Devita, Hellman, and Rosenberg's Cancer

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

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

Question 20.1.15.A 65-year-old woman underwent a D2 subtotal gastrectomy for a T3N1

moderately differentiated gastric cancer at a community hospital. On

recovery from the operation, 9 weeks later, she was offered adjuvant

fluoropyrimidine-based chemoradiation. Which of the following state-

ments about adjuvant therapy for completely resected gastric cancer is

TRUE?

A. Comparable local control can be achieved with optimal surgery that

includes D2 lymph node dissection, and if this can be confirmed by

a second pathology review, she does not need additional therapy.

B. Adjuvant chemotherapy alone based on data from the MAGIC trial

is indicated because she has had adequate surgery. Radiation will not

add any further improvement in local control.

C. The recommendation is based on results of the Intergroup study

where D2 dissections were performed in only 10% of patients; thus,

this may not be the best approach for this patient.

D. Adjuvant 5FU-based chemoradiation with 45 Gy radiotherapy has

been shown to have a major advantage in survival, disease-free sur-

vival, and local–regional control compared with surgery alone, with

much of the advantage in terms of improved local and regional con-

trol.

Question 20.1.16.A 79-year-old African American man presents with advanced gastric can-

cer, peritoneal carcinomatosis, and malnutrition. Parenteral nutrition is

initiated, and his performance status is slowly improving. He is now able

to perform activities of daily living and has gained 8 lbs. His daughter

would like to know what your recommendations are at this point. Your

response would be:

A. His survival with best supportive care alone is likely to be approxi-

mately 3 months. Now that he is strong enough to tolerate the side

effects of chemotherapy, he could have a prolonged survival and bet-

ter quality of life if he opts for chemotherapy.

B. His survival with best supportive care alone is likely to be 3 months;

chemotherapy may improve his quality of life.

C. With chemotherapy, an improvement in survival is expected in

patients with a performance status of 0 or 1, essentially only those

who are fit and relatively asymptomatic from their cancer.

D. Intraperitoneal chemotherapy may be better in this case for better

delivery of chemotherapy in the peritoneal cavity because it would

avoid the toxicities of systemic therapy.

Question 20.1.17.All of the following are thought to be protective against the development

of adenocarcinoma of the esophagus, EXCEPT:

A. Smoking cessation

B. Consumption of raw fruits and vegetables

C. Aspirin use

D. H. pylori infection