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Rad therapy 2 > GI Oncology > Flashcards

GI Oncology Flashcards

1
Q

What does the upper GI tract consist of?

A

Stomach
Pancreas
Liver
Gallbladder

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2
Q

How many cases of stomach cancer worldwide?

A

790000
M:F 2:1 roughly
Highest rates in far east Russia and Europe
Incidence increases with age 200/100000 over 80 yrs old
Spicy foods

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3
Q

What is Epidemiology?

A

Pattern of spread or population

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4
Q

What is Aetiology?

A

Causes

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5
Q

What are some diet factors for stomach cancer?

A
  • Low intake of animal proteins
  • High Carbs, starch, salt and grain
  • Low fruit and veg
  • Smoked foods
  • High nitrates
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6
Q

Lifestyle factors for stomach cancer?

A
  • Alcohol and Tobacco
  • Poor nutrition
  • Low socioeconomic status
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7
Q

Occupation factors for stomach cancer?

A

Industrial dust exposure

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8
Q

Medical factors for stomach cancer?

A
  • Helicobacter pylori infection
  • Anaemia
  • Genetic-Blood group A
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9
Q

Signs and symptoms of stomach cancer?

A 
Vague epigastric discomfort 
Loss of appetite 
Weight loss 
Nausea, vomiting 
Palpable epigastric mass 
Ascites (fluid in peritoneal cavity) 
Left supraclavicular adenopathy 
Jaundice 
Left axillary adenopathy
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10
Q

Pattern of spread for stomach cancer?

A

1/3 metastatic at presentation
Local spread:

Many adjacent organs, omenta, pancreas

Regional lymph and blood channels in submucosa, subserosa

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11
Q

Lymphatic spread for stomach cancer?

A

Lymphatics:
Nodes in the left gastric chain
Then splenic, coeliac, & hepatic

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12
Q

spread to the blood for stomach cancer via?

A

Blood:

Liver & lung via portal system

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13
Q

What is the histology of stomach cancer?

A

95%-Adenocarcinoma
5%-Lymphoma
Carcinoids
Gastrointestinal stromal tumours

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14
Q

What is the success rate of primary resection for stomach cancer?

A

25-30% for curative only

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15
Q

What are some treatment types for stomach cancer?

A

Surgery
Neoadjuvant and adjuvant
Palliative Chemo and XRT

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16
Q

What is Adjuvant therapy and why is it used?

A

Post or Pre op treatment
High toxicity due to dose limiting
Good performance on positive margins
Chemo/RT improves post op survival

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17
Q

What is palliative XRT used for and what are the effects?

A

Inoperable local control of symptoms
Dysphagia, haemorrphage, pain
Chemo-inoperable metastatic disease

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18
Q

What should the stomach CTV include?

A
  • Tumour bed
  • gastric remnant
  • Nodal stations on both curvatures
  • Coeliac axis, suprapancreatic porta hepatis and splenic groups
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19
Q

OARS for stomach cancer?

A

Heart, lungs, kidney and liver

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20
Q

What is an adjuvant prescription for stomach cancer?

A
  • 45Gy in 25# with concomitant 5FU and leucovorin(chemo post RT)
  • Conformal techniques
  • critical organ doses less than 2/3 of one kidney receive less than 20 gy
  • Liver V30<60%
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21
Q

Patient care for stomach?

A 
Monitored carefully
Weekly full blood counts
Biochemistry
Dietetic assessments – including weight
Adequate measures for gastrointestinal toxicity (nausea, vomiting and diarrhoea)
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22
Q

What are Exocrine and Endocrine functions?

A

Exocrine function –
Adding digestive juices and enzymes to partially digested food via small ducts - duodenum

Endocrine function –
produces hormones insulin, help control amount of sugar in blood stream

23
Q

What is the Pancreas epidemiology and Aetiology?

A

790 000 new cases
M:F roughly 1:1
Incident increase with age and urban location

24
Q

Signs and symptoms of pancreatic cancer?

A

Jaundice, abdominal pain, Anorexia weight loss

25
Q

Signs of cancer in Head, neck and ulcinate process of pancreas?

A
  • Obstructive Jaundice

- Dark urine and clay coloured stool

26
Q

Signs of cancer in Body and tail?

A

Back pain and weight loss

27
Q

Epidemiology of pancreatic cancer?

A

Smoking

Occupation
Rubber industry
Benzidine dye industry (dry cleaning)

Medical
Diabetes mellitus
Chronic pancreatitis
Possible familial trend

Diet
High fat
Lifestyle

28
Q

Pattern of spread for Pancreatic cancer?

A

-Usually advanced at time of diagnosis

-Local spread: Throughout pancreas
Duodenum, stomach, colon
Obstructs common bile duct

Blood: Liver via Portal vein and lung

29
Q

Pathology of Pancreatic cancer?

A
  • Adenocarcinoma-80%

- Islet tumour cells, acinar carcinoma and cystadenocarcinoma

30
Q

Staging of Pancreatic cancer?

