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Flashcards in GI cancers Deck (14)
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1
Q

what is the process of diagnostic tests in oesophageal-gastric cancers?

A

start with endoscopy (macroscopic)

do a CT to exclude metastatic disease

EUS should be next to stage, particularly the T stage

then PET if considering curative treatment.

2
Q

what is the treatment of distal oesophageal ca? (broadly speaking)

A

if curative, surgery is the mainstay

there should always be either chemo or chemoRTX. It’s still unclear if pre, peri or post op treatment

3
Q

what is the treatment of incurable gastro-oesophageal and gastric cancer?

A

chemo

there is now also evidence of role for trastuzamab (herceptin) for tumours that are HER2 over-expressors.

4
Q

in the work up of painless jaundice, what are the investigations?

A

CT is most often. usually dual phase

if the patient is to proceed to surgery, there is no need for biopsy before hand

PET has no established role in management

5
Q

what is the treatment of curative pancreatic Ca?

A

surgery (Whipple’s) and then adjuvant chemotherapy (5FU or gemcitabine)

6
Q

what is the origin cell of GIST tumours?

A

interstitial cells of Cajal (the GI pacemaker cell)

they are often “spindle shaped”

they are OFTEN (>85%) driven by C-KIT mutation (CD117), which causes an uncontrolled downstream autophosphorylation and downstream signaling

7
Q

what is the benefit of the faecal occult blood test?

A

it reduces mortality in randomised trials

8
Q

if someone has microsatellite instability and BRAF mutations, what does that mean about their germline?

A

HNPCC is associated with microsatellite instability, but not the BRAF mutation.

therefore, BRAF and MSI means methylation and not germline mutation

9
Q

What is the treatment of CRC?
stage 1?
stage 2?

stage 3?
stage 4?

A

stages 1 and 2 should be treated with resection

Resected stage III should be treated with 5FU +/- oxaliplatin

stage IV treatment should be bevacizumab plus some sort of chemo. Never stop bevacizumab (avastin - a VEGF ligand inhibitor)

10
Q

what are the adverse events associated with bevacizumab?

A

this is a VEGF inhibitor
it has impact on vessels

therefore, we can think of the side effects as hypertension
epistaxis

proteinuria

GI perforation
wound healing interference - should not be used 6 weeks either side of surgery

MI/stroke can occur, but are rare

11
Q

what is cetuximab?

A

this is a EGFR MAb (EGF-Receptor MAb)

that are active with chemo or as single agent

They ONLY WORK IN K-RAS WILD TYPE

12
Q

what are the adverse events associated with cetuximab?

A

this can be associated with allergic reactions (chimeric antibody)

Rash is very common - this is PREDICTIVE of response - it looks like acne but is NOT acne

diarrhoea
low Mg

13
Q

what is the treatment of carcinoid syndrome?

A

this shoudl be treated with somatostatin analogues (such as octreotide)

14
Q

what are some ways to monitor carcinoid syndrome and carcinoid tumours?

A

24 hour urine 5HIAA is important

but

chromogranin A is also a useful marker and is probably more closely aligned to the tumour growth