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Gastrointestinal 2 > GI Oncology > Flashcards

GI Oncology Flashcards

1
Q

Where does colorectal cancer rank among amount of deaths and new cases of all cancers?

A

3 for men and women

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2
Q

Has the incidence of colorectal cancer gone up or down since 1975?

A

down actually due to screening! :)

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3
Q

Are most colorectal cancers diagnosed in advanced stages?

A

YES

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4
Q

What is the 5 year survival for metastatic colorectal cancer?

A

10% :(

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5
Q

What is the most important risk factor for colorectal cancer?

A

increasing age followed by genetic factors

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6
Q

If you have FAP, what is your risk of developing colorectal carcinoma by age 39?

A

100%

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7
Q

What disease is similar but less severe than FAP?

A

MUTYH-associated polyposis (MAP)

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8
Q

How long does it take for the adenoma-carcinoma sequence to occur?

A

over many years (that’s why pts get a colonoscopy every 10 years after age 50).
*APC, K-RAS, p53 mutations in that order

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9
Q

What is the symptomatology of colon cancer?

A
  • 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.
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10
Q

What is the staging workup for CRC?

A
  • 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)
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11
Q

What are the 4 stages of colorectal cancer (Dukes staging)?

A
  • 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
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12
Q

What should you look for on a pathology report for a pt with possible CRC?

A
  • 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
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13
Q

How do we treat non-metastatic CRC?

A
  • stage I= surgery
  • stage II= surgery + chemo (if high risk)
  • stage III= surgery + 6 months of 5-FU (FOLFOX)
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14
Q

What drugs combined with 5-FU help with treatment of metastatic colon cancer?

A
  • 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)
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15
Q

If you have a RAS gene mutation, do you get any help from drugs that target epidermal growth factor (EGFR) (cetuximab or panitumumab)?

A

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.

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16
Q

How do you treat RECTAL cancer?

A
  • combination chemo with RADIATION then followed by surgery, due to higher chance of metastasis in the rectum.
  • adjuvant chemo with 5-FU (FOLFOX)
17
Q

What are the 2 types of pancreatic cancer?

A
  1. ductal adenocarcinoma (90%) VERY AGGRESSIVE.

2. Neuroendocrine tumors (islet-cell tumors, VIPoma, glucagonoma); not as aggressive.

18
Q

What is the symptomatology of pancreatic cancer?

A
  • abdominal pain
  • anorexia/weight loss
  • obstructive jaundice from biliary obstruction
  • venous thrombosis
  • malabsorption/steatorrhea
19
Q

What genetic syndromes are associated with pancreatic cancer?

A
  • BRCA2, Peutz-Jeghers syndrome, Lynch syndrome (HNPCC)
20
Q

How do you diagnose pancreatic cancer?

A
  • CT scan, ERCP/EUS (diagnostic and therapeutic), LFTs
21
Q

How do you treat pancreatic cancer?

A
  • pancreatoduodenectomy (whipple resection)

- adjuvant chemoradiation (5-FU) or chemo (gemcitabine)

22
Q

How do we manage symptoms with pancreatic cancer?

A
  • biliary stents, celiac blocks (due to pain from pressure of tumor on the celiac plexus), pancreatic enzymes, and palliative surgery for bypass
23
Q

How do we treat hepatocellular carcinoma?

A
  • surgery, liver transplant
24
Q

How do we score liver disease?

A
  • Child-Pugh scoring system
25
Q

Is squamous cell carcinoma or adenocarcinoma of the esophagus now more common in the U.S.?

A

adenocarcinoma due to GERD and western diet

26
Q

How do we treat esophageal cancer?

A
  • endoscopic mucosal resection
  • pre-op chemoradiation
  • surgery
  • Advanced disease (add traastuzumab for Her 2 positive disease)
27
Q

With what 2 cancers is H. pylori associated?

A

Gastric and MALT lymphoma

28
Q

What is hereditary diffuse gastric cancer?

A

autosomal dominant syndrome associated with diffuse-type gastric cancer, developing lobular breast cancer, and signet ring cell colon cancer.
*CDH1 gene mutation

29
Q

How do we treat gastric cancer?

A
  • chemo
  • gastrectomy
  • post-op chemoradiation

Gastrointestinal 2 (18 decks)

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