Devita, Hellman, and Rosenberg's Cancer

LWBK1006-37 LWW-Govindan-Review November 24, 2011 11:29

Chapter 37•Peritoneal Carcinomatosis 489

Question 37.10. A 45-year-old woman presented with 3 months’ duration of abdomi-

nal discomfort and chronic reflux. She underwent an esophagogastro-

duodenoscopy that showed a stomach mass at the antrum. Endoscopic

ultrasound/fine-needle aspiration confirmed an adenocarcinoma with

clinical staging of a T3N0 lesion. CT scans did not show any metastatic

lesions. The patient is scheduled for curative surgical resection and now

wants to discuss the potential use of intraperitoneal chemotherapy.

A. Postoperative intraperitoneal chemotherapy provides survival benefit

when compared with surgery alone and should be offered as part of

the standard of care.

B. The role of adjuvant intraperitoneal chemotherapy after complete

resection of primary tumors remains to be determined.

C. 5FU and mitomycin C will be used as part of intraperitoneal treat-

ment.

D. Cisplatin and mitomycin C are the agents of choice for intraperitoneal

therapy.

Question 37.11. A 50-year-old man was found to have a near obstructing adenocarcinoma

involving the splenic flexure of his colon. His staging CT scans showed five

small nodules associated with the greater omentum. No distant metastases

were identified. He underwent surgical resection of the primary mass

and debulking of his intraperitoneal carcinomatosis. However, complete

cytoreduction was not possible because of the intraoperative discovery of

multiple tumor masses firmly adhering to intra-abdominal vital organs.

He now wants to know his overall prognosis and treatment plan.

A. His prognosis is the same as if he had complete cytoreduction.

B. Hyperthermic intraperitoneal chemoperfusion does not significantly

improve prognosis in incomplete cytoreduction.

C. His prognosis is much poorer when compared with those with

complete cytoreduction, and the need for systemic chemotherapy is

inevitable.

D. Both B and C.

Question 37.12. What is not a risk factor for malignant peritoneal mesothelioma?

A. Asbestos exposure

B. Abdominal radiation

C. Simian virus 40 exposure

D. Cigarette smoking

Question 37.13. Which of the histologic subtypes of malignant peritoneal mesothelioma

has the best prognosis?

A. Epithelial

B. Sarcomatoid

C. Mixed