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CGSO oral boards > Upper GI > Flashcards

Upper GI Flashcards

1
Q

post-op therapy for esophageal SCC?

A

no systemic until progression.

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2
Q

GE cancer with positive supraclavicular node?

A

unresectable per NCCN guidelines

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3
Q

Longterm survival of T1b GE cancer?

A

Not good, need agressive surveilance or go to esophagectomy

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4
Q

Esophageal Stent at the diagnosis of GEJ cancer?

A

Only if patient will never be a surgical candidate or if they cannot swallow their own saliva.

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5
Q

Ideal lymph nodes for GE cancer staging?

A

15 if no preop therapy

undefined after neoadjuvant therapy but try for 15

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6
Q

Anatomic definition of proximal location of resectable esophageal cancer?

A

any tumor >5cm from the cricopharyngeus

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7
Q

What % of patients tolerate chemo/RT after GE junction resection?

A

Only a little over half the patients in MacDonald completed therapy.

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8
Q

What test before starting systemic therapy for esophageal adeno?

A

check HER2 status

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9
Q

Level of evidence for endoscopic resection of esophageal cancer?

A

large institutional data, no level I, but accepted.

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10
Q

Follow-up for gastric cancer?

A

Would get serial CT scans, but little evidence to support.

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11
Q

EGD surveillance after endoscopic resection/ablation of esophageal cancer?

A

start with q3month deescalate to yearly after 3 years

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12
Q

EUS after nonsurgical therapy for gastroesophageal cancer?

A

considered less reliable

[nccn 2019]

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13
Q

Trastuzumab for HER2 GEJ cancer?

A

add to chemo for all stage IV

[NCCN 2019]

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14
Q

Things to check before starting neoadjuvant therapy for GEJ cancer?

A

nutrition status and think about a j-tube

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15
Q

When is endoscopic resection likely to be fully therapeutic? (esophageal SCC - 5)

A 
lesion <2cm
lesion fully removed
well to moderate differentiation
superficial to submucosa
no LVI
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16
Q

Value of PET for gastroesophageal cancer?

A

No evidence it is superior to CT scan for staging.

Radiation Oncology uses for treatment planning.

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17
Q

Criteria to conservatively manage a thoracic esophageal leak?

A

<1/3 of circumpherence of esophagus

No evidence of ischemia.

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18
Q

When to do endoscopic resection?

A

Any nodular lesion <2cm.

If it is not therapeutic then it is more diagnostic of T stage than EUS

NCCN 2019

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19
Q

Does everyone get dumping syndrome after gastrectomy?

A

no!

do not put on low glucose diet until they get symptoms.

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20
Q

Longterm survival of Tis and T1a GE cancer?

A

close to non-cancer patients

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21
Q

NCCN guidelines for neoadjuvant therapy for SCC?

A

all T3 or N+,

can offer to all T1b or above.

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22
Q

Outcomes for robotic v open gastrectomy?

A

4 Asian RCTs suggest equivalent and on MSKCC study (V. Strong)

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23
Q

Number of chemo agents for GEJ cancer

A

double agents preferred to triple agent outside of a trial or high volume center

[NCCN 2019]

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24
Q

Progressive oligometastatic GIST on Gleevec?

A

Resect! still good survival in carefully selected patients.

[retrospective data - Raut Brigham]

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25
Q

when to start surveilance endoscopy after definitive radiation for esophageal cancer?

A

at least 6 weeks

[nccn 2019]

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26
Q

No residual disease after radiation of endoscopy, what next?

A

still do four quadrant blind biopsy of neomucosa. Residual dysplasia may be below the mucosa.

[nccn 2019]

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27
Q

Three types gastric carcinoids?

A

I - solitary larger mass
II - associated with achlorohydrea
III- associated with gastrinoma.

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28
Q

Is there utility in getting peritoneal washings for gastric cancer?

A

no, very rarely positive in absence of clinically detectable mets. retrospective series

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29
Q

Endoscopic Surveillance for Fanconi’s anemia

A

Consider immediately at diagnosis

may be limited by other conditions

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30
Q

Endoscopic therapy for esophageal adenocarcinoma?

A

up to superficial T1b

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31
Q

Classic start to work-up of dysphagia?

A

Do a barium swallow if not immediately a diagnosis of cancer.

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32
Q

Difference between linear and circular stapled anastomosis in GE surgery?

A

No difference in leak, some higher rate of stenosis with circular stapler.

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33
Q

Fanconi’s Anemia

A

multiple genes - DNA repair deficiency
anemia
bleeding
SCC of multiple locations

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34
Q

When to not offer chemo for Stage IV esophageal SCC?

