cases of all cancers?
3 for men and women
Has the incidence of colorectal cancer gone up or down since 1975?
down actually due to screening! :)
Are most colorectal cancers diagnosed in advanced stages?
YES
What is the 5 year survival for metastatic colorectal cancer?
10% :(
What is the most important risk factor for colorectal cancer?
increasing age followed by genetic factors
If you have FAP, what is your risk of developing colorectal carcinoma by age 39?
100%
What disease is similar but less severe than FAP?
MUTYH-associated polyposis (MAP)
How long does it take for the adenoma-carcinoma sequence to occur?
over many years (that’s why pts get a colonoscopy every 10 years after age 50).
*APC, K-RAS, p53 mutations in that order
What is the symptomatology of colon cancer?
- change in bowel habits (more common with left-sided tumors).
- hematochezia (bleeding through anus)
- iron deficiency anemia (more common with right-sided CRCs).
- abdominal pain (related to obstruction/perforation/carcinomatosis).
- tenesmus, rectal pain, and diminished caliber of stools (seen with rectal primaries).
- rare presentation= bacteremia/endocarditis, fistuals.
What is the staging workup for CRC?
- colonoscopy and biopsy, EUS for rectal tumors
- CBC
- CEA tumor marker (remember only shows treatment response or recurrence).
- pathologic tissue review
- CT scans with contrast
- MRI liver (for metastasis) or PET (for metastasis)
What are the 4 stages of colorectal cancer (Dukes staging)?
- stage I= NOT passed the muscularis propria
- stage II= passed the muscular layers of the bowel
- stage III= any regional lymph nodes involved
- stage IV= distal metastasis
What should you look for on a pathology report for a pt with possible CRC?
- grade of cancer
- depth of invasion
- extension to adjacent structures
- number of nodes and number evacuated
- metastasis to other organs (liver, peritoneum, lung…)
- satellite nodules (irregular tumor deposits in the pericolorecal fat; look like lymph nodes, but with no lymph tissue).
- lymphovascular= BAD
How do we treat non-metastatic CRC?
- stage I= surgery
- stage II= surgery + chemo (if high risk)
- stage III= surgery + 6 months of 5-FU (FOLFOX)
What drugs combined with 5-FU help with treatment of metastatic colon cancer?
- irinotecan
- capecitabine
- oxaliplatin
- cetuximab (biologics; antibodies target epidermal growth factor).
- bevacizumab (biologics; antibodies)
- panitumumab (biologics; antibodies target epidermal growth factor).
- Regorafenib and Aflibercept (anti-VEGF drugs)
If you have a RAS gene mutation, do you get any help from drugs that target epidermal growth factor (EGFR) (cetuximab or panitumumab)?
NO, because RAS is a step following EGFR, and if RAS is already mutated to be constitutively activated, then these drugs will have no effect.
How do you treat RECTAL cancer?
- combination chemo with RADIATION then followed by surgery, due to higher chance of metastasis in the rectum.
- adjuvant chemo with 5-FU (FOLFOX)
What are the 2 types of pancreatic cancer?
- ductal adenocarcinoma (90%) VERY AGGRESSIVE.
2. Neuroendocrine tumors (islet-cell tumors, VIPoma, glucagonoma); not as aggressive.
What is the symptomatology of pancreatic cancer?
- abdominal pain
- anorexia/weight loss
- obstructive jaundice from biliary obstruction
- venous thrombosis
- malabsorption/steatorrhea
What genetic syndromes are associated with pancreatic cancer?
- BRCA2, Peutz-Jeghers syndrome, Lynch syndrome (HNPCC)
How do you diagnose pancreatic cancer?
- CT scan, ERCP/EUS (diagnostic and therapeutic), LFTs
How do you treat pancreatic cancer?
- pancreatoduodenectomy (whipple resection)
- adjuvant chemoradiation (5-FU) or chemo (gemcitabine)
How do we manage symptoms with pancreatic cancer?
- biliary stents, celiac blocks (due to pain from pressure of tumor on the celiac plexus), pancreatic enzymes, and palliative surgery for bypass
How do we treat hepatocellular carcinoma?
- surgery, liver transplant
How do we score liver disease?
- Child-Pugh scoring system
Is squamous cell carcinoma or adenocarcinoma of the esophagus now more common in the U.S.?
adenocarcinoma due to GERD and western diet
How do we treat esophageal cancer?
- endoscopic mucosal resection
- pre-op chemoradiation
- surgery
- Advanced disease (add traastuzumab for Her 2 positive disease)
With what 2 cancers is H. pylori associated?
Gastric and MALT lymphoma
What is hereditary diffuse gastric cancer?
autosomal dominant syndrome associated with diffuse-type gastric cancer, developing lobular breast cancer, and signet ring cell colon cancer.
*CDH1 gene mutation
How do we treat gastric cancer?
- chemo
- gastrectomy
- post-op chemoradiation
