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OB2 > GI > Flashcards

GI Flashcards

1
Q

Colorectal T4a

A

invades serosa (visceral peritoneum)

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2
Q

Anal cancer: T1-2N0 definitive radiation dose and fields

A

42Gy/28fxs with SIB to 50.4Gy, concurrent chemo

CTV 50.4 = GTV plus anal canal with a 2 cm CTV margin, entire mesorectum

CTV 42 = mesorectal, bilateral inguinal, ext, and int iliacs with 7mm margin

PTV is 1cm

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3
Q

Gastric cancer: surgical approaches

A

Subtotal gastrectomy, 5 cm margin on tumor with D2 dissection removing >15 LNs, ex lap to look for peritoneal disease

Total gastrectomy for large or proximal/fundus lesions

Ivor-Lews esophagectomy if tumor at GEJ, Seweirt III

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4
Q

Gastric yp Stage II

A

adds to 3 or 4 (excluding T4bN0)

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5
Q

Esophageal cancer: NCCN constraints for lung, heart, liver, stomach

A

Lung: V20 < 20%, V5 < 50%

Heart: V30 < 25%, mean < 30Gy

Liver: V20 < 30%, mean < 25Gy

Stomach: mean < 30Gy (excluding PTV)

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6
Q

Anal cancer: simulation

A

supine, frog leg, vac loc, oral contrast, full bladder, bead marker at anal verge

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7
Q

Perianal Cancer: criteria for WLE

A

T1

well differentiated

>1cm margins

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8
Q

Distal bile duct T4

A

celiac axis, SMA, common hepatic artery

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9
Q

Colorectal N1c

A

negative nodes with tumor deposits in the subserosa, mesentery, or perirectal/mesorectal tissues

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10
Q

Gallbladder T2b

A

invades perimuscular connective tissue on hepatic side

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11
Q

Colorectal Stage IIIC

A

T4aN2a, T3-4aN2b, T4bN+

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12
Q

Anal canal cancer: criteria for excision

A

superficially invasive

<3mm basement membrane invasion

horizontal spread <7mm

negative margins

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13
Q

Gastric Pathological Stage IIB

A

T1N3a, T2N2, T3N1, T4aN0 (adds to 4)

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14
Q

Pancreatic cancer: adjuvant chemo

A

concurrent capecitabine 825mg/m2 BID

then adjuvant gemcitabine / capecitabine

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15
Q

Esophagus yp Stage II

A

T3N0

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16
Q

Colorectal Stage IIIA

A

T1-2N1, T1N2

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17
Q

Esophageal Adeno clincical Stage IIA

A

T1N1

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18
Q

Gastric Pathological Stage IIIB

A

T1-2N3b, T3-4aN3a, T4bN1-2

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19
Q

Rectal cancer: simulation

A

PRONE, belly board, anal marker, oral contrast two hours before, full bladder

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20
Q

Gastric Clinical Stage IVA

A

T4b

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21
Q

Intrahepatic Bile Duct Stage II

A

T2

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22
Q

Distal bile duct T2

A

tumor invades bile duct wall 5-12mm

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23
Q

Anus Stage IIIA

A

T1-2N1

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24
Q

Rectal cancer: treatment paradigm with short course radiation

A

T3-4N0-2 patients

25Gy/5fxs to pelvis without concurrent chemotherapy

surgery 4-8 weeks after radiation (better than 1 week on Stockholm III)

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25
Q

Rectal cancer: concurrent chemotherapy dosing

A

capecitabine 800mg BID M-F

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26
Q

Colorectal M1c

A

peritoneal metastasis

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27
Q

Gallbladder T2a

A

invades perimuscular connective tissue on peritoneal side

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28
Q

Anal cancer: considerations for HIV+ patients

A

Test CD4 and consider treatment de-escalation if CD4 count < 200

May decrease dose to 50Gy or reduce superior field border to bottom of SI joints

Ensure patient is following with ID and is on HAART

Consider concurrent cisplatin instead of mitomycin

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29
Q

Anus Stage IIIC

A

T3-4N1

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30
Q

Gastric T3

A

invades subserosal connective tissue

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31
Q

Gallbladder Stage IIIA

A

T3

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32
Q

Unresectable pancreatic cancer: MS and LC with chemo/xrt

A

MS 16 months

LC 45%

(results from LAP 07 which showed LC benefit but no OS benefit)