A

KPS <60
ECOG >3 limited self care, sedentary >50% of time

[NCCN]

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35
Q

Management of cT4b SSC of the esophagus?

A

definitive chemoradiation

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36
Q

Can peritoneal washings change in response to neoadjuvant therapy?

A

yes

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37
Q

FLOT regimen

A

5FU over 24 hours
Leucovorin
Oxaliplatin
Docetaxel

14 day cycles
4 cycles preop
4 cycles post-op

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38
Q

Endoscopic Surveillance for Familial Barrett’s

A

After age 40

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39
Q

reresect recurrent esophageal SCC?

A

yes if feasible per NCCN

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40
Q

Esophageal endoscopic resection v. ablation?

A

nodular lesion - needs ER for staging
flat lesion <2cm - can do either, (ER prefered)
flat lesion >2cm - ablation is safer

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41
Q

Treatment for cancer in cervical esophagus?

A

definitive chemo radiation

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42
Q

Dilate an obstructing tumor to complete and EUS?

A

associated with perforation, would not do

43
Q

What to do before starting neoadjuvant therapy for Gastric cancer?

A

Do staging laparoscopy and peritoneal cytology

M1 cytology has 60-80% chance of progressing during therapy. Need to consider surgery only as part of a trial.

44
Q

surveillance for complete clinical response for neoadjuvant chemoRT for esophageal SCC?

A

accepted by NCCN, but probably wouldn’t do

45
Q

Endoscopic Surveillance for Tylosis

A

After age 20

46
Q

Level I evidence for surveillance after definitive therapy for GEJ cancer?

A

none

47
Q

High risk genetic conditions for GE cancer?

A

Tylosis
Familial Barrett’s Esophagus
Bloom Syndrome
Fanconi’s Anemia

48
Q

Neoadjuvant dosing of FOLFOX for GEJ cancer?

A

Continuous 5FU for first 48 hours of each cycle.
Oxaliplatin and Leucovorin on day 1
Cycle every 2 weeks x 3 cycles with RT
3 more cycles after RT

49
Q

incidence of gastric cancer in <40 year olds?

A

Is increasing similar to that of CRC, unclear mechanism

50
Q

NCCN statement of systemic therapy for GEJ cancers

A

Most systemic therapies can be considered interchangeable

51
Q

Rainbow trial?

A

established VEGF + FOLFOX second line for gastric cancer.

52
Q

Acute bleeding from an esophageal tumor, nccn statement

A

may represent a pre-terminal event from aorto-esophageal fistulazation.
Use endoscopy cautiously, recurrent bleeding is high.

53
Q

Chronic bleeding from an esophageal tumor

A

palliative radiation

54
Q

What test to order right after an esophageal stent is placed?

A

swallow study to ensure no leaks.

55
Q

EGD surveillance after definitive chemoradiation of esophageal cancer?

A

EGD every 3-6 months for 2 years

Annual for next 3 (years 3-5)

56
Q

GE junction cancer invading the liver or spleen?

A

unresectable per NCCN guidelines

57
Q

Timeframe of “actionable” GEJ recurrences?

A

90% within 2 years.

[NCCN 2019]

58
Q

Minimal esophageal biopsies?

A

6-8 biopsies with standard to large forcepts

59
Q

Treatment for esophageal cancer within 5 cm of the cricopharyngeus?

A

definitive chemoradiation

60
Q

Additional biomarkers/targets to test for for stage IV GE cancer?

A

MSI and PDL-1 testing

can be done of FFPE tissue

61
Q

What is main toxicity of ECF?

A

hand foot syndrome

neuropathy

62
Q

Bloom’s Syndrome

A

BLM gene

AML, ALL and esophageal SCC at age 20

63
Q

EUS biopsy esophageal nodes?

A

Yes for all unless there is a blood vessel in the way (check flow with doppler)

64
Q

What is response rate for dose escalation of Imatinib 400 to 800?

A

33% in metastatic progression.

65
Q

Neoadjuvant chemoradiation for Siewert III lesions?

A

generally not; if you do it use the gastric guidelines.

66
Q

complete response rate of esophageal SCC to definitive chemoradiation?

A

~60%

67
Q

Tylosis

A

RHBDF2 gene

high risk of esophageal SCC

68
Q

TOGA trial?

A

14 months OS with FOLFOX+ Herceptin v

11 months with FOLFOX alone for gastric cancer

69
Q

reconstruction after gastrectomy?

A

always a roux limb.