A
  • 50% diagnosed with distant mets
  • 60% in head
  • 25% in body and tail
  • 15% tail alone
31
Q

Clinical management of Pancreas?

A
  • Resection is the only chance of cure

- Less than 20% resectable

32
Q

What pancreaticoduodenectomy?

A

Resection of head of pancreas+ duodenum, distal stomach, gallbladder and common bile duct

33
Q

Risk factors of pancreatic cancer?

A
  • High local failure
  • High mortality 5%
  • Difficult operation and long patient recovery
34
Q

What is clinical management of Pancreas?

A
  • Adjuvant therapy:
  • Chemo/EBRT
  • Chemo: gemcitabine and 5 fluoro uracil
  • Neo-adjuvant chemo 6-8 wks
35
Q

Palliative therapies for pancreatic cancer?

A 
Narcotics 
Coeliac plexus nerve blocks 
Biliary stenting (for jaundice) 
Drainage of ascites 
Palliative chemo
Palliative RT (bone or brain mets)
36
Q

Margins for CTV expansion for pancreatic cancer?

A

ANT, POST, SUP-1.5-2cm covering coeliac axis, vertebral body

pancreas motion should be taken into account 1.5-2cm with respiration.

37
Q

Field arrangements for Pancreas?

A

Pancreas
Conformal planning
Minimise dose to Critical structures – both kidneys, liver, stomach, spinal cord & surrounding small bowel

Radical (combination with chemotherapy gemcitabine or
5 FU – 45-50.4 Gy in 25-28# (1.8 Gy/# 5-5.5 weeks)
Palliative – 30 Gy in 10#, 3 Gy/# in 2 wks

38
Q

Side effects and Patient care?

A

Acute:Nausea, diarrhoea and pain may - (Antiemetics and pain relief)
Severe mucositis or even ulceration of the stomach or duodenum may occur. Maintaining adequate nutrition and hydration.

39
Q

Long term side effects for pancreatic cancer?

A 
Concomitant chemotherapy - bone marrow suppression.
Renal failure (rare – improper shielding?)
40
Q

Liver Epidemiology?

A 
5th most common cancer in the world
More frequent in Asia than in Europe and USA 
Associated with chronic viral hepatatis 
Ageing population
Obesity
41
Q

Live cancer in indigenous patients?

A

-3 times more likely

Lower chance of surviving 21:33%

42
Q

Signs and symptoms of Liver cancer?

A

Presenting features: abdominal pain, weight loss

If hepatic mass present: hepatic failure, ascites & other signs of chronic liver disease,

alpha-fetoprotein (afp) is elevated in 50-70% of such patients

43
Q

Spread of liver cancer?

A 
Primary hepatic cancers may be classified as:
-unifocal exposure
-infiltrating
-multifocal
Invade the portal vein-lungs
44
Q

Management of liver cancer?

A
  • Surgery is only chance of survival-20% resectable
  • Hepatectomy and transplant more widespread
  • chemo drug used Doxorubcin response rate of 10-20%
  • XRT and stereotactic may lead to 5-10% long term control
45
Q

Palliative radiation for liver cancer?

A

Must not exceed 30Gy to whole liver or radiation hepatitis

-EBRT and IMRT- individual metastases

46
Q

Side effects and patient care of liver cancer?

A

Nausea and vomiting (5-HT antagonist antiemetics with or without steroids.)

Bilirubin, prothrombin time and albumin must be monitored.

47
Q

Tumours of the gallbladder?

A

Primary biliary tumours- gall bladder and cholangiocarcinoma-arising from the ductal epithelium of the biliary tree

48
Q

Epidemiology and Aetiology of Gallbladder?

A 
Equal incidence in male and female
After age 65
Gallbladder lethal – 10% 5 year survival rate
Chile, Japan &amp; Northern India
Gallstones , liver flukes
49
Q

Gallbladder signs and symptoms?

A 
Right upper quadrant pain
In advanced cases
Nausea
Vomiting
Weight loss
Obstructive jaundice
Cancers of the biliary tree – obstructive jaundice
50
Q

Gallbladder spread?

A

Usually arises in the body & rare in cystic duct (4%)
Adenocarcinomas (85%)
Anaplastic (6%)
Squamous (5%)
Spread –
Lymphatic spread – coeliac & aortic nodes
Hepatic mets, seed into peritoneum, invade liver

51
Q

Gallbladder management?

A

Cholangiocarcinoma
Surgical resection only curative treatment – rare
Palliative treatment – biliary stenting
5 year survival rate is 5% or less
EBRT studies have shown some responses which increase survival rate

52
Q

Treatment of gallbladder?

A

Surgical excision best chance
Chemo-radiation shown to extend survival
Intrabiliary stenting
Less than 5% 5 year survival

Combination cisplatin & gemcitabine –significant improvement for overall survival rates for patients

53
Q

Side effects of patient care for Gallbladder?

A

Nausea and vomiting
Controlled with Anti-emetic
With or without steroids

Rad therapy 2 (5 decks)

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