Neoadjuvant and Adjuvant Therapy for Gastric Cancer

Audrey E. Kam, MD

Hematology-Oncology Fellow, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY

Lakshmi Rajdev, MD

Associate Professor of Medicine, Department of Medical Oncology, Montefiore Medical Center, Bronx, NY

Question 11

A 72-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia presents with epigastric abdominal pain and melena for 5 days. He also endorses a10-lb weight loss over the past month. Physical exam is notable only for epigastric tenderness. Laboratory testing reveals a hemoglobin of 10.9 g/dL with a mean corpuscular volume of 84 fL; baseline hemoglobin is 12.8 g/dL measured 3 months ago. He undergoes an esophagogastroduodenoscopy (EGD), which reveals a large cratered ulcer in the gastric cardia. Biopsy of the lesion demonstrates invasive adenocarcinoma. Computed tomography (CT) of the abdomen/pelvis reveals a 5.1 1.1 cm area of irregular wall thickening along the cardia of the stomach and prominent lymph nodes in the gastric hepatic ligament measuring up to 1 cm.

Which of the following is needed to complete the staging work-up?

  •   CT chest
  •   Measurement of carcinoembryonic antigen (CEA) and cancer antigen (CA)
    19-9, CT chest
  •   CT chest, endoscopic ultrasound (EUS)
  •   CT chest, EUS, diagnostic laparoscopy
  •   CT chest, diagnostic laparoscopy

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