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33
Q

Esophageal cancer: concurrent chemo dosing

A

carboplatin AUC 2 weekly

paclitaxel 50mg/m2 weekly

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34
Q

Esophageal Adeno clincical Stage IVA

A

T4b or N2-3

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35
Q

Gastric T2

A

invades muscularis propria

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36
Q

Intrahepatic Bile Duct Stage IIIA

A

T3

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37
Q

Gastric cancer: nodal targets for T4 or N+

A

CP5S2 (+/- splenic):

  • celiac
  • pancreaticoduodenal
  • paraaortic
  • periesophageal
  • perigastric
  • portahepatic
  • superior mesenteric
  • suprapancreatic

only include splenic for tumor in proximal (cardia) or middle (body) location

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38
Q

Anus N1a

A

inguinal, mesorectal, or internal iliac nodes

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39
Q

Colorectal Stage IIC

A

T4bN0

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40
Q

Pancreatic cancer: criteria for borderline resectability

A

SMV/PV > 180

CA/SMA < 180

CHA/IVC contact

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41
Q

Intrahepatic Bile Duct Stage IIIB

A

T4 or N1

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42
Q

Gastric cancer: constraints for kidneys and liver

A

2/3 of one kidney < 20Gy

liver V30 < 60%

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43
Q

Borderline resectable pancreatic cancer: treatment paradigm with concurrent radiation

A

induction FOLFIRINOX or gemcitabine/nab-paclitaxel

scan to assess for progression

concurrent chemoradiation (capecitabine 825mg BID, 50.4Gy)

scan to assess for resectability

surgery if possible

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44
Q

Intrahepatic Bile Duct Stage IV

A

M1

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45
Q

Gallbladder T3

A

serosa (visceral peritoneum), liver, and/or one other structure

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46
Q

Anus Stage IIA

A

T2N0

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47
Q

Rectal cancer: outcomes if inoperable or refuses surgery

A

treat tumor to 60Gy with concurrent chemo

complete response rate is 80%

for patients with complete response, 1yr LR is 16%

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48
Q

Colorectal N2a

A

4-6 nodes

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49
Q

Gallbladder Stage IVA

A

T4

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50
Q

Gastric Pathological Stage IIA

A

T1N2, T2N1, T3N0 (adds to 3)

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51
Q

Esophageal SCCa clinical Stage IVA

A

T4 or N3

52
Q

Gastric Clinical Stage III

A

T3N+, T4N+

53
Q

Esophageal SCCa Middle Location

A

azygous vein to inferior pulmonary vein (lower border)

54
Q

Intrahepatic Bile Duct N1

A

positive node(s)

55
Q

SWOG 0809 dose and field

A

CTV 45: tumor bed and portal vein nodes, consider pancreatic and celiac nodes

CTV54-59.4: tumor bed +1.5cm margin

PTV: 0.5 radial, 0.7 sup/inf (if contouring ITV on 4DCT)

56
Q

Gastric cancer: workup

A

H&P, family history, nutrition/weight loss, IBD

Labs: CBC, CMP

Upper GI with biopsy and H pylori testing, EUS, CT A/P, consider PET

consider J-tube and nutrition eval, renal perfusion scan (if not doing IMRT)

57
Q

Gallbladder Stage IIB

A

T2b

58
Q

Anus N1b

A

external iliac nodes

59
Q

Colorectal M1a

A

metastasis to one site without peritoneal metastasis

60
Q

Esophageal Adeno clincical Stage III

A

T2N1 or T3-4aN0-1

61
Q

Colorectal M1b

A

metastasis to two or more sites without peritoneal metastasis

62
Q

Pancreatic cancer: simulation

A

supine, wingboard, abdominal compression, 4DCT, oral contrast, IV contrast

63
Q

Distal bile duct N2

A

4+ regional nodes

64
Q

Colorectal N1a

A

1 node

65
Q

Anus T4

A

invading adjacent organ

66
Q

Gastric cancer: considerations for follow up

A

if proximal stomach was removed, supplement with B12, calcium, and iron

67
Q

Esophagus N2

A

3-6 regional nodes

68
Q

Treatment paradigm for extrahepatic cholangiocarcinoma and gallbladder carcinoma on SWOG 0809