70
Q

When to do esophagectomy for T1a SCC?

A

extensive disease, especially nodular disease not controlled by ablation.

71
Q

What to do with progression of metastatic GIST?

A

Dose escalate from Imatinib 400 to Imatinib 800.

72
Q

NCCN position on peritoneal washings for GE cancer?

A

“consider” for T3 or N+ disease

73
Q

Complete clinical response to neoadjuvant thererapy for gastric adeno?

A

still need surgery, do not let them trap you into watch and wait.

74
Q

Goal gross margins for gastric cancer?

A

> 4 cm

15 lymph nodes

75
Q

Older patient with difficult to localized pylorus?

A

Can always do upper endoscopy intraop.

76
Q

hand foot syndrome

A

occurs during capecitabine or 5-FU.

hand and foot erythema, blistering and skin peeling

no treatment

gradually improves once chemo stopped/reduced

77
Q

Who could you potentially omit staging laparoscopy on for gastric cancer?

A

T2 or lower

no nodal involvement.

78
Q

EGD Surveillance after esophagectomy?

A

as needed unless Barrets left over, then start with q3 month endoscopy

79
Q

Linitis plastica on pathology?

A

Always do a total gastrectomy and be prepared to chase the superior margin into the chest.

80
Q

What early gastric cancers should not get an endoscopic mucosal resection?

A

poorly differentiated

ulcerated on endoscopy

81
Q

Siewert Classification

A

I is 1-5 cm above GE junction
II is 1 cm above or 2 cm below the GE junction
III is more than 2cm below, treat as gastric.

82
Q

How do you do Endoscopic Lumen restoration for complete lumen restoration with an esophageal cancer?

A

Via anteriograde and retrograde (via gastrostomy) endoscopy.

[NCCN guidelines]

83
Q

Was diagnostic laparoscopy routine for Magic study?

A

no! may have worsened results.

84
Q

Cutoff for endoscopic resection of esophageal SCC?

A

T1a or lower. (tumor invades muscularis mucosa)

85
Q

What do you do before starting neoadjuvant chemo for gastric cancer?

A

Diagnostic laparoscopy in addition to standard staging.

86
Q

Familial Barret’s

A

numerous genes associated

87
Q

Staging after diagnosis of GE cancer?

A

start with CT C/A/P

if no M1 disease go on to PET and EUS

88
Q

Endoscopic Surveillance for Blooms Syndrome

A

After age 20

89
Q

When do you do adjuvant chemoradiation after esophagectomy (SCC)?

A

only for R1 resection

90
Q

esophageal SCC invading trachea, great vessels of heat?

A

consider chemotherapy alone

91
Q

Supplements needed after total gastrectomy? (3)

A

Vit D
Iron
B12

92
Q

NCCN imaging surveillance after esophagectomy by stage?

A 
Stage I (T1N0) - only with symptoms
Stage II - III - imaging only (unless Barrets)
93
Q

PAtient has M1 cytology and then good response to palliative chemo; repeat cytology is M0?

A

You have probably already passed the room, this is the population to look at clinical trials of HIPEC.

94
Q

Assessment of HER2 status of GE cancers?

A

do if unresectable and planning for systemic therapy

may still be equivocal and need FISH, just like breast cancer.

95
Q

Three main theoretic benefits of neoadjuvant RT

A

improved tissue oxygenation
Smaller defined field (helps rad/onc aim)
increase rate of R0 resection

96
Q

Signet ring cell gastric cancer

A

more diffuse spread
presents at higher stage
more chemo-resistant
associated with CDH1 mutations

97
Q

multiple low grade gastric NETs?

A

check a gastrin level

check for achlorohydria (gastric pH)

98
Q

pericardial invasion of GE cancer?

A

still resectable, take the pericardium

99
Q

Operation for esophageal leak?

A

try to save the conduit if no necrosis.
debride edges
cover defect with an intercostal or pleural flap
cervical diversion.

100
Q

treatment of goblet cell of the appendix

A

R0N0 - right hemicolectomy
N+ add FOLFOX
M1 - FOLFOX v HIPEC

101
Q

median survival of mucinous appendiceal tumors?

A

16 years

102
Q

adjuvant therapy for low grade mucinous appendiceal tumor?

A

HIPEC only for cellular mucin,
no chemo,
no radiation

103
Q

most common complication of HIPEC?

A

prolonged ileus

104
Q

survival benefit to doing right hemicolectomy at the time of rupture of a appendiceal mucinous neoplasm?

A

no, only if you do HIPEC at the same time as resection.

CGSO oral boards (7 decks)

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