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Basma Medical Oncology > LGI > Flashcards

LGI Flashcards

1
Q

A tumour is CK20 positive- this suggests which primary?

A

Adenocarcinoma of large bowel origin

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2
Q

How do you treat early and late onset irinotecan diarrhoea?

A

Early (24 hrs) high dose loperamide

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3
Q

Taking which drugs reduces risk of rectal cancer?

A

NSAIDs

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4
Q

What is the most common molecular abnormality in rectal cancer?

A

Chromosomal instability

MSI is rare

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5
Q

What is the frequency of BRAF mutations like in rectal cancer?

A

Low- unlike colon cancer

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6
Q

Indications post op DXT in a pt who has upfront surgery for rectal cancer?

A

Involved CRM

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7
Q

Indications post op chemo in a pt who has upfront surgery for rectal cancer?

A

Positive nodes

Tumour perforation

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8
Q

How long should oxali be given over to prevent pharyngolaryngeal dysethesia from recurring?

A

6 hours

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9
Q

The highest lymph node in the chain closest to the surgical tie is involved. What is it called and what Duke’s stage does it make it?

A

The high tie node

DUKE’s C2

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10
Q

Most common gene mutation in Lynch syndrome?

A

MSH2

Others MLH1 and MSH6

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11
Q

In what percent of anal SCC is HPV16 and 18 found?

A

90%

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12
Q

Is there screening for anal cancer in the UK?

A

Not currently

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13
Q

What is Gardasil?

A

Quatravalent vaccine against HPV 6, 11, 16 and 18
Protects against genital warts and cancer of the anus vagina and vulva
Boys not currently vaccinated

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14
Q

What percent of AIN 3 will progress to invasive anal cancer?

A

5%

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15
Q

What is the dentate line?

A

Line where below it the epithelium is squamous (it’s near the internal anal sphincter)

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16
Q

What percent of palpable inguinal nodes in anal cancer work up turn out to be malignant?

A

Only 50%- need FNA to confirm

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17
Q

Is PET useful for anal cancer staging?

A

Yes to pick up distant mets and is high sensitivity for nodes

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18
Q

How is the T stage in anal cancer worked out?

A 
Size related 
T1 up to 2cm
T2 up to 5cm
T3 more than 5cm 
T4 any size invading adjacent organ (subcut tissue or sphincter doesn't count)
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19
Q

What percent of anal cancer is node positive at presentation? What does this mean for survival?

A

40% node positive

5 year survival 45%

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20
Q

Tell me about nodal staging anal cancer?

A 
It's based on LOCATION of nodes 
N0 none 
N1 peri rectal
N2 unilateral internal iliac or inguinal 
N3 bilat inguinal
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21
Q

What is the management of anal cancer?

A

Majority of patients definitive chemoradiotherapy

Only a v few T1 are suitable for excision biopsy (IE less than 2cm) - if leaves residual disease then give them chemoRT

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22
Q

What is the regimen of chemo RT for anal SCC?

A

DXT 50.4 Gy in 28# to primary and nodes
Chemo 5FU pumps (or cap) in two four day blocks
Mitomycin C bolus day 1 only

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23
Q

What is the complete response rate for definitive CRT for anal SCC?

A

80% (impressive!)

24
Q

How long does it take for a tumour to regress completely after CRT for anal SCC?

A

6 months- don’t over biopsy

If patient fails then for salvage surgery- AP resection with stoma

25
Q

What are the side effects of Mitomycin C?

A

Myelosupression- check weekly FBC
Dermatitis
Pulmonary fibrosis
Haemolytic uraemic syndrome

26
Q

What changes have to be made if a patient with HIV has treatment for anal SCC with chemo RT?

A

None if CD4>400

If CD4

27
Q

What is first line chemo for metastatic anal cancer?

A

Cis 5FU

28
Q

Should you resect oligo met anal SCC?

A

No evidence for it but there are some case reports of successful liver met resections

29
Q

Are polyps a big deal?

A

Well ALL colorectal cancer originally arises within precursor polyps so you could say so

30
Q

What kind of polyp is the most risky in terms of CRC?

