Devita, Hellman, and Rosenberg's Cancer

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

Chapter 20•Cancer of the Gastrointestinal Tract 235

Question 20.1.12.In the United States, preoperative chemoradiation for locally advanced

esophageal cancer followed by esophagectomy is commonly used as evi-

dence suggests that this approach offers a survival advantage over surgery

alone. Which of the following statements about the benefits of neoadju-

vant chemoradiation are TRUE?

A. In approximately two-thirds of patients, disease is downstaged.

B. A survival advantage exists for patients experiencing downstaging

to pathologically confirmed complete response or minimal residual

disease status.

C. Locoregional control is improved, whereas distant failure is frequent

and is the major cause of death.

D. All of the above.

Question 20.1.13.A 67-year-old man with dysphagia to solids and a 20-lb weight loss

presents for evaluation and workup. Endoscopy reveals a 4-cm-long stric-

ture from 28 to 32 cm, and biopsy confirms moderately differentiated

squamous cell cancer, likely with regional nodal involvement noted on

PET scan. The patient has long-standing diabetes mellitus, hypertension,

and peripheral vascular disease and is not thought to be a good surgical

candidate. The best treatment approach would be:

A. Photodynamic therapy followed by salvage chemoradiation

B. Chemoradiation with cisplatin, 5FU, and 64.8 Gy of radiation to

tumor and involved nodal regions, including 5-cm margins above

and below the tumor

C. Chemoradiation with cisplatin, 5FU, and 50.4 Gy of radiation to

tumor, including the nodes involved

D. Radiation alone because he is unlikely to tolerate any kind of

chemotherapy.

Question 20.1.14.A 57-year-old Caucasian woman with long-standing reflux symptoms pre-

sented with hematemesis to a local emergency department. Endoscopy

revealed a distal esophageal malignant ulcer with involvement of the

gastroesophageal (GE) junction and 5 cm of the gastric cardia. Biopsy

revealed intestinal metaplasia at the GE junction and confirmed a diag-

nosis of adenocarcinoma. CT shows thickened distal esophagus and prox-

imal stomach, hiatal hernia, and enlarged celiac nodes. Which statement

most accurately describes her cancer?

A. She has a Siewert type I cancer: adenocarcinoma of the distal esoph-

agus, which usually arises from an area with specialized intestinal

metaplasia of the esophagus (i.e., Barrett’s esophagus) and may infil-

trate the esophagogastric junction from above.

B. She has a Siewert type II cancer: adenocarcinoma of the cardia, which

arises from the epithelium of the cardia or from short segments with

intestinal metaplasia at the esophagogastric junction.

C. She has a Siewert type III cancer: adenocarcinoma of the subcardial

stomach, which may infiltrate the esophagogastric junction or distal

esophagus from below.