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Oncology > Upper GI > Flashcards

Upper GI Flashcards

0
Q

Women or men with GERD has a higher risk of Barrett?

A

Men.

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1
Q

What are the risk factors for squamous cell carcinoma of the esophagus, adenocarcinoma of the esophagus, and gastric cancer?

A

Squamous esophageal: diet, smoking. Adeno esophageal: Barrett. Gastric: diet, H. pylori.

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2
Q

True or False: The longer the Barrett’s segment is, the higher the risk of cancer is.

A

True.

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3
Q

Does endoscopic surveillance decrease mortality from esophageal adenocarcinoma?

A

No.

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4
Q

At what depth of invasion is endoscopic mucosal resection no longer curative?

A

Submucosa. However, endoscopic submucosal resection for shallow submucosal invasion can be considered.

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5
Q

In Japan, what is the reduction in gastric cancer mortality by screening with barium studies?

A

40-60%

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6
Q

Which countries have the highest incidence of esophageal cancer (mostly squamous)?

A

Iran, Russia, and northern China. Less common in Japan, Europe, and the US.

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7
Q

What are the risk factors for Barrett’s esophagus?

A

GERD, white or Hispanic, male, advancing age, smoking, obesity.

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8
Q

What is the relative risk of developing esophageal adenocarcinoma in patients with Barrett’s esophagus?

A

11.3 compared to the general population.

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9
Q

Does H. pylori infection reduce or increase the risk of esophageal cancer? How about HPV infection?

A

Reduce esophageal adenocarcinoma due to reduced acidity. HPV increases incidence of squamous cell cancers of the upper esophagus.

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10
Q

Is adjuvant therapy needed after trimodality treatment for esophageal cancer?

A

No. Not supported by strong evidence but still often given, especially for positive nodes.

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11
Q

What is the 5-year survival for patients with esophageal cancer treated with just surgery?

A

Less than 10-15%

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12
Q

For esophageal cancer, neoadjuvant or adjuvant radiation has been associated with what outcomes?

A

Tumor shrinkage, dysphasia improvement, better local-regional control, but no survival benefit over surgery alone.

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13
Q

Are squamous cancers of the esophagus or adenocarcinomas more sensitive to chemorad, suggesting surgery might not be necessary afterwards?

A

Squamous.

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14
Q

What are the results of the MAGIC trial comparing perioperative ECF with surgery alone?

A

Better survival for perioperative chemo. This trial included gastric, esophageal, and GEJ cancers. Only about 55% of patients on the chemo arm received postoperative chemo, suggesting that the benefit was due to preoperative chemo.

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15
Q

T or F: Neoadjuvant chemorad for esophageal cancer has similar outcomes to surgery alone.

A

False. Neoadjuvant chemorad has significantly better outcome.

16
Q

In esophageal cancer treatment, is chemorad with carbo/taxane less or more toxic than 5-FU/platinum?

A

Less toxic.

17
Q

What are the roles of bevacizumab and cetuximab in the treatment of metastatic esophageal cancer?

A

Bev not helpful. Cetuximab might even be harmful. On the other hand, ramucirumab (anti-VEGFR-2) had better survival than BSC.

18
Q

T or F: Aspirin and other NSAID use has been associated with a lower risk for GI cancer.

A

True.

19
Q

Main risk factors for gastric cancer?

A

High salt and nitrate intake, low vitamin A and C intake, smoked or cured foods, poor drinking water. H. pylori too.

20
Q

Does treating H. pylori reduce gastric cancer risk?

A

A large Chinese study says no. A meta-analysis suggests yes.

21
Q

T or F: Surgical resection is the only potentially curative treatment for gastric cancer.

A

True. For early-stage, node-negative disease, the cure rate for surgery can be 75-80%.

22
Q

T or F: D2 resection for gastric cancer is routinely done in Asia but has not been proven to be better than D1 resection.

A

False. A large Dutch trial showed D2 had better locoregional control and fewer gastric cancer-related deaths than D1.

23
Q

For gastric cancer, is surgery alone as good as surgery followed by chemorad?

A

Not as good.

24
Q

What are the general approaches to early-stage gastric cancer?

A

Adjuvant chemorad in the US, perioperative chemo in the UK, adjuvant chemo after D2 resection in Asia.

25
Q

What is the standard chemo regimen for advanced gastric cancer?

A

A platinum and a fluoropyrimidine, with or without epirubicin or docetaxel. Irinotecan can replace the platinum.

26
Q

The ToGA trial randomized patients with advanced gastric or GEJ adenocarcinoma and HER2 over expression to cis/5-FU or cis/5-FU/trastuzumab. What were the results?

A

Trastuzumab increased OS from 11.1 mos to 13.8 months. (Trials with lapatinib have been disappointing, as are ones involving EGFR monoclonal antibodies.)

27
Q

What is the role of bev in advanced gastric cancer?

A

The AVAGAST trial showed superior OS with bev, but for Asian patients.

28
Q

What is the role of ramucirumab in advanced gastric?

A

In the second line setting, ramucirumab plus paclitaxel was associated with better OS than paclitaxel alone.

29
Q

What are the risk factors for pancreas cancer?

A

Tobacco, chronic pancreatitis, selective mutations of BRCA2 and, to a lesser degree, BRCA1…

30
Q

T or F: Most pancreatic cancers have KRAS mutations.

A

True

31
Q

What are the precursors of invasive ductal carcinoma of the pancreas?

A

Pancreatic intraepithelial neoplasia, intraductal papillary mucinous neoplasms, and mucinous cystic neoplasms.

32
Q

Surgery is the only potentially curative treatment for pancreatic cancer. What is the 5-year survival rate for those able to undergo resection?

A

5-25%

33
Q

What is the adjuvant therapy after resection of pancreatic cancer?

A

Gemcitabine is better than nothing. Gemcitabine is similar to bolus 5-FU/LV. Gemcitabine is inferior to S-1. Gem + chemorad with 5-FU + gem is better than chemorad with 5-FU.

34
Q

What is the treatment for locally advanced pancreatic cancer?

A

Chemorad with 5-FU is commonly used. However, in a European phase III, chemorad with cis/5-FU is inferior to gem alone. The LAP-07 phase III showed that (1) the addition of erlotinib to gem has no added benefit and (2) no survival benefit when switching from chemotherapy to consolidating chemorad.

35
Q

Should preoperative biliary drainage be done routinely in patients undergoing subsequent surgery for pancreas cancer?

A

No

36
Q

What is the treatment for metastatic pancreatic cancer?

A

Gem is better than 5-FU (without LV). Gem + erlotinib is better than gem, by 2 weeks. Gem + a platinum or fluoropyrimidine might be better than gem for patients with good PS. Gem is inferior to FOLFIRINOX, 6.8 mos vs 11.1 mos. Gem is inferior to gem + nab-paclitaxel, 6.7 mos vs 8.5 mos. VEGF and EGFR therapies (except for erlotinib) have been disappointing.

37
Q

Hereditary diffuse gastric cancer is associated with __ mutation in 30-50% of affected kindreds.

A

CDH1 (E-Cadherin)

Oncology (12 decks)

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