A

Pedunculated

31
Q

What is the 10 year risk of a > 1cm polyp progressing to cancer?

A

15%

32
Q

Name the three main molecular patterns of CRC?

A

(1) Chromosome unstable (80%) lots of chromosomal stuff
(2) DNA mismatch repair (15%) 1000’s of point mutations, small del, ins
(3) “serrated” CpG island hypermethylation. BRAF Mutant. RIGHT Sided.

33
Q

RR of CRC if longstanding UC?

A

X10

34
Q

% CRC familial

A

5%

35
Q

Two main types familial CRC

A

FAP (APC gene)

HNPCC (Lynch syndrome) DNA mismatch repair (MSH2 most common)

36
Q

Which familial CRC syndrome get tumours youngest?

A

FAP - have to start annual colonoscopy age 10!

In HNPCC start colonoscopy age 30

37
Q

Management of risk in APC?

A

100% risk of CRC by age 40 so it’s intensive
Annual colonoscopy from age 10
OGD age 25
NSAIDS
Prophylactic colectomy and monitor rectal stump

38
Q

What kind of gene is APC?

A

Gatekeeper TSG- controls wnt signalling pathway

39
Q

Common mutations in CRC (4)

A

APC
KRAS
P53
PIK3CA

40
Q

Two prognostic molecular biology factors in CRC:

A

Poorer prognosis 18q alleli can loss

MSI/MMR may identify patients at lower risk of recurrence

41
Q

Describe the UK bowel screening program

A

Part 1 Age 60-74 faecal occult blood every 2 years reduces CRC mortality by 15%
In in 10 of those with positive FOBT will turn out to have cancer
Part 2 one off flexi sig age 55 NNTS 300 to pick up one CRC (ESMO don’t recommend a one off sigi)

42
Q

Adverse signs in a colorectal polyp - unfavourable histology meaning operative resection needed

A 
Invasion into stalk 
Grade 3
LVI 
Involved margin
Invades sub mucosa
43
Q

What structure do malignant cells have to cross in the bowel wall for them no longer to be in situ but become invasive?

A

Lamina propria

44
Q

What is the significance of an elevated pre op CEA?

A

CEA>5 worse prognosis

Should normalise by 1 month post operative

45
Q

How many nodes should be examined in CRC surgery?

A

At least 12

46
Q

What is Dukes C1 disease in CRC?

A

Node positive but the highest node IE nearest surgical tie is negative

47
Q

Who gets adjuvant treatment in CRC?

A 
YES Node positive (stage 3 or dukes C) 
PLUS High risk Dukes B (t3 or t4) plus high risk features like 
Less than 12 LN sampled
Poorly diff 
LVI 
Perf/obstr
48
Q

What is the evidence for not giving oxaliplatin to patients over age 70?

A

MOSAIC trial sub analysis >70 did not benefit from adding oxaliplatin

49
Q

What proximal and distal margins are needed with surgery for CRC?

A

5cm

50
Q

Where is the cut off between rectal cancer and colon cancer?

A

15 cm from the anal margin

51
Q

What is T2 and T3 rectal cancer?

A

T2 is in the muscularis propria

T3 is in the subserosal/ perirectal tissue

52
Q

If rectal cancer has reached the serosal surface what stage is that?

A

T4a invasion of the visceral peritoneum

53
Q

What is the impact on prognosis in CRC if a patient has BRAF mutation?

A

Adverse prognostic indicator

No consistent data on impact of EGFR treatment

54
Q

Describe TNM anal scc

A

T1 up to 2cm
T2 up to 5cm
T3 more than 5cm
T4 any size invades adj organ

N1 perirectal
N2 unilat int iliac or unilat inguinal
N3 bilat inguinal

55
Q

Indications for post Op RT in rectal cancer

And indications for post op chemo

A

Involved CRM
Tumour perf

Chemo:
Positive nodes
Tumour perforation

56
Q

A rectal tumour extends 1mm from rectal wall what T stage is that?

A

T3a

57
Q

Age a first degree relative has to be diagnosed with bowel cancer to make you at increased risk?

A

Below age 50

Basma Medical Oncology (26 decks)

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