upper Gi cancers Flashcards
(23 cards)
Which genetic syndromes are associated with pancreatic cancer?
BRCA2 HNPCC Familial pancretic cancer for which gene not known Peutz Jeghers Syndrome p16INK4 (melanoma and panc cancer)
standard of care for panc cancer adjuvant chemo
gemcitibine (Based on ESPAC 3 gemcitabine vs 5FU study)
Metastatic panc cancer standard of care
gemcitabne plus abraxane (nab-paclitaxel)
3 month survival benefit
sudden onset diabetes or suddenly brittle diabetes…suspect what?
pancreatic ca
Which is the only medical therapy for HCC?
Sorafenib
How does sorafenib work?
multi-targeted kinase inhibitor; don’t know which one is useful
also
FGF activity so may make the cirrhosis a bit better
also
VEGF inhibition effect (so need to do endoscopy pre to check for and band varices)
3 month survival benefit
Risk factors for gastric ca
H pylori EBV smoking genetic factors (BRCA2, HNPCC/Lynch, Peutz jegher syndrome, familial diffuse gastric cancer (CDH1) blood group A pernicious anaemia salty, spicy, nitrate rich food
Where do H pylori associated gastric cancers tend to be found?
Distal stomach
How do you stage a gastric cancer?
Need to do CT, endoscopy but ALSO laparoscopy- this can help find small peritoneal disease that may have been missed by CT.
How is chemo used in gastric ca and what was the name of the study?
Pre-op chemo plus surgery- MAGIC study
post op (adjuvant ) chemo only shown survival benefit in Japan
Post op chemoradio is used often if no chemo pre-op and nodes ended up being involved
Can used trastuzumab in HER2 positive
RF for oesophageal ca
smoking
alcohol
barretts (replacement of normal stratified squamous with gastric columnar)
oesophageal adeno ca work up
endoscopy PET- will exclude some people from surgery as cannot clear nodes more than about 5cm away from cancer CT UES and biopsy laparoscopy if GOJ
How do you treat oesophageal cancer based on stage and location?
Lower 2/3 oesophagus and T1 or T2 and adenoca–>surgery alone
Upper 1/3 oesophagus and T1 or T2–>definitive chemoradiotherapy
Resectable T1-3 and node positive or T3 and node neg–> get pre-op chemoradiotherapy
What are the different presentations of carcinoid tumours (gastroenteropancreatic neuroendocrine tumours GEPNETS)
Non functioning - most insulinomas-->hypoglycaemia glucagonomas-->hyperglycaemia VIPomas-->diarrhoea gastrinomas-->gastric ulcers (ZES)
How do you grade a neuroendocrine tumour?
base on mitotic count and Ki-67 lung index (percent)
over 20% is high burden
often a tumour is mixed and there is a bit of higher grade and bit of lower grade.
How are octreotide scintigraphy and gallium Dotatate PET/CT used?
When staging grade 1 and 2 neuroendocrine tumours
diagnosis and management: assess somastostatin receptor density to see if suitable for somatostatin analogue treatment and potentially for peptide radionucleotide receptor therapy
changes management in 20-30% cases, usually by upstaging
How to manage carcinoid syndrome
Avoid precipitants of fushing eg alcohol, pressure on RUQ Loperamide and codeine for diarrhoea steroids H1 and H2 receptor blockers Chlorpromazine for flushies echo 6-12 monthly long acting octreotide
If have a adeno early stage at gastroesoph/lower oesoph.?
surgery alone
if nodes then pre op chemoradio and try and salvage
signet cells in
spindle cells in
signet in stomach
spindle in GIST
Treat a gastric cancer
preop chemo
post op chemoradio
What is the best chemo for panc now? For operative disease
JUST gemcitabine for operative disease
chemoradio increases relapse
5FU actually worse
still combo if inoperative
data clearly shows that just do surgery rather than stenting someone first as long as no cholangitis and bili under 300
Why is chromogranin A measurement useful
do in neuroendocrine tumour to estimate BULK not activity
MOST COMMON BUT IN FEB NEUT
staph epidermis
mostly endogenous organisms
