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CGSO oral boards > Upper GI > Flashcards

Upper GI Flashcards

(104 cards)

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1
Q

post-op therapy for esophageal SCC?

A

no systemic until progression.

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2
Q

GE cancer with positive supraclavicular node?

A

unresectable per NCCN guidelines

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3
Q

Longterm survival of T1b GE cancer?

A

Not good, need agressive surveilance or go to esophagectomy

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4
Q

Esophageal Stent at the diagnosis of GEJ cancer?

A

Only if patient will never be a surgical candidate or if they cannot swallow their own saliva.

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5
Q

Ideal lymph nodes for GE cancer staging?

A

15 if no preop therapy

undefined after neoadjuvant therapy but try for 15

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6
Q

Anatomic definition of proximal location of resectable esophageal cancer?

A

any tumor >5cm from the cricopharyngeus

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7
Q

What % of patients tolerate chemo/RT after GE junction resection?

A

Only a little over half the patients in MacDonald completed therapy.

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8
Q

What test before starting systemic therapy for esophageal adeno?

A

check HER2 status

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9
Q

Level of evidence for endoscopic resection of esophageal cancer?

A

large institutional data, no level I, but accepted.

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10
Q

Follow-up for gastric cancer?

A

Would get serial CT scans, but little evidence to support.

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11
Q

EGD surveillance after endoscopic resection/ablation of esophageal cancer?

A

start with q3month deescalate to yearly after 3 years

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12
Q

EUS after nonsurgical therapy for gastroesophageal cancer?

A

considered less reliable

[nccn 2019]

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13
Q

Trastuzumab for HER2 GEJ cancer?

A

add to chemo for all stage IV

[NCCN 2019]

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14
Q

Things to check before starting neoadjuvant therapy for GEJ cancer?

A

nutrition status and think about a j-tube

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15
Q

When is endoscopic resection likely to be fully therapeutic? (esophageal SCC - 5)

A 
lesion <2cm
lesion fully removed
well to moderate differentiation
superficial to submucosa
no LVI
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16
Q

Value of PET for gastroesophageal cancer?

A

No evidence it is superior to CT scan for staging.

Radiation Oncology uses for treatment planning.

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17
Q

Criteria to conservatively manage a thoracic esophageal leak?

A

<1/3 of circumpherence of esophagus

No evidence of ischemia.

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18
Q

When to do endoscopic resection?

A

Any nodular lesion <2cm.

If it is not therapeutic then it is more diagnostic of T stage than EUS

NCCN 2019

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19
Q

Does everyone get dumping syndrome after gastrectomy?

A

no!

do not put on low glucose diet until they get symptoms.

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20
Q

Longterm survival of Tis and T1a GE cancer?

A

close to non-cancer patients

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21
Q

NCCN guidelines for neoadjuvant therapy for SCC?

A

all T3 or N+,

can offer to all T1b or above.

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22
Q

Outcomes for robotic v open gastrectomy?

A

4 Asian RCTs suggest equivalent and on MSKCC study (V. Strong)

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23
Q

Number of chemo agents for GEJ cancer

A

double agents preferred to triple agent outside of a trial or high volume center

[NCCN 2019]

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24
Q

Progressive oligometastatic GIST on Gleevec?

A

Resect! still good survival in carefully selected patients.

[retrospective data - Raut Brigham]

