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GI > pancreatic > Flashcards

pancreatic Flashcards

1
Q

pancreatic cancer mutations

A

p16 80%; p53 70%; SMAD4 55%; K-RAS 90%; the more the worse

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2
Q

risk factor pancreatic cancer

A

A-A, male, tobacco (RR 2.5), obesity, fat/alcohol, chronic pancreatitis, diabetes, chronic hep B/C, cirrhosis

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3
Q

familial pancreatic cancer

A

10% of patients; BRCA, peutz-jegher, HNPCC (MLH1,MSH2), ataxia telangiectasia

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4
Q

resectable pancreatic cancer treatment

A

2 options: up front surgery versus NACT +/- chemorad

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5
Q

borderline resectable pancreatic treatment

A

favor neoadjuvant with chemoradiation (one of only situations where chemorad is used)

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6
Q

pancreaticoduodenectomy

A

mortality 2-4% morbidity 30%, high volume center maximizes outcome

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7
Q

post-op chemo for pancreatic

A

CONKO-001: gem v. observation–> doubling of OS; 10yr OS 12.2 v 7.7%; ESPAC-3: compare to 5-FU: no difference, gemcitabine better because of improved toxicity

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8
Q

gemcitabine complications

A

HUS, pneumonitis

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9
Q

adjuvant chemoradiation in addition to adjuvant therapy?

A

NO, inferior

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10
Q

adjuvant 2 versus one chemo?

A

all pending trials

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11
Q

adjuvant S1 v. gem?

A

70 v 53% 2yr OS in favor of S1! but was non-inferiority endpoint

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12
Q

pancreatic adeno thromboembolic events

A

20-50% rate

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13
Q

metastatic: gem v. 5-FU

A

gem 18% 1yr OS v. 2%

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14
Q

chemo metastatic setting

A

addition to 5-FU or platinum to gem might be better

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15
Q

Prodige 4-ACCORD 11

A

ECOG0-1, FOLFIRINOX v. gemcitabine–> 11.1 v 6.8mo, delays worsening quality of life; ORR rate 31 v 9.4%,

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16
Q

FOLFIRINOX tox

A

neuropathy, febrile neurtopenia 5%, thrombocytopenia, neuropathy, diarrhea 13%, vomiting 14%

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17
Q

MPACT

A

KPS 70-100; Nab-pac + gem v. gem; OS 8.5 v 6.7mo, worsening neuropenia,fatigue,neuropathy

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18
Q

erlotinib data in pancreatic

A

PA.3–> 6.24mo v 5.9mo median OS but significant. FDA APPROVED WITH GEMZAR!

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19
Q

GERCOR phase III trial- locally advanced

A

gem +/- erlotinib, then +/-chemoRT–> adding erlotinib worse; chemoradiation not clearly better

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20
Q

well-diff neuroendocrine tumor

A

mostly aerodigestive tract (carcinoid)

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21
Q

PNET

A

pancreatic neuroendocrine; only <20% functional

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22
Q

behavior of NE tumors

A

look at differentiation and Ki67 and grade (high grade >20mit/HPF and 20%ki67

23
Q

PROMID study

A

octreotide v. placebo: 14.3mo time to tumor progression v 6mo

24
Q

genetic mutations in pancreatic

A

KRas, P16, p53, SMAD4, BRCA1/2 (5%), MMR, STK11(Peutz-Jeghers), FANCC/FANCG (fanconi)

25
Q

Whipple surgery for pancreas

A

mortality <.5% in major institutions, median survival 2years. complicated by leaks, fistula

26
Q

borderline resectable pancrease cancer

A

significant venous involvement, but not arterial. favor neoadjuvant therapy and re-staging. may require vascular resection

27
Q

adjuvant chemo for pancreas

A

CONKO-001 trial- gem v. observation, doubling of DFS, 2.6month improved OS. doubling of 5yr survival (20v.10), 12% 10-year survival. if gem not tolerated (pneumonitis), can complete adjuvant therapy with bolus 5-FU which has same survival.

28
Q

pancreatic cancer sequelae

A

50% thrombolic,

29
Q

prognosis pancreatic

A

ECOG2 2.8mo OS, 0 OS 8mo

30
Q

first line metastatic pancreas

A

gem>5, 1yr OS 18% v. 2%

31
Q

FOLFIRINOX for pancreatic ca

A

FOLFIRINOX v. gem- PS0-1, improved OS 11.1 v. 6.8mo, delays worsening of QOL,

32
Q

FOLFIRINOX toxicities

A

myelosuppression, GI tox, need for GMCSF, LFTs, 9% neuropathy. age limit 70, only ECOG 0-1

33
Q

nab-taxol + gem v. gem for pancreatic

A

improved OS 8.5 v. 6.7mo, significant,

34
Q

locally advanced pancreatic

A

if no progression after chemo, may consider switching to chemoRT with 5-FU based regimen but no data to support

35
Q

second line chemo for pancreatic

A

FOLFOX, what you didn’t get

36
Q

well-diff PNET when to tx

A

treat if uncontrolled Sx, or progression under observation

37
Q

when to resect a PNET

A

can debulk if a lot of symptoms with some benefit. if resectable, can resect

38
Q

treatment of PNET options

A

octreotide v. placebo- time to progression 14.3 v. 6mo; lanreotide is subQ monthly, improved PFS.

39
Q

other tx for PNET

A

temozolamide, strep/dox, 5-FU, regional approaches, pancreas-sunitinib, everolimus, maybe somatostatin analogues

40
Q

Peutz-Jehgers

A

STK11/LKB1 gene mutation. mucocutaneous lesions, hamartomas of GI tract, pancreatic cancer, breast, lung, ovarian

41
Q

adjuvant radiation for pancreas

A

no definitive data, can give adj chemo+5-U +/- gemcitabine (pre and post)

42
Q

unresectable pancreatic cancer

A

standard is infusional 5-FU/RT –> gem alone. Alternative is gem alone (no RT). no data yet on nab/gem or FOLFIRINOX

43
Q

MENI

A

pancreatic neuroendocrine tumors, pituitary tumors, parathyroid tumors (men 1)

44
Q

MENII

A

RET gene- parathyroid tumors, pheo, and medullary thyroid [2 is worse]

45
Q

carcinoid tumor prognossi

A

great if resected and LN-negative. latent mets frequent if LN-positive

46
Q

appendix carcinoid management

A

appendectomy if

47
Q

intestinal carcinoids

A

only have systemic symptoms if liver mets (due to liver first pass clearance)

48
Q

carcinoid evlauation

A

if long disease course, need echo to look for R side of heart. PET is bad. get octreotide scan or CT/MRI

49
Q

carcinoid/PNET resections

A

can be complete, or palliative for debulking

50
Q

therapies for carcinoid

A

octreotide, interferon alpha (superior to streptozocin/5-FU)

51
Q

standardtherapy for non-carcinoid PNET tumor

A

streptozosin + doxorubicin

52
Q

poorly differentiated gut neuroendocine tumors therapy

A

small cell regimens: etoposide/cisplatin

53
Q

PNET alternative therapies

A

sunitib, everolimus. NOT effective for carcinoids

54
Q

high grade neuroendocrine/carcinoid

A

TREATED AS SMALL CELL/LARGE CELL– chemo

GI (7 decks)

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