A

surgical resection (pT2-4, N+, or positive margin)

adjuvant induction capecitabine/gemcitabine x 4 cycles

adjuvant concurrent capecitabine with radiation (45Gy with boost to 54-59.4Gy

69
Q

Anal cancer: T3-4N0 fields and dose

A

45Gy/30fxs with SIB to 54Gy, concurrent chemo

CTV 54 = GTV plus anal canal with a 2 cm CTV margin, entire mesorectum

CTV 45 = mesorectal, bilateral inguinal, ext, and int iliacs with 7mm margin

PTV is 1cm

70
Q

Intrahepatic Bile Duct T2

A

solitary tumor with intrahepatic vascular invasion or multiple tumors

71
Q

Esophageal Adeno clincical Stage IIB

A

T2N0

72
Q

Anal cancer: 5yr OS for stage I-IV

A

stage I 80%

stage II 75%

stage III 50%

stage IV 10%

73
Q

Esophagus yp Stage I

A

T0-2N0

74
Q

Anus N1c

A

external iliac nodes AND inguinal/mesorectal/internal iliac

75
Q

Pancreatic cancer: constraints for stomach, duodenum, small intestine, liver, and kidney

A

stomach / duodenum / small intestine max dose < 54Gy

liver mean < 25Gy

single kidney D30% < 18Gy

76
Q

Esophageal cancer: workup

A

H&P, assess nutritional status / weight loss, Family history, IBD, smoking history (cessation)

Labs: CBC, CMP

Imaging: EGD with biopsy, EUS, CT, PET

consider J tube and dietary eval

77
Q

Gallbladder N2

A

4+ nodes

78
Q

Rectal cancer: classic fields

A

sup: L5/S1
inf: bottom of obturator foramen or 3 cm below tumor, whichever is more inferior
lat: 2 cm beyond pelvic brim
ant: behind pubic symphysis and 3cm in front of sacral promontory
post: 1 cm behind sacrum

79
Q

Gastric Pathological Stage IIIA

A

T2N3a, T3N2, T4aN1-2, T4bN0

80
Q

Cholangiocarcinoma: workup and treatment paradigm

A

CT/MRI, chest CT, cholangiography, consider CEA and CA 19-9, amylase, lipase, LFTs, EUS

Distal extrahepatic: whipple

For extrahepatic R1/R2 can give RT+4FU OR cis/gem

Intrahepatice R1 give chemoRT.

For intrahepatic R2 give cis/gem category 1, or chemoRT.

For anything unresectable give cis/gem. RT+5FU also an option

81
Q

Gastric cancer: simulation

A

supine, 4DCT, wingboard, empty stomach, small amount of oral contrast

treat daily on empty stomach (clearly, only if subtotal gastrectomy was performed)

82
Q

Esophagus N3

A

7 or more regional nodes

83
Q

Gastric T4a

A

invades serosa (visceral peritoneum)

84
Q

Rectal cancer: workup

A

H&P, family history, genetic or hereditary disorders, IBD, DRE (distance from verge, size, circumference, sphincter tone), GYN exam

Labs: CBC, CMP, CEA.

Colonoscopy with biopsy, MRI pelvis, CT A/P

85
Q

Esophagus yp Stage IIIB

A

T3N1, T0-3N2, T4aN0

86
Q

Anus Stage IIB

A

T3N0

87
Q

Gastric Pathological Stage IVC

A

T3N3b, any T4N3

88
Q

Rectal cancer: criteria for transanal excision

A

<3 cm

<30% circumference

margin >3mm

within 8 cm of anal verge

T1

mobile

grade 1-2

no LVSI or PNI

89
Q

Gallbladder T4

A

main portal vein, hepatic artery, or two or more extrahepatic structures

90
Q

Gastric N3b

A

16+ nodes

91
Q

Anus T2

A

2-5cm

92
Q

Gastric Clinical Stage IIB

A

T3-4aN0

93
Q

Anus Stage IIIB

A

T4N0

94
Q

Esophageal SCCa clinical Stage II

A

T2N0-1

95
Q

Esophagus yp Stage IVA

A

T4aN1-2, T4b, N3

96
Q

Intrahepatic Bile Duct T3

A

perforating visceral peritoneum

97
Q

Colorectal T4b

A

invades adjacent structures

98
Q

Pancreatic cancer: adjuvant dose and contouring targets

A

CTV 50.4:

tumor bed + 2cm

PJ, HJ, SMA, CA, PV, and clips + 1cm

aorta from T11 to L3 + 3cm right, 2cm ant, 1cm left, and 0.2cm post

99
Q

Esophageal SCCa Lower Location

A

inferior pulmonary vein to stomach

100
Q

Esophageal SCCa Upper Location

A

cervical esophagus to azygous vein (lower border)

