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Stomach Cancer FRCR CO2A Flashcards

1
Q

parts of stomach

A

Fundus
Body
Pylorus

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2
Q

covering of stomach

A

antr: peritoneum of the greater sac

Post: peritoneum of lesser sac

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3
Q

Blood supply of stomach

A
  1. Celiac axis via left gastric, right gastric and gastro-epiploic arteries
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4
Q

at what vertebral level celiac axis originate?

A

T12 in 75 % and at or above the pedicle of L1 in 25%

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5
Q

malignant conditions of stomach

A

Adenocarcinoma
Squamous Cell
Small Cell

Lymphoma
Carcinoid
GIST

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6
Q

Peak Incidence of Gastric Cancer

A

65 years

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7
Q

Risk Factors for Ca Stomach

A
  1. Environmental: diets low in vitamins A and C; diets high in salty/smoked foods or nitrates; smoking; low SE status
  2. infection: H. PYlori 3 to 6 X
  3. Inflammation: Barett’s esophagus
  4. pernicious anemia
  5. genertic: CDH1 mutation (E Cadherin), 80 % risk by age 80
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8
Q

Protective factors for stomach cancer

A

use of aspirin or NSAIDS, diets rich in fruit and vegetables or vitamin C; blood group O

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9
Q

2 Histological Variants

A

Lauren Classification:
1. Intestinal
2. Diffuse

both are mucin secreting adenocarcinoma

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10
Q

IHC markers for Stomach Cancers

A

CK 7
CK 20 and mucin (MUC1, 2, 5 AC, and 6)

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11
Q

what % of pts overexpress HER2

A

20 %

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12
Q

spread of gastric cancer

A
  1. direct extension
  2. Lymphatic
  3. Hematogenous
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13
Q

stomach cancer, at presentation, what % have liver and nodal involvement?

A

30 % and 60 %

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14
Q

Krukenberg tumors

A

peritoneal dissemination after extension through the serosal surface of the stomach to the ovaries

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15
Q

Blumer’s tumor

A

peritoneal dissemination after extension through the serosal surface of the stomach to the rectum or the rectal shelf

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15
Q

s/s of stomach cancer

A

anorexia

wt loss

epigastric discomfort

early satiety

dysphagia

vomiting

bleeding (hemetemesis or malena)

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16
Q

Rx fo Tis to T1b and N0

A

Endoscopic Resection or Surgery

17
Q

Rx for >T1b

A

perioperative Chemotherapy (cat 1)

18
Q

R1 post surgery

A

Chemo-Radiation

19
Q

R0 but T3 T4 or N+

A

CRT if < D2 dissection

chemotherapy if D2 dissection

20
Q

recommended regimen in peri-operative setting

21
Q

CRT regimen post Surgery

with < D2 dissection

A

Fluoropyrimidine (infusional fluorouracil or capecitabine)
before and after fluoropyrimidine-based chemoradiation

22
Q

Adj. Chemo who has undergone D2 dissection

A
  • Capecitabine and oxaliplatin (category 1)9
  • Fluorouracil and oxaliplatin
23
Q

Metastatic disease Rx

A

depends on MSI/MMR status, HER 2 expression and PDL1 status

24
Q

if dMMR/MSI - H, for metastatic stomach cancer

A

Pembrolizumab

Dostarlimab

Nivolumab and ipilimumab

Fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and nivolumab

Fluoropyrimidine (fluorouracil or capecitabine), oxaliplatin, and pembrolizumab

25
Q

2nd L regimens for stomach cancer

A

Ramucirumab and paclitaxel (category 1)

  • Fam-trastuzumab deruxtecan for HER2 overexpression-positive adenocarcinoma
  • Docetaxel (category 1)
  • Paclitaxel (category 1)
  • Irinotecan (category 1)
  • Fluorouracil and irinotecan
  • Trifluridine and tipiracil for third-line or subsequent therapy (category 1)
26
Q

NTRK fusion +

A
  • Entrectini, larotrectini, or repotrectinib
27
Q

MSI - H/dMMR

TMB high i.e > 10 mutations/megabase

A
  • Pembrolizumabe, for MSI-H/dMMR tumors
  • Nivolumab and ipilimumab for MSI-H/dMMR tumors
  • Pembrolizumabe,f for TMB-high (TMB-H) (≥10 mutations/megabase) tumors
  • Dostarlimab-gxlye for MSI-H/dMMR tumors
28
Q

surgery for distal tumors

A

partial gastrectomy if 6 cm proximal clearance can be achieved

29
Q

D1 dissection

A

removal of perigastric nodes within 3 cm of the tumor

30
Q

D2 resection

A

more extensive LND with removal of LNs around left gastric artery, hepatic artery, splenic hilum and also splenectomy and distal pancreatectomy

31
Q

within what time should adjuvant RT be started

A

within 10 weeks of surgery

32
Q

Evidence for adj CRT in gastric cancer

A

US Intergroup 0116 study

33
Q

where is adj. CRT usually practiced for pts < D2 dissection

34
Q

Dose constraint for kidneys

A

at least 3 quarters of one kidney should receive < 20 Gy

35
Q

what’s the target volume for post op gastric cancer RT?

A

tumor bed, anastomosis, residual gastric remnant

Nodal areas: gastric and Gastroepiploic, coeliac nodes, porta hepatis, sub pyloric, gastroduodenal, splenic suprapancreatic and retro pancreaticoduodenal nodes

36
Q

Overall 5 yr survival in gastric cancer

37
Q

T1 5 yr survival

38
Q

median survival for unresectable disease or metastatic disease

39
Q

pall RT dose

A

30 Gy/ 10 #

or 8 Gy SF

FRCR CO2A (24 decks)

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