GI

Question 1

1. Anal canal S&S
2. Colorectal S&S
3. Esophagus S&S
4. Stomach S&S

Answer 1

1. Rectal bleeding
2. asymptomatic–>abdominal pain and rectal bleeding
3. dysphagia and wt loss
4. anorexia

Question 2

Epi/Eti

1. Anal canal
2. Colorectal
3. Esophagus
4. Stomach

Answer 2

1. increase in women & HPV 16
2. increase in males & increase BMI, chronic ulcerative colitis, hereditary
3. increase in males & SCC: alcohol and tobacco
   Adeno: barretts esophagus
4. more common than esophagus and anal canal combined, increase in males & H.pylori infx and tobacco

Question 3

Prognostic indicators in

1. Anal canal
2. Colorectal
3. Esophagus
4. Stomach

Answer 3

1. stage
2. stage
3. R status
4. stage

Question 4

Pathology in

1. Anal canal
2. Colorectal
3. Esophagus
4. Stomach

Answer 4

1. SCC
2. Adenocarcinoma
3. SCC: upper and middle
   Adeno; lower 1/2 + GE jxn (barrets esophagus)
4. Adenocarcinoma

Question 5

Anal canal dose

Answer 5

*Sx is no longer initial tx

Chemo RT

• primary: 54-60
• LN 30-50

RT only

• primary: 60-65
• LN: 30-50

Question 6

Colon dose

Answer 6

tumour bed +3-5cm margin=45Gy

then reduced fields to 50.4-54

Question 7

Stomach Dose

Answer 7

post-op ChemoRT
45-50.4Gy
field reduction after 45Gy

Question 8

Rectum dose

Answer 8

Long course

• PH 1: primary, LN & margins 45Gy/25
• PH 2: includes primary and margin 540/3\

Short course
-Single phase 25/5

Question 9

Esophagus Dose

Answer 9

Neo-adj chemo RT followed by sx (5cm)
4140/23

RT only
45Gy +15-20Gy boost=60-65

RTchemo only
45Gy +540/28

Question 10

Colon Disease Management

Answer 10

sx primary tx
T1-T2 no RT just sx

Stage III-chemo

Question 11

Rectum Disease Management

Answer 11

Sx primary tx
most disease require LAR (upper) and APR (lower)
RT Chemo pre-op

Question 12

Esophagus Disease Management

Answer 12

Sx primary tx (only in thoracic region)

Stage I-III sx+/- neo-adj chemo and RT

Question 13

Stomach Disease Management

Answer 13

sx

Question 14

Anal canal Lymphatics and metastasis

Answer 14

pelvic or inguinal
50% have spread into rectum or perianal skin

M: Liver and lungs

Question 15

Colorectal Mets

Answer 15

Peritoneal seeding

M: Liver then lungs

Question 16

Esophagus Lymphatics and metastasis

Answer 16

No serosal layer (ski mets up to 8cm)

possible M to liver and lungs

Question 17

Stomach Lymphatics and metastasis

Answer 17

ultimately drain to celiac nodes
M: GE junction to liver and lungs
pylorus to liver

Question 18

Anal canal field borders

Answer 18

APPA
Sup: L5/S1 (after 30Gy border goes to SI joint)
Inf: 3cm distal of primary tumour
Post: Past sacrum
Ant: Ant of pubic symphysis (if treating ext nodes)

Question 19

Rectum field borders

Answer 19

Sup: L5/S1
Inf: below obturators (LAR) or past perineum (APR)
*Need 3cm coverage past lowest extent of disease
Post: 2cm past sacrum
Ant; inside pubic symphysis (fem heads)

Question 20

Stomach field size

Answer 20

APPA 15x15cm