101
Q

Esophageal SCCa clinical Stage III

A

T3 or N2

102
Q

Gallbladder Stage IIIB

A

N1

103
Q

Esophagus T4b

A

aorta, vertebral body, airway (unresectable tumor)

104
Q

Pancreatic cancer: workup

A

H&P, family history, weight loss / nutrition, abdominal exam

Labs: CBC, CMP, CEA, CA-19-9, amylase, lipase

EUS with biopsy, CT C/A/P with contrast in 3 phases per pancreatic protocol.

Only do ERCP/MRCP if no mass seen.

Can consider PET, but not a substitute for high quality CT

105
Q

Anal cancer: concurrent chemo dosing

A

capecitabine 825mg/m2 BID M-F

mitomycin 12mg/m2 on day 1

106
Q

Gastric cancer: dose and general targets for T3N0

A

45Gy/25fxs

T3N0: treat anastomosis, whole stomach (except for GEJ tumors), and perigastric nodes

107
Q

Esophagus T4a

A

pleura, pericardium, peritoneum, azgous vein, diagphragm

108
Q

Gastric cancer: adjuvant capecitabine dose/schedule

A

capecitabine 825mg/m2, BID, days 1-14, q28days for one cycle before RT and 2 cycles after RT

capecitabine 825mg/m2 BID M-F during RT

start RT one month after surgery

109
Q

Colorectal T3

A

invades through muscularis propria into pericolorectal tissue

110
Q

Intrahepatic Bile Duct T4

A

local extrahepatic structures

111
Q

Colorectal N1b

A

2-3 nodes

112
Q

Esophagus yp Stage IIIA

A

T0-2N1

113
Q

SWOG 0809: MS

A

MS 35mo

114
Q

Anal Cancer: workup

A

H&P, sexual history, HIV risk factors, IBD, family history, LN eval, DRE, anal sphincter tone, GYN exam

Labs: CBC, CMP, HIV if risk factors

Anoscopy/colonoscopy with bx. FNA of inguinal nodes.

PET/CT

115
Q

Pancreatic cancer: adjuvant 3D fields

A

AP/PA FIELD:

sup: top of T11
inf: bottom of L3

left lateral: 1.5cm lateral to vertebral body

right lateral: 2cm lateral to vertebral bodies

LATERAL FIELD:

ant: 2cm anterior to preop GTV
post: split vertebral bodies

116
Q

Esophageal cancer: simulation

A

supine, wingboard, small amount of oral contrast

117
Q

Gallbladder Stage IVB

A

N2 or M1

118
Q

Anal cancer: N+ fields and dose

A

54/50.4/45 Gy in 30 fx (1.8/1.68/1.5 daily)

54 to primary and nodal regions with nodes>3 cm

50.4 to nodal regions with nodes<3 cm

45 to negative nodal regions

119
Q

Colorectal Stage IIIB

A

T3-4aN1, T2-3N2a, T1-2N2b

120
Q

Anus T3

A

>5cm

121
Q

Colorectal N2b

A

7+ nodes

122
Q

Rectal cancer: adjuvant chemotherapy

A

FOLFOX q2wks for 6 months

123
Q

Gastric cancer: 3D fields

A

AP/PA FIELD:

sup: top of T9
inf: bottom of L3

left lateral: include two thirds of left diaphragm

right lateral: 4cm lateral to vertebral bodies

LATERAL FIELD:

ant: abdominal wall
post: split vertebral bodies

124
Q

Gastric N2

A

3-6 nodes

125
Q

Esophageal cancer: fields and dose

A

CTV 45: primary with 4 cm sup/inf margin and 1 cm radial margin, plus nodes with a 1 cm margin, with volume enlarged to cover celiac if GEJ

CTV 50.4: GTV

PTV: 0.5cm

OB2 (10 decks)

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