Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

FRCR2 > oesophagus > Flashcards

oesophagus Flashcards

1
Q

What are the risk factors for oesophageal adenoca

A

Typically distal oesophagus

GORD
Obesity
Reflux & Barretts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for oesophageal SCC

A

Typically proximal oesophagus
Alcohol, smoking

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the investigations for a potential oesophageal cancer

A

Assess local disease:
OGD & biopsy
EUS for nodal assessment
+/- bronchoscopy if threat of tracheal invasion / involvement

Assess distant disease:
CTCAP
PET (if considering radical treatment)
Laparoscopy to exclude peritoneal mets (in GOJ or T3/4 tumours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the frequency of follow up OGD for surveillance of dysplasia on biopsy

A

No dysplasia: OGD every 2-3 years
LG dysplasia: OGD every 6 months
HG dysplasia: discuss in MDT – resect vs surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What molecular markers are sent for a metastatic oesophageal cancer

A

PDL1, MMR and HER2
PDL1 - CPS >10, or TPS >1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is a T1 oesophageal cancer defined

A

Invasion into mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is a T2 oesophageal cancer defined

A

Muscular invasion - muscularis propia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is a T3 oesophageal cancer defined

A

Invasion into adventitia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is a T4 oesophageal cancer categorised and defined

A

Resectable local invasion - 4a - pleura, pericardium, diaphragm, peritoneum
Non-resectable local invasion - 4b - aorta, trachea vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is nodal staging defined for oesophageal cancer

A

N1 - 1-2 nodes
N2 - 3-6 nodes
N3 - ≥7 nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is endoscopic surgery indicated for oesophageal cancer

A

T1N0 disease, and <2cm, <1/3 oesophageal circumference, non-ulcerated, well diff cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the treatment regime for a T2-4 or node positive oesophageal adenocarcinoma

A

Neoadjuvant FLOT x4 cycles, followed by surgery and adjuvant FLOT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the regimen for neoadjuvant CRT for oesophageal SCC or adenocarcinoma

A

Weekly carboplatin (AUC2)/paclitaxel (50mg/m2) x5 with 41.4Gy/23# RT

CROSS trial demonstrated improved R0 resection and benefit in mOS (SCC better than adeno)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the types of oesophagectomy and when are they indicated

A

2 stage - Ivor-Lewis, with en bloc two field lymphadenectomy - for mid/lower 1/3 oesophageal cancer
3 - stage - McKeown - for proximal cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When is definitive CRT for oesophageal cancer indicated

A

Surgery is SOC

CRT indicated if:
Pt declines surgery
Pt not fit for surgery
Local disease precludes, ie unlikely to achieve an R0 resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the chemoRT regimen for oesophageal cancer
How does CRT compare to surgery

A

4 cycles of 3wkly cisplatin (75mg/m2 - D1) & 5FU (1000mg/m2 - D1-4)
OR 3wkly cisplatin (60mg/m2 - D1) & bd capecitabine (625mg/m2) throughout treatment

RT given with cycles 3 & 4
50Gy/25# (or 50.4Gy/28#)

Local control rates better with surgery, but equivalent overall survival
ESOPEC trial is investigating neoadjuvant FLOT vs CRT

17
Q

When is adjuvant nivolumab indicated for oesophageal cancer
What was the benefit

A

Only following trimodality treatment, ie chemoRT and surgery, where there is residual disease on pathology, either for SCC or adeno

1yr adjuvant nivolumab, no PDL1 status needed

Improved DFS from 11mths to 22.4 and reduction in risk of death

18
Q

When is radical RT alone indicated and what is the dose

A

when not fit for surgery or CRT

Dose:
If <5cm - 50Gy/16#
If >5cm - 55Gy/20#

19
Q

What is the maximal oesophageal tumour length that can be treated with RT

A

17cm - 10-12cm tumour and nodes, + margin

20
Q

What is the GTVp & GTVn

What is the GTV-CTV margin and what else is included in the CTV?

What is the CTV-PTV margin

A

GTVp - Tumour + nodes within 3cm
GTVn - nodes >3cm from primary

CTV - GTVp +2cm sup/inf, or GTVn +1cm (whichever is greater), then 1cm radially
If GOJ involvement - extend CTV to 2cm below GTV
CTV also includes elective nodal regions, gastrohepatic ligament, paracardial and left gastric LNs

CTV-PTV margin - 1cm sup/inf & 0.5cm radially

21
Q

What are the OAR dose constraints for oesophageal RT - lung

A

Lungs - V20Gy < 25%

22
Q

What is the treatment given to a HER2+ metastatic oesophageal adenocarcinoma

A

Trastuzumab with cis-cape / carbo-cape / cap-ox

23
Q

What palliative RT can be given to oesophageal cancer
What volume

A

20 in 5 or 30 in 10, for dysphagia or bleeding
CTV - GTV +3cm sup/inf
PTV - CTV +1.5cm all around, and 7mm for field edge if field based RT
6MV POP

24
Q

What is the prognosis for radically treated oesophageal cancer

A

Radical surgery
T1/2 N0 - 50%
T3/4 or N1-3 - 20%

Radical RT - 20%

CRT - 30%

25
Q

What are the OAR dose constraints for oesophageal RT - heart

A

V40Gy<30%

26
Q

What are the OAR dose constraints for oesophageal RT - kidneys

A

Mean <18Gy
Ipsi V20 <40%
Contra V20 <25%

27
Q

What are the OAR dose constraints for oesophageal RT - spinal cord

A

objective <48Gy, constraint <50Gy

28
Q

What are the OAR dose constraints for oesophageal RT - liver

A

V30Gy<60%

29
Q

What are the OAR dose constraints for oesophageal RT - spleen

A

<10Gy mean

30
Q

How is PDL1 status categorised for metastatic oesophageal SCC

how does this determine management

A

SCC

PDL1 ≥10 (CPS)
PDL1 TPS ≥1% but CPS <10
PDL1 negative

PDL1 ≥10 (CPS) - pembro + ChT (Pt/FP)
PDL1 TPS ≥1% but CPS <10 - Nivolumab-ChT
PDL1 negative - ChT only, nivolumab 2nd line (no PDL1 requirement)

Taxane or irinotecan on progression

31
Q

How is PDL1 status categorised for metastatic oesophageal adenocarcinoma

how does this determine management

A

Adeno

PDL1 ≥10 (CPS)
PDL1 CPS 5-10
PDL1 negative (CPS <5)

PDL1 ≥10 (CPS) - Pt/FP + pembro or nivo
PDL1 CPS 5-10 - Nivolumab-ChT
PDL1 negative (CPS <5) - Pt/FP ChT (or carboplatin/paclitaxel if FP intolerant)

32
Q
A

FRCR2 (38 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions