Gastrointestinal Cancers   

Some patients have declined surgery knowing they achieved cCR. Would you observe or recommend chemoRT?

How would your planning be influenced by a possible, single inguinal lymph node metastasis?

Or, to manage tenesmus and discomfort after any type of pelvic radiation.

For example, if mass is ulcerated and cannot be excised with polypectomy? Would you ever consider radiation and chemotherapy?

Would you wait until bowel symptoms are controlled or ever pursue diversion before starting treatment?

Consider some stalk invasion, but no deep submucosal extent and negative margins by 9 mm. 

For example, there are no abnormalities on CT or PET in the upper GI and the pathology demonstrates strong CK7 staining and mucinous features with neg...

Is liquid biopsy helpful? Would you treat if this shows somatic mutation?

Do you have a preference in ordering MRI, endoscopy, CT scan (chest, abdomen, pelvis), EUS, or other testing before starting any treatment, for re-sta...

Taking into account follow up from NEO, OPERA and other organ preservation trials?

I.E., can a patient with a questionable 5 mm node (MRI T2N1) which is negative on pathology after short course radiation be staged T2N0 and receive no...

Would you give additional treatment after surgery?

If the patient is outpatient and coming into clinic each day, at what point would you initiate a C. diff workup?

Have you noted significant diarrhea until the ileostomy is reversed?

Are there any medications that you can prescribe? Diet changes? Does this typically resolve on its own after time?

Would you follow the same guideline recommendations for adenocarcinoma if the adenoma component is invading miscle wall?

Are you doing more TNT to prolong time to surgery? If so, do are you starting with CRT or chemotherapy?

How do you counsel patients on the benefit of adjuvant therapy who thought surgical resection was curative?

Does extension to the anus affect your determination of T classification? Would you consider this a T2 tumor if it does not extend to the external sph...

Patients can develop sensory and motor symptoms such as paresthesias, jaw/facial pain and stiffness, cramping and twitching, ptosis and vision changes...

Is there a subset of patients you would avoid neoadjuvant CRT and operate first?

Would preop RT still be the treatment option for these kind of patients? Assuming that the rectovaginal fistula was from tumor progression.

Is it possible or common for patients to have mucosal telangiectasias along the portions of the GI tract in the radiation fields? If present, would yo...

If biopsies consistently show high grade adenoma and there is a locally advanced rectal tumor with MRF involvement on imaging, what is the next step i...

MRI? Endoscopy? Physical exam?

Are you placing more weight on patient risk factors such as age >65 or co-morbidities?

Would you be concerned about toxicity given that he has ulcerative colitis?

Do you recommend definitive therapy? Would your approach change if there are more than 1 site of bone metastases, such as 2-3?

For instance, in borderline cases for neoadjuvant therapy (e.g. T2N1 disease), should both be obtained to increase accuracy?

Is this patient considered to have metastatic disease? Should definitive surgery be considered?

Is curative intent surgery off the table?  

Is obtaining serial MRIs or other imaging appropriate?

Specifically, rising levels noted while on somatostatin analogue. 

Fecal incontinence can be one indication. What are others?

What about T3N0 disease?  Would you use a recurrence score to help inform decisions?

Does your management differ if the hiccups are felt to be related to chemotherapy as opposed to the disease itself?

Is MRI being considered the primary mode of imaging in multidisciplinary tumor boards, especially in light of the results of the MERCURY trial (JCO 20...

Are there any indications to choose one over the other?