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25
when to start surveilance endoscopy after definitive radiation for esophageal cancer?
at least 6 weeks [nccn 2019]
26
No residual disease after radiation of endoscopy, what next?
still do four quadrant blind biopsy of neomucosa. Residual dysplasia may be below the mucosa. [nccn 2019]
27
Three types gastric carcinoids?
I - solitary larger mass II - associated with achlorohydrea III- associated with gastrinoma.
28
Is there utility in getting peritoneal washings for gastric cancer?
no, very rarely positive in absence of clinically detectable mets. retrospective series
29
Endoscopic Surveillance for Fanconi's anemia
Consider immediately at diagnosis | may be limited by other conditions
30
Endoscopic therapy for esophageal adenocarcinoma?
up to superficial T1b
31
Classic start to work-up of dysphagia?
Do a barium swallow if not immediately a diagnosis of cancer.
32
Difference between linear and circular stapled anastomosis in GE surgery?
No difference in leak, some higher rate of stenosis with circular stapler.
33
Fanconi's Anemia
multiple genes - DNA repair deficiency anemia bleeding SCC of multiple locations
34
When to not offer chemo for Stage IV esophageal SCC?
KPS <60 ECOG >3 limited self care, sedentary >50% of time [NCCN]
35
Management of cT4b SSC of the esophagus?
definitive chemoradiation
36
Can peritoneal washings change in response to neoadjuvant therapy?
yes
37
FLOT regimen
5FU over 24 hours Leucovorin Oxaliplatin Docetaxel 14 day cycles 4 cycles preop 4 cycles post-op
38
Endoscopic Surveillance for Familial Barrett's
After age 40
39
reresect recurrent esophageal SCC?
yes if feasible per NCCN
40
Esophageal endoscopic resection v. ablation?
nodular lesion - needs ER for staging flat lesion <2cm - can do either, (ER prefered) flat lesion >2cm - ablation is safer
41
Treatment for cancer in cervical esophagus?
definitive chemo radiation
42
Dilate an obstructing tumor to complete and EUS?
associated with perforation, would not do
43
What to do before starting neoadjuvant therapy for Gastric cancer?
Do staging laparoscopy and peritoneal cytology M1 cytology has 60-80% chance of progressing during therapy. Need to consider surgery only as part of a trial.
44
surveillance for complete clinical response for neoadjuvant chemoRT for esophageal SCC?
accepted by NCCN, but probably wouldn't do
45
Endoscopic Surveillance for Tylosis
After age 20
46
Level I evidence for surveillance after definitive therapy for GEJ cancer?
none
47
High risk genetic conditions for GE cancer?
Tylosis Familial Barrett's Esophagus Bloom Syndrome Fanconi's Anemia
48
Neoadjuvant dosing of FOLFOX for GEJ cancer?
Continuous 5FU for first 48 hours of each cycle. Oxaliplatin and Leucovorin on day 1 Cycle every 2 weeks x 3 cycles with RT 3 more cycles after RT
49
incidence of gastric cancer in <40 year olds?
Is increasing similar to that of CRC, unclear mechanism
50
NCCN statement of systemic therapy for GEJ cancers
Most systemic therapies can be considered interchangeable
51
Rainbow trial?
established VEGF + FOLFOX second line for gastric cancer.
52
Acute bleeding from an esophageal tumor, nccn statement
may represent a pre-terminal event from aorto-esophageal fistulazation. Use endoscopy cautiously, recurrent bleeding is high.
53
Chronic bleeding from an esophageal tumor
palliative radiation
54
What test to order right after an esophageal stent is placed?
swallow study to ensure no leaks.
55
EGD surveillance after definitive chemoradiation of esophageal cancer?
EGD every 3-6 months for 2 years | Annual for next 3 (years 3-5)
56
GE junction cancer invading the liver or spleen?
unresectable per NCCN guidelines
57
Timeframe of "actionable" GEJ recurrences?
90% within 2 years. [NCCN 2019]
58
Minimal esophageal biopsies?
6-8 biopsies with standard to large forcepts
59
Treatment for esophageal cancer within 5 cm of the cricopharyngeus?
definitive chemoradiation
60
Additional biomarkers/targets to test for for stage IV GE cancer?
MSI and PDL-1 testing | can be done of FFPE tissue
61
What is main toxicity of ECF?
hand foot syndrome | neuropathy
62
Bloom's Syndrome
BLM gene | AML, ALL and esophageal SCC at age 20
63
EUS biopsy esophageal nodes?
Yes for all unless there is a blood vessel in the way (check flow with doppler)
64
What is response rate for dose escalation of Imatinib 400 to 800?
33% in metastatic progression.
65
