Devita, Hellman, and Rosenberg's Cancer

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

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

ANSWERS

Answer 20.1.1. The answer is E.

Similar trends have been noted in Western European countries. This trend

of increased incidence of adenocarcinoma of the esophagus has paralleled

the upward trend in rates of both GE reflux disease and obesity.

Answer 20.1.2. The answer is B.

Achalasia, tylosis, characterized by hyperkeratosis of the palms and soles

as well as esophageal papillomas, Plummer–Vinson syndrome, character-

ized by iron deficiency anemia, brittle fingernails, and esophageal webs,

are all associated with the development of squamous cell carcinoma of

the esophagus. Gastroesophageal reflux, however, is associated with the

development of Barrett’s esophagus and adenocarcinoma.

Answer 20.1.3. The answer is C.

The prevalence of Barrett’s esophagus in the general population under-

going endoscopy is approximately 1.5%, ranging from 1.2% to 2.3% in

those without and with reflux symptoms, respectively. Although antire-

flux therapies are effective in reducing or even eliminating the symp-

toms, there is no clear evidence that either medical or surgical procedures

decrease the risk of developing esophageal carcinoma. Patients with Bar-

rett’s esophagus have a 40- to 125-fold increase in the risk of developing

esophageal carcinoma compared to the general population. The presence

of any degree of dysplasia indicates the need for endoscopic surveillance,

with annual endoscopy recommended for those with low-grade dysplasia

and more frequent surveillance for those with higher grades of dysplasia.

Answer 20.1.4. The answer is A.

In a recent study evaluating the role of trastuzumab in combination

with chemotherapy for patients with gastroesophageal cancer, more than

3800 patients were screened for HER2 overexpression and 22.5% had

HER2 overexpression. The addition of trastuzumab to cisplatin-based

chemotherapy was associated with improved response rates, progression-

free survival, and overall survival compared to chemotherapy alone.

Answer 20.1.5. The answer is D.

Large families with an autosomal dominant, highly penetrant inherited

predisposition for the development of gastric cancer are rare. However,

early-onset diffuse gastric cancers have been described and linked to the

E-cadherin/CDH1 locus on 16q and associated with mutations in this

gene, which may be the case in this family. This seminal finding has been

confirmed in other studies with gastric cancers at a relatively high (67% to

83%) penetrance rate. Thus, E-cadherin mutation testing should be con-

sidered in the appropriate clinical setting. In fact, prophylactic gastrec-

tomy should be considered strongly in families with germ line E-cadherin