American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the typical treatment for patients with stages I, II, and III gastroesophageal cancer?

1. Surgery and adjuvant chemotherapy

2. Surgery with neoadjuvant chemotherapy or chemoradiation therapy

3. Palliative chemotherapy only

4. Radiation therapy alone

The correct answer is: Surgery with neoadjuvant chemotherapy or chemoradiation therapy

In the management of stages I, II, and III gastroesophageal cancer, the typical treatment involves a multimodal approach that often includes neoadjuvant chemotherapy or chemoradiation therapy prior to surgical intervention. This strategy is based on evidence suggesting that administering chemotherapy or chemoradiation before surgery can shrink tumors, potentially making them more resectable and improving surgical outcomes. Neoadjuvant therapy helps to address micrometastatic disease and can also minimize the risk of recurrence. The treatment regimen is tailored to the individual patient, considering factors such as tumor characteristics and overall health. In contrast, surgery and adjuvant chemotherapy may be appropriate for certain cases, particularly in earlier stages or for patients who present with resectable tumors without significant downstaging from the neoadjuvant approach. However, neoadjuvant therapy is generally favored for stages I to III gastroesophageal cancer due to its potential to improve long-term survival. Palliative chemotherapy is primarily reserved for advanced disease when curative options are no longer viable. Similarly, radiation therapy alone may play a role in the palliation of symptoms or in specific circumstances, such as when used in conjunction with other therapies, but it is not standard treatment for the earlier stages of