GI Flashcards by Clark Anderson

T staging for gastric cancer

T1a: lamina propria or muscularis mucosa, T1b: invades submucosa, T2: invades muscularis propria, T#: invades subserosa, T4a: invades serosa, T4b: invades adjacent structures

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Management of cT1-2N0 anal

chemoradiation 42/5040

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Liver mean constraint during gastric RT

mean <25 Gy

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femoral heads constraint

V40<40%, V45<25%, Max , 50 Gy

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management for resectable panc

whippe, adj chemo, adj CCRT for positive margin or N+ disease.

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Which surgery spares sphincter

LAR

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Lab workup for gastric

CBC, CMP, H. pylori, CEA

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management of T2N0 esophagus

esophagectomy for select candidates, primary <3cm, well-differentiated

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management of cT2+ or N+ gastric cancer

periop chemo, FLOT gastrectomy FLOT, adj CCRT if positive margin or poor responder.

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Management for T1N0 rectal

Transanal excision

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What nodes to treat in extrahepatic HCC

RPLN, celiac, SM, PH, Gastrohepatic

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Anal canal superior edge

palpable upper border of anal sphincter

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management of extrahepatic HCC

surgery, LND, adj cape x 6 months, adjuvant CCRT for margin positive, llT2-T4 or any N1, 54 in 30 45 to nodes.

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constraints for liver for liver sbrt

Spare 700 cc to < 15 Gy, Mean < 15 Gy

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Bladder constraint during rectal rt

V40<40%, V45<15%, Max , 50 Gy

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N staging for pancreas

N1: 1-3 LN, N2: 4+ LN

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anal margin distance

5 cm from anal verge

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labs for pancreatic cancer workpu

CBC/CMP, CA19-9, glucose, amylase, lipase, LDH, CEA

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N staging for gastric cancer

N1:1-2LN, N2: 3-6 LN, N3a: 7-15 LN, N3b: 16+ LN

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T staging for rectal cancer

T1: invasion of submucosa, T2: muscularis propria, T3: into perirectal tissue, T4a: through visceral peritoneum, T4b: organ invasion

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Kidney constraint during panc radiation

V18<30%, if only 1 kidney V18%<10%

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lower thoracic esophagus location

30-40 cm

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Siewert III

2-5 cm into stomach, treat like gastric.

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Anal canal inferior edge

anal verge

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cervical esophagus lengths

15-20 cm

Concurrent chemo for anal

CI 5-Fu 1000mg/m2 D1-4 D29-32 + MMC 10 mg/m2 D1 D29 q4w x2. (cisplatin to replace MMC if can't tolerate)

SB constraint during 5 fraction rectal

Max<25 Gy

High risk colonoscopy screening

q5y starting at age 40

What imaging is needed for pancreas

triphasic CT

SBRT dose for HCC

50 in 5

GE junction location

40-45 cm, GEJ to 5 cm into stomach.

management of T3+ N+ esophagus

preop CCRT

Rectal SB constraint

V35<180 cc, V40<100cc, V45<65cc

workup for T1b+ gastric cancer

diagnostic laparoscopy

Concurrent chemo for rectal

cape: 825 mg/m2 PO BID 5 days/week during RT

Layers of rectum

muscularis mucosa, submucosa, muscularis propria, perirectal fat

T stage for pancreatic cancer

T1a: <=0.5mm, T1b: 5-10mm, T1c: 1-2 cm, T2: 2-4 cm, T3: >4 cm, T4: involves CA, SMA, or CHA

Lab workup for anal

CBC, CMP, HPV, HIV, pregnancy

management of oligometastatic rectal cancer

chemo then short course, restage at 8 weeks and resect primary, SBRT to mets, then additional chemo

Siewert I

1-5 cm above

Stomach max during panc rt

55 Gy max

mid thoracic esophagus location

25-30 cm

Average risk colonscopy screening

age 50 q10 years

management for cTis-T1a gastric cancer

endoscopic resection or gastrectomy, if R0: observe, if R1: adj CCRT, R2: adj CCRT

What is resected in whipple?

panc head and body, distal stomach, duodenum, proximal jejunum, gallbladder, distal CBD.

