GI Oncology

Question 1

Where does colorectal cancer rank among amount of deaths and new cases of all cancers?

Answer 1

3 for men and women

Question 2

Has the incidence of colorectal cancer gone up or down since 1975?

Answer 2

down actually due to screening! :)

Question 3

Are most colorectal cancers diagnosed in advanced stages?

Answer 3

YES

Question 4

What is the 5 year survival for metastatic colorectal cancer?

Answer 4

10% :(

Question 5

What is the most important risk factor for colorectal cancer?

Answer 5

increasing age followed by genetic factors

Question 6

If you have FAP, what is your risk of developing colorectal carcinoma by age 39?

Answer 6

100%

Question 7

What disease is similar but less severe than FAP?

Answer 7

MUTYH-associated polyposis (MAP)

Question 8

How long does it take for the adenoma-carcinoma sequence to occur?

Answer 8

over many years (that’s why pts get a colonoscopy every 10 years after age 50).
*APC, K-RAS, p53 mutations in that order

Question 9

What is the symptomatology of colon cancer?

Answer 9

• change in bowel habits (more common with left-sided tumors).
• hematochezia (bleeding through anus)
• iron deficiency anemia (more common with right-sided CRCs).
• abdominal pain (related to obstruction/perforation/carcinomatosis).
• tenesmus, rectal pain, and diminished caliber of stools (seen with rectal primaries).
• rare presentation= bacteremia/endocarditis, fistuals.

Question 10

What is the staging workup for CRC?

Answer 10

• colonoscopy and biopsy, EUS for rectal tumors
• CBC
• CEA tumor marker (remember only shows treatment response or recurrence).
• pathologic tissue review
• CT scans with contrast
• MRI liver (for metastasis) or PET (for metastasis)

Question 11

What are the 4 stages of colorectal cancer (Dukes staging)?

Answer 11

• stage I= NOT passed the muscularis propria
• stage II= passed the muscular layers of the bowel
• stage III= any regional lymph nodes involved
• stage IV= distal metastasis

Question 12

What should you look for on a pathology report for a pt with possible CRC?

Answer 12

• grade of cancer
• depth of invasion
• extension to adjacent structures
• number of nodes and number evacuated
• metastasis to other organs (liver, peritoneum, lung…)
• satellite nodules (irregular tumor deposits in the pericolorecal fat; look like lymph nodes, but with no lymph tissue).
• lymphovascular= BAD

Question 13

How do we treat non-metastatic CRC?

Answer 13

• stage I= surgery
• stage II= surgery + chemo (if high risk)
• stage III= surgery + 6 months of 5-FU (FOLFOX)

Question 14

What drugs combined with 5-FU help with treatment of metastatic colon cancer?

Answer 14

• irinotecan
• capecitabine
• oxaliplatin
• cetuximab (biologics; antibodies target epidermal growth factor).
• bevacizumab (biologics; antibodies)
• panitumumab (biologics; antibodies target epidermal growth factor).
• Regorafenib and Aflibercept (anti-VEGF drugs)

Question 15

If you have a RAS gene mutation, do you get any help from drugs that target epidermal growth factor (EGFR) (cetuximab or panitumumab)?

Answer 15

NO, because RAS is a step following EGFR, and if RAS is already mutated to be constitutively activated, then these drugs will have no effect.

Question 16

How do you treat RECTAL cancer?

Answer 16

• combination chemo with RADIATION then followed by surgery, due to higher chance of metastasis in the rectum.
• adjuvant chemo with 5-FU (FOLFOX)

Question 17

What are the 2 types of pancreatic cancer?

Answer 17

1. ductal adenocarcinoma (90%) VERY AGGRESSIVE.

2. Neuroendocrine tumors (islet-cell tumors, VIPoma, glucagonoma); not as aggressive.

Question 18

What is the symptomatology of pancreatic cancer?

Answer 18

• abdominal pain
• anorexia/weight loss
• obstructive jaundice from biliary obstruction
• venous thrombosis
• malabsorption/steatorrhea

Question 19

What genetic syndromes are associated with pancreatic cancer?

Answer 19

• BRCA2, Peutz-Jeghers syndrome, Lynch syndrome (HNPCC)

Question 20

How do you diagnose pancreatic cancer?

Answer 20

• CT scan, ERCP/EUS (diagnostic and therapeutic), LFTs

Question 21

How do you treat pancreatic cancer?

Answer 21

• pancreatoduodenectomy (whipple resection)

- adjuvant chemoradiation (5-FU) or chemo (gemcitabine)

Question 22

How do we manage symptoms with pancreatic cancer?

Answer 22

• biliary stents, celiac blocks (due to pain from pressure of tumor on the celiac plexus), pancreatic enzymes, and palliative surgery for bypass

Question 23

How do we treat hepatocellular carcinoma?

Answer 23

• surgery, liver transplant

Question 24

How do we score liver disease?

Answer 24

• Child-Pugh scoring system

Question 25

Is squamous cell carcinoma or adenocarcinoma of the esophagus now more common in the U.S.?

Answer 25

adenocarcinoma due to GERD and western diet

Question 26

How do we treat esophageal cancer?

Answer 26

- endoscopic mucosal resection - pre-op chemoradiation - surgery - Advanced disease (add traastuzumab for Her 2 positive disease)

Question 27

With what 2 cancers is H. pylori associated?

Answer 27

Gastric and MALT lymphoma

Question 28

What is hereditary diffuse gastric cancer?

Answer 28

autosomal dominant syndrome associated with diffuse-type gastric cancer, developing lobular breast cancer, and signet ring cell colon cancer. *CDH1 gene mutation

Question 29

How do we treat gastric cancer?

Answer 29

- chemo - gastrectomy - post-op chemoradiation