Upper GI Cancers Flashcards
What are the symptoms of pancreatic cancer?
obstructive jaundice, epigastric/back pain, fatigue, anorexia, weight loss, malabsorption
Why is the prognosis of pancreatic cancer so poor?
delayed presentation, impaired drug delivery/resistance to chemotherapy because of the microenvironment
What investigations are required for pancreatic cancer?
CT C/A/P, sometimes MRCP, tissue via endoscopic US or CT guided biopsy, LFTs, CA 19-9
What is the treatment for resectable localised pancreatic cancer?
surgery + adjuvant chemotherapy
What is the treatment for borderline resectable localised pancreatic cancer?
neo adjuvant chemotherapy then surgery
What is the treatment for locally advanced or oligometastatic pancreatic cancer?
chemotherapy
consider radiotherapy
What is the treatment for disseminated metastatic pancreatic cancer?
palliative chemotherapy
What surgery is used for pancreatic cancer?
whipple’s for head of pancreas or distal pancreatectomy for pancreatic tail
What chemotherapy is used for pancreatic cancer?
nab-paclitaxel and gemcitabine or folfirinox (triplet 5FU/oxaliplatin/irinotecan)
Can PARP inhibitors be used in pancreatic cancer?
maybe - if BRCA mutation
What are the risk factors for hepatocellular carcinoma?
CLD (viral heaptitis, EtOH, autoimmune), hepatitis B (non cirrhotic), obesity, type II diabetes, NASH
How are liver cirrhosis patients screened for HCC?
liver US, AFP
What imaging technique is used for HCC?
multiphase CT - see washout in portal venous phase
What is required for diagnostic workup of HCC?
investigation of underlying aetiology (e.g. hepatitis serology), LFTs, platelet count, AFP, CT C/A/P (looking for extrahepatic spread
What is the treatment for limited HCC?
locoregional therapy such as ablation, TACE, stereotactic radiosurgery, brachytherapy, selective internal radiotherapy
can consider surgical resection or liver transplant
What systemic therapy can be used for advanced HCC?
sorafenib or lenvatinib
What are the common toxicities of sorafenib?
diarrhoea, hand foot syndrome, hypertension
What new immunotherapy can be used in HCC?
?atezolizumab and bevacizumab - early data
What are the risk factors for gastric cancer?
obesity, H. pylori infection, salt intake, EBV infection, smoking, barrett’s, CDH1 mutation, lynch syndrome, polyposis syndrome
What is required for diagnostic work up of gastric cancer?
endoscopy - to make diagnosis EUS - to determine depth (T stage) CT C/A/P - look for distant spread PET - for suspicious lesions on PET laparoscopy - to rule out peritoneal disease (common site of secondary)
What is the treatment for gastic cancer?
neo adjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy
What chemotherapy is used for gastric cancer?
docetaxel, oxaliplatin and 5FU (FLOT regimen)
