Gastroesophageal

    Table of contents

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    Introduction

     

    Staging

    • TNM
    • Stage 1 - Superficial Lesion (does not penetrate esophagus/stomach wall)
    • Stage 2 - Full-thickness lesion
    • Stage 3 - Locoregional LN's
    • Stage 4 - Distal Metastatic

     

    Treatment

    • Locoregional disease (AJCC Stage I-III) --> surgery
      • Recurrence rates high, surgical cure is low
    • Neoadjuvant chemotherapy
      • Improves outcomes (modestly, but statistically significant)
    • Pre-Op Radiation
      • Supported (less robust data)
    • Post-Op Chemoradiation
      • Combination used
    • Metastatic Disease
      • Usually palliative
      • Some modest activity from chemo agents:
        • Combination cisplatin-based regimen (single agents aren't as effective)
    • HER2 Growth Factor
      • Expressed in 20% gastric and 30% gastroesophageal
      • Trastuzumab added to chemo therapy
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