What are N1 sites for gastric cancer

Lesser curv, greater curv, left/right cardia, suprapyloric, infrapyloric

N stage for anal cancer

N1a: inguinal, perirectal, or internal iliac LN, N1b: external iliac LN, N1c: N1a+N1b

Do you treat common iliac with rectal

only if T4

Management of HCC

resect if possible, ClassA/B no portal HTN

management of cT1b gastric cancer

gastrectomy, R0: observe, R1-R2: adj ccrt (45Gy in 25)

Management of T2N0 rectal

LAR/APR

postop treatemnt T4 or N+ after APR/LAR

FOLFOX then CCRT

Mangement of Intrahepatic cholangio

like HCC

managemenet of unrsectable panc

neoadj folfirinox, restaging, defintive CCRT if needed

What do you need to calculate child's pugh score

total bili, serum albumin, PT INR, Ascites, Encephalopathy, A5-6, B 7-9, C10-15

T stage anal

T1: <=2cm, T2 2-5, T3: >5, T4: invasion of organs

N2 sites for gastric cancer

Celiac, Left gastric, common hepatic, splenic hilum, splenic artery

management of T1bN0 esgphagus

esophagectomy

T stage for esophagus

T1a: lamina propria or muscularis mucosa, T1b: invades submucosa, T2: invades muscularis propria, T3: invades adventitia, T4a: invades pleura, pericardium, diaphragm, azygos vein, or peritoneum, T4b: invades aorta, vert body, or airway

Do you treat external iliac with rectal

only if T4

upper thoracic esophagus location

20-25 cm

Nonoperative approach for rectal

T1-2N): ccrt, T3 or N+: CCRT then chemo. cCR can observe

Rectal length

12-15 cm

Siewert II

1 to -2 cm around GEJ

What are criteria for no further tx after transanal resection for rectal cancer?

<3cm, margins>3mm, <30% lumen circumference, G1, No LVSI, mobile

Treatment for Tis esophagus

endoscopic resection preferred over esophagectomy

M staging rectal

M1a: 1 DM, M1b: 2+ DM without peritoneal mets, M1c: peritoneal mets

management for borderline resectable pancreas

neoadj folfirinox, restaging, neoadj ccrt if needed

Anal canal length

3-5 cm

chemo for ccrt of esophagus

carboplatin AUC=2, paclitaxel 50 mg/m2 q1w x5

When do you treat nodes for pancreatic

postop

N3 sites for gastric

hepatoduodenal, retropanc, pancreaticoduodenal, peripanc, superior mesenteric, middle colic (N4), para-aortic (N4)

MRI T staging for rectum

T3a<1mm, T3b: 1-5mm, T3c: 5-15 mm, T3d >15 mm

postop treatemnt T1-2N0 after APR/LAR

observe

Liver mean during panc RT

Mean <30 Gy

What LNs to cover when doing RT for gastric cancer

perigastric, celiac, left gastric, splenic artery, common hepatic artery/porta hepatis, suprapyloric/infrapyloric, pancreaticoduodenal

N stage for esophagus

N1: 1-2 LN, N2: 3-6 LN, N3: 7+ LN

Management of cT3-4 or N+ anal

CCRT 45/50.4/54/54, elective, <3cm LN, >3cm LN, primary

postop treatemnt T3N0 after APR/LAR

CCRT then folfox or capeox, consier obs for low grade upper rectum, minimal invasion, no LVSI

Management of T3N0 or higher rectal cancer

TNT

management of T1aN0 esophagus

endoscopic resection preferred over esophagectomy

N staging for rectal cancer

N1a: 1 LN, N1b: 2-3 LN, N1c: No regional LN but tumor deposits in subserosa, mesentery, or non-peritonealized perirectal/mesorectal tissues., N2a: 4-6 LN, N2b: 7+ LN

What if you have high risk features after Transanal excision for rectal cancer

finish with LAR or APR

Heart mean and V30 during panc rt

Mean<30 Gy and V30<20%

Rectal lateral field posterior border

T4: 1 cm behind sacrum T3: 2 cm into sacrum

Rectal lateral field anterior border:

T4: anterior to pubic symphysis, T3: posterior to pubic symphysis

GI Flashcards

(86 cards)