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Oncology > upper Gi cancers > Flashcards

upper Gi cancers Flashcards

1
Q

Which genetic syndromes are associated with pancreatic cancer?

A 
BRCA2
HNPCC
Familial pancretic cancer for which gene not known
Peutz Jeghers Syndrome
p16INK4 (melanoma and panc cancer)
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2
Q

standard of care for panc cancer adjuvant chemo

A

gemcitibine (Based on ESPAC 3 gemcitabine vs 5FU study)

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3
Q

Metastatic panc cancer standard of care

A

gemcitabne plus abraxane (nab-paclitaxel)

3 month survival benefit

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4
Q

sudden onset diabetes or suddenly brittle diabetes…suspect what?

A

pancreatic ca

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5
Q

Which is the only medical therapy for HCC?

A

Sorafenib

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6
Q

How does sorafenib work?

A

multi-targeted kinase inhibitor; don’t know which one is useful
also
FGF activity so may make the cirrhosis a bit better
also
VEGF inhibition effect (so need to do endoscopy pre to check for and band varices)

3 month survival benefit

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7
Q

Risk factors for gastric ca

A 
H pylori
EBV
smoking
genetic factors (BRCA2, HNPCC/Lynch, Peutz jegher syndrome, familial diffuse gastric cancer (CDH1)
blood group A
pernicious anaemia
salty, spicy, nitrate rich food
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8
Q

Where do H pylori associated gastric cancers tend to be found?

A

Distal stomach

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9
Q

How do you stage a gastric cancer?

A

Need to do CT, endoscopy but ALSO laparoscopy- this can help find small peritoneal disease that may have been missed by CT.

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10
Q

How is chemo used in gastric ca and what was the name of the study?

A

Pre-op chemo plus surgery- MAGIC study
post op (adjuvant ) chemo only shown survival benefit in Japan
Post op chemoradio is used often if no chemo pre-op and nodes ended up being involved

Can used trastuzumab in HER2 positive

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11
Q

RF for oesophageal ca

A

smoking
alcohol
barretts (replacement of normal stratified squamous with gastric columnar)

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12
Q

oesophageal adeno ca work up

A 
endoscopy
PET- will exclude some people from surgery as cannot clear nodes more than about 5cm away from cancer
CT
UES and biopsy
laparoscopy if GOJ
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13
Q

How do you treat oesophageal cancer based on stage and location?

A

Lower 2/3 oesophagus and T1 or T2 and adenoca–>surgery alone
Upper 1/3 oesophagus and T1 or T2–>definitive chemoradiotherapy
Resectable T1-3 and node positive or T3 and node neg–> get pre-op chemoradiotherapy

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14
Q

What are the different presentations of carcinoid tumours (gastroenteropancreatic neuroendocrine tumours GEPNETS)

A 
Non functioning - most
insulinomas-->hypoglycaemia
glucagonomas-->hyperglycaemia
VIPomas-->diarrhoea
gastrinomas-->gastric ulcers (ZES)
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15
Q

How do you grade a neuroendocrine tumour?

A

base on mitotic count and Ki-67 lung index (percent)
over 20% is high burden

often a tumour is mixed and there is a bit of higher grade and bit of lower grade.

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16
Q

How are octreotide scintigraphy and gallium Dotatate PET/CT used?

A

When staging grade 1 and 2 neuroendocrine tumours
diagnosis and management: assess somastostatin receptor density to see if suitable for somatostatin analogue treatment and potentially for peptide radionucleotide receptor therapy

changes management in 20-30% cases, usually by upstaging

17
Q

How to manage carcinoid syndrome

A 
Avoid precipitants of fushing eg alcohol, pressure on RUQ
Loperamide and codeine for diarrhoea
steroids
H1 and H2 receptor blockers
Chlorpromazine for flushies
echo 6-12 monthly
long acting octreotide
18
Q

If have a adeno early stage at gastroesoph/lower oesoph.?

A

surgery alone

if nodes then pre op chemoradio and try and salvage

19
Q

signet cells in

spindle cells in

A

signet in stomach

spindle in GIST

20
Q

Treat a gastric cancer

A

preop chemo

post op chemoradio

21
Q

What is the best chemo for panc now? For operative disease

A

JUST gemcitabine for operative disease

chemoradio increases relapse
5FU actually worse
still combo if inoperative

data clearly shows that just do surgery rather than stenting someone first as long as no cholangitis and bili under 300

22
Q

Why is chromogranin A measurement useful

A

do in neuroendocrine tumour to estimate BULK not activity

23
Q

MOST COMMON BUT IN FEB NEUT

A

staph epidermis

mostly endogenous organisms

Oncology (13 decks)

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