Neoadjuvant chemoradiation for Siewert III lesions?
generally not; if you do it use the gastric guidelines.
66
complete response rate of esophageal SCC to definitive chemoradiation?
~60%
67
Tylosis
RHBDF2 gene | high risk of esophageal SCC
68
TOGA trial?
14 months OS with FOLFOX+ Herceptin v | 11 months with FOLFOX alone for gastric cancer
69
reconstruction after gastrectomy?
always a roux limb.
70
When to do esophagectomy for T1a SCC?
extensive disease, especially nodular disease not controlled by ablation.
71
What to do with progression of metastatic GIST?
Dose escalate from Imatinib 400 to Imatinib 800.
72
NCCN position on peritoneal washings for GE cancer?
"consider" for T3 or N+ disease
73
Complete clinical response to neoadjuvant thererapy for gastric adeno?
still need surgery, do not let them trap you into watch and wait.
74
Goal gross margins for gastric cancer?
> 4 cm | 15 lymph nodes
75
Older patient with difficult to localized pylorus?
Can always do upper endoscopy intraop.
76
hand foot syndrome
occurs during capecitabine or 5-FU. hand and foot erythema, blistering and skin peeling no treatment gradually improves once chemo stopped/reduced
77
Who could you potentially omit staging laparoscopy on for gastric cancer?
T2 or lower | no nodal involvement.
78
EGD Surveillance after esophagectomy?
as needed unless Barrets left over, then start with q3 month endoscopy
79
Linitis plastica on pathology?
Always do a total gastrectomy and be prepared to chase the superior margin into the chest.
80
What early gastric cancers should not get an endoscopic mucosal resection?
poorly differentiated | ulcerated on endoscopy
81
Siewert Classification
I is 1-5 cm above GE junction II is 1 cm above or 2 cm below the GE junction III is more than 2cm below, treat as gastric.
82
How do you do Endoscopic Lumen restoration for complete lumen restoration with an esophageal cancer?
Via anteriograde and retrograde (via gastrostomy) endoscopy. [NCCN guidelines]
83
Was diagnostic laparoscopy routine for Magic study?
no! may have worsened results.
84
Cutoff for endoscopic resection of esophageal SCC?
T1a or lower. (tumor invades muscularis mucosa)
85
What do you do before starting neoadjuvant chemo for gastric cancer?
Diagnostic laparoscopy in addition to standard staging.
86
Familial Barret's
numerous genes associated
87
Staging after diagnosis of GE cancer?
start with CT C/A/P | if no M1 disease go on to PET and EUS
88
Endoscopic Surveillance for Blooms Syndrome
After age 20
89
When do you do adjuvant chemoradiation after esophagectomy (SCC)?
only for R1 resection
90
esophageal SCC invading trachea, great vessels of heat?
consider chemotherapy alone
91
Supplements needed after total gastrectomy? (3)
Vit D Iron B12
92
NCCN imaging surveillance after esophagectomy by stage?
``` Stage I (T1N0) - only with symptoms Stage II - III - imaging only (unless Barrets) ```
93
PAtient has M1 cytology and then good response to palliative chemo; repeat cytology is M0?
You have probably already passed the room, this is the population to look at clinical trials of HIPEC.
94
Assessment of HER2 status of GE cancers?
do if unresectable and planning for systemic therapy may still be equivocal and need FISH, just like breast cancer.
95
Three main theoretic benefits of neoadjuvant RT
improved tissue oxygenation Smaller defined field (helps rad/onc aim) increase rate of R0 resection
96
Signet ring cell gastric cancer
more diffuse spread presents at higher stage more chemo-resistant associated with CDH1 mutations
97
multiple low grade gastric NETs?
check a gastrin level | check for achlorohydria (gastric pH)
98
pericardial invasion of GE cancer?
still resectable, take the pericardium
99
Operation for esophageal leak?
try to save the conduit if no necrosis. debride edges cover defect with an intercostal or pleural flap cervical diversion.
100
treatment of goblet cell of the appendix
R0N0 - right hemicolectomy N+ add FOLFOX M1 - FOLFOX v HIPEC
101
median survival of mucinous appendiceal tumors?
16 years
102
adjuvant therapy for low grade mucinous appendiceal tumor?
HIPEC only for cellular mucin, no chemo, no radiation
103
most common complication of HIPEC?
prolonged ileus
104
survival benefit to doing right hemicolectomy at the time of rupture of a appendiceal mucinous neoplasm?
no, only if you do HIPEC at the same time as resection.

CGSO oral boards (7 decks)

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