Upper GI/ Hepatobiliary Cancer Flashcards
Risk factors for UGI cancers?
Environmental
- H. pylori infection
- Salt intake
- Epstein Barr virus infection
- Cigarette smoking
Host factors
- Obesity
- Barretts oesophagus
- CDH1 mutation (Hereditary diffuse gastric cancer)
- Lynch syndrome (Mismatch repair deficient)
- Polyposis syndromes – FAP, Peutz-Jeghers
Treatment of early stage oesophageal cancer?
Oesophagectomy
- neo-adjuvant chemo therapy - increase chance of suitability
(cisplatin/ 5-FU OR FLOT if gastro-oesophageal - docetaxel, o platin, fluorouracil and leucovorin)
In SCC:
- can have curative chemo-radiotherapy
+/- nivolumab
Treatment of late stage oesophageal cancer?
Palliative approach
- 5-FU palliative chemotherapy (or capecitabine)
- oesophageal stents
- endoscopic ablation (to control bleeding)
Trent of early stage gastric cancer?
If endoscopically resectable: endoscopically resect
If surgically operable: gastrectomy and lymphadenectomy
Chemotherapy - either neo-adjuvant or adjuvant
IF HER2 positive: trastuzumab OR pertuzumab OR trastuzumab derucxtecan
IF MMR, high MSI or PDL1 overexpression: checkpoint inhibitors
Trent of late stage gastric cancer?
Palliative Chemotherapy
Nutritional Support
Symptom control
?Coeliac plexus block
?palliative radiotherapy
IF HER2 positive: trastuzumab, OR trastuzumab derucxtecan
Consider: anti-VEGFR2 (ramucirumab) or CPI
What are GISTs?
Gastrointestinal stromal tumours
- rare, slow-growing neoplasms that may arise in the stomach or small or large intestine.
- Prognosis depends on size, site, Ki-67 proliferation index and association with neurofibromatosis type 1
Treatment for GISTs?
If c-KIT or PDGFRA mutations: imatinib, 2nd line other TKIs
if local: surgically reset
Main risk factor(s) for HCC?
Cirrhosis (95%)
HBV > HCV
(don’t have to have cirrhosis in HBV pt, but do in HCV)
M > F
Screening for HCC
alpha feto-protein
(Also increased in testicular cancer and pregnancy)
Not cost effective
Ix for HCC?
Quad phase CT Abdomen
- LiRAD criteria
Biopsy rarely needed
Management of HCC
IF < 5cm OR 3x < 3cm: surgically resect or liver transplant (better)
otherwise consider:
- transarterial embolization/ chemoembolization/ radioembolization,
- radiofrequency ablation and stereotactic body radiotherapy
Consider anti-angiogenic agents:
- sorafenib
- lenvantanib
Is gall bag cancer more common in women of men?
women (3:1)
Risk factors for gall bag cancer
- Female (3:1)
- gall stones/ calcification of gall bladder from cholecystitis,
- adenomatous polyps of gall bladder
Treatment for gall bag cancer?
Surgical resection
Chemo: 5-FU or gemcitabine/ cisplatin
?radiotherapy (small proportion of cases sensitive)
Treatment for gall bag cancer?
Surgical resection
Chemo: 5-FU or gemcitabine/ cisplatin
?radiotherapy (small proportion of cases sensitive)
Risk factors for biliary tract carcinomas?
- choledochal cyst
- chronic infection of biliary tract (e .g Clonorchis sinensis).
- AI diseases : PSC, IBD
Treatment of cholangiocarcinoma
Surgically resect if able:
- peri-hilar lesions: partial heptaic resection + biliary resection
- CBD lesions: partial biliary resection
- distal lesions: Whipple’s
Palliaitve
- biliary decompression
- gemcitabine/ cisplatin
- radiotherapy
?neo-adjuvant therapy/ liver transplant
Types of pancreatic cancer?
• Adenocarcinoma (PDAC) 90% - 60-70% originate from head of pancreas
• Neuroendocrine (PanNET)
• Lymphoma
• Sarcoma
Approx 5 year survival for pancreatic cancer?
2-5%
Treatment for Pancreatic Cancer
Early stage:
- surgery + adjuvant chemo
Borderline resectable: neo-adjuvant chemo +/- surgery
Late stage:
- palliative chemo
- stents
- radiotherapy (pain)
