Upper GI Cancers Flashcards

1
Q

What are the symptoms of pancreatic cancer?

A

obstructive jaundice, epigastric/back pain, fatigue, anorexia, weight loss, malabsorption

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2
Q

Why is the prognosis of pancreatic cancer so poor?

A

delayed presentation, impaired drug delivery/resistance to chemotherapy because of the microenvironment

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3
Q

What investigations are required for pancreatic cancer?

A

CT C/A/P, sometimes MRCP, tissue via endoscopic US or CT guided biopsy, LFTs, CA 19-9

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4
Q

What is the treatment for resectable localised pancreatic cancer?

A

surgery + adjuvant chemotherapy

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5
Q

What is the treatment for borderline resectable localised pancreatic cancer?

A

neo adjuvant chemotherapy then surgery

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6
Q

What is the treatment for locally advanced or oligometastatic pancreatic cancer?

A

chemotherapy

consider radiotherapy

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7
Q

What is the treatment for disseminated metastatic pancreatic cancer?

A

palliative chemotherapy

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8
Q

What surgery is used for pancreatic cancer?

A

whipple’s for head of pancreas or distal pancreatectomy for pancreatic tail

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9
Q

What chemotherapy is used for pancreatic cancer?

A

nab-paclitaxel and gemcitabine or folfirinox (triplet 5FU/oxaliplatin/irinotecan)

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10
Q

Can PARP inhibitors be used in pancreatic cancer?

A

maybe - if BRCA mutation

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11
Q

What are the risk factors for hepatocellular carcinoma?

A

CLD (viral heaptitis, EtOH, autoimmune), hepatitis B (non cirrhotic), obesity, type II diabetes, NASH

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12
Q

How are liver cirrhosis patients screened for HCC?

A

liver US, AFP

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13
Q

What imaging technique is used for HCC?

A

multiphase CT - see washout in portal venous phase

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14
Q

What is required for diagnostic workup of HCC?

A

investigation of underlying aetiology (e.g. hepatitis serology), LFTs, platelet count, AFP, CT C/A/P (looking for extrahepatic spread

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15
Q

What is the treatment for limited HCC?

A

locoregional therapy such as ablation, TACE, stereotactic radiosurgery, brachytherapy, selective internal radiotherapy
can consider surgical resection or liver transplant

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16
Q

What systemic therapy can be used for advanced HCC?

A

sorafenib or lenvatinib

17
Q

What are the common toxicities of sorafenib?

A

diarrhoea, hand foot syndrome, hypertension

18
Q

What new immunotherapy can be used in HCC?

A

?atezolizumab and bevacizumab - early data

19
Q

What are the risk factors for gastric cancer?

A

obesity, H. pylori infection, salt intake, EBV infection, smoking, barrett’s, CDH1 mutation, lynch syndrome, polyposis syndrome

20
Q

What is required for diagnostic work up of gastric cancer?

A
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)
21
Q

What is the treatment for gastic cancer?

A

neo adjuvant chemotherapy followed by surgery followed by adjuvant chemotherapy

22
Q

What chemotherapy is used for gastric cancer?

A

docetaxel, oxaliplatin and 5FU (FLOT regimen)