This interactive educational activity developed from the proceedings of a live CME meeting held in January that featured multidisciplinary community-based "tumor boards" presenting current cases of GI cancer allows you to vote on your preferred treatment recommendations for these patients and then compare your responses to those of the faculty and live audience members. For each case, the video-recorded discussions from the meeting or interviews with specific faculty members are available to provide additional perspectives on the current clinical evidence guiding decision-making for the scenarios in question.
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Case 1: A 67-year-old man presents with HER2-positive metastatic gastric cancer
A 67-year-old man with a prior h/o stent placement for coronary artery disease (CAD) presents with HER2-positive gastric cancer with extensive pulmonary metastases and experiences a major clinical response to FOLFOX/trastuzumab, but his ejection fraction (EF) decreases from 70 percent to 30 percent. He has no congestive heart failure symptoms, and treatment with trastuzumab is stopped.
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Case 2: A 76-year-old man with locally advanced HER2-negative gastric cancer
A 76-year-old man with CAD and a PS of 1 presents with moderate upper gastrointestinal bleeding that proves to be the result of locally advanced gastric cancer. The patient does not wish to undergo surgery but is open to treatment.
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Case 3: A 78-year-old woman with HER2-positive metastatic gastric cancer
A 78-year-old woman with metastatic HER2-positive (FISH 6.9) adenocarcinoma of the GE junction demonstrates a good response to FOLFOX/trastuzumab. Oxaliplatin is discontinued because of neurotoxicity.
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Case 4: A 79-year-old man with CRC and an isolated hepatic metastasis
A 79-year-old man in good condition received prior adjuvant capecitabine for Stage T3N2M0 colon cancer after which an elevated CEA led to a CAT scan demonstrating an isolated peripheral lesion in the right lobe of the liver. PET shows no disease elsewhere. Biopsy is compatible with colon cancer metastasis.
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Case 5: A 65-year-old woman has obstructive colon cancer and liver metastases
A 65-year-old woman has obstructive colon cancer and liver metastases.
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Case 6: An 83-year-old woman with locally advanced rectal cancer
An 83-year-old woman with a 40-year history of inflammatory bowel disease (currently well controlled) presents with locally advanced rectal cancer.
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Case 7: A 77-year-old man initially seen for Stage III colon cancer presents with liver lesions
A 77-year-old man underwent a hemicolectomy for Stage III colon cancer in 2003 and received adjuvant chemotherapy. In 2007, a testicle was removed for diffuse large B-cell lymphoma, and he received R-CVP. He now presents with liver lesions suggestive of “tumor.”
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Case 8: An 84-year-old woman with K-ras wild-type, recurrent metastatic CRC
An 84-year-old woman presents with bowel perforation and obstruction from K-ras wild-type colon cancer and undergoes a surgical resection but is postoperatively found to have elevated CEA levels and new imaging evidence of liver metastases.
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Case 9: An 80-year-old man with inoperable HCC
An 80-year-old man, previously active and healthy, presents with weight loss and right upper quadrant pain and is found to have large masses in the right lobe of the liver. Biopsy demonstrates HCC. He is not considered a surgical candidate.
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Case 10: A 66-year-old man with hepatitis C presents with asymptomatic HCC
A 66-year-old asymptomatic man with known hepatitis C presents with a screening AFP of 120,000 and imaging evidence of multiple hepatic defects suggestive of extensive hepatocellular carcinoma (HCC) and cirrhosis.
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Case 11: An 80-year-old man with HCC and a vertebral metastasis
An 80-year-old man in previously good health presents with abdominal pain and is found on CAT scan to have an 8-cm centrally located hepatic mass that on biopsy is HCC. He is also found to have an expansile lytic lesion in the L3 vertebra that is positive on bone scan.
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Case 12: A 44-year-old woman with recurrent metastatic pancreatic cancer
An otherwise healthy 44-year-old woman with prior removal of primary pancreatic cancer and one small liver met now has multiple recurrent liver metastases and elevated tumor markers.
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Case 13: A 22-year-old woman diagnosed with Stage IV pancreatic cancer
A 22-year-old woman presents with minimal abdominal pain, and imaging shows a mass in the pancreatic tail and multiple liver defects. Pancreatic and liver biopsies are compatible with pancreatic cancer.