Devita, Hellman, and Rosenberg's Cancer

LWBK1006-20 LWW-Govindan-Review December 12, 2011 19:4

234 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Question 20.1.9. A 58-year-old Caucasian man with a long-standing history of alcohol

abuse and 40 pack-year smoking history is evaluated by his primary care

physician for symptoms of acid reflux. He is placed on a trial of proton

pump inhibitor with partial relief of symptoms. He undergoes an upper

endoscopy, and salmon pink color mucosa extending in a tongue-like fash-

ion is identified at the gastroesophageal junction, extending 8 cm in length.

Biopsy results reveal Barrett’s esophagus with high-grade dysplasia and

a 1.5-cm focus of submucosal adenocarcinoma. Staging PET/CT scan is

negative for metastatic disease. The patient has neoadjuvant chemora-

diation followed by esophagogastrectomy, and pathology is consistent

with a residual 0.8-cm area of moderately differentiated adenocarcinoma

extending into the muscularis, with no lymphovascular invasion or lymph

node involvement with tumor. The patient is here for follow-up today

6 weeks postoperatively. He feels well and states he is thinking of return-

ing to work. What are your recommendations?

A. Baseline postoperative restaging scan and annual radiographic

surveillance, 3-month history, and physical examination

B. Adjuvant chemotherapy with cisplatin+5-fluorouracil (5FU)

C. Adjuvant chemoradiation therapy with cisplatin+5FU

D. Follow-up in 4 months with complete blood count (CBC) and com-

prehensive metabolic panel (CMP)

Question 20.1.10.In the case described in Question 9, what is the pathologic stage of the

patient?

A. T1N0M0 stage I

B. T2N0M0 stage IIA

C. T3N0M0 stage IIB

D. T3N0M0 stage III

Question 20.1.11.Which of the following statements regarding the use of capecitabine and

oxaliplatin in patients with advanced carcinoma of the esophagus or stom-

ach is FALSE?

A. Capecitabine and oxaliplatin are non-inferior to infusional 5FU and

cisplatin, respectively.

B. Oxaliplatin was associated with higher incidence of neutropenia com-

pared to cisplatin.

C. The median survival for EOX (epirubicin, oxaliplatin, and

capecitabine) is superior to ECF (epirubicin, cisplatin, and 5FU).

D. None of the above.