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Living with cancer· Appointment prep

Appointment sheet: Microsatellite-unstable (MSI-high) gastric cancer

One page to bring and write on: your details, the questions for Microsatellite-unstable (MSI-high) gastric cancer plus your own, the words you may hear, what to bring, the treatments the standard of care names, and room for the answers and agreed next steps. What you type stays in this browser. Print it or save it as a PDF. New to all this? Start with the first 60 days. Orientation, not medical advice.

Tick the questions to print

All of this cancer's questions start ticked. Untick what does not apply; ticks are kept in this browser. .

Your own questions

Shared with the prep pack, so questions you add there appear here too.

Print or save as PDF

Use (or Ctrl+P, Cmd+P on a Mac). To keep a copy, choose Save as PDF as the destination in the print dialog. Only the sheet prints; the controls stay on screen. Your typed notes print where you typed them; empty fields print as ruled lines to write on.

Appointment sheet

Microsatellite-unstable (MSI-high) gastric cancer

Prepared with OnCo (onco.cc/prep/gastric-msi-high/). Orientation, not medical advice; your team knows your case.

My details

Name
Date of appointment
Hospital and clinician
Who is coming with me

What I know, what is unclear, changes to discuss

Saved in this browser
What I know so far
What is unclear to me
Changes since last time

My questions

17 on the sheet
Newly diagnosed
  1. 1.What is my exact diagnosis, stage, and grade, and which tests established them?
  2. 2.Which biomarkers have been tested on my tumour (for example Mismatch repair proteins by immunohistochemistry, Microsatellite instability by polymerase chain reaction or sequencing, Tumour mutational burden, PD-L1 combined positive score, Germline mismatch repair genes where Lynch syndrome is suspected), and what were the results?
  3. 3.Which subtype is my cancer, and does that change the recommended treatment?
  4. 4.Is germline (inherited) genetic testing recommended for me or my family?
Advanced, first line
  1. 5.For my situation (advanced, first line), which of the standard options do you recommend and why?
  2. 6.Am I a candidate for Pembrolizumab, Nivolumab, Ipilimumab, and what side effects should I expect?
  3. 7.How do the results of CheckMate 649 and KEYNOTE-859 apply to someone like me?
Advanced, after chemotherapy
  1. 8.For my situation (advanced, after chemotherapy), which of the standard options do you recommend and why?
  2. 9.Am I a candidate for Pembrolizumab, and what side effects should I expect?
Resectable
  1. 10.For my situation (resectable), which of the standard options do you recommend and why?
  2. 11.Am I a candidate for Nivolumab, Ipilimumab, Durvalumab or related drugs, and what side effects should I expect?
Hereditary risk
  1. 12.For my situation (hereditary risk), which of the standard options do you recommend and why?
Any stage
  1. 13.Are there clinical trials I could join, for example of Nivolumab, Ipilimumab, Durvalumab, Tremelimumab?
  2. 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
  3. 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
  4. 16.I read that “Whether surgery can be omitted after a complete response to neoadjuvant immunotherapy”. How does that affect my plan?
  5. 17.I read that “Whether chemotherapy should be dropped altogether in metastatic disease”. How does that affect my plan?

The words I may hear

  • Gastrectomy: Removing part (subtotal) or all (total) of the stomach for stomach cancer, with the bowel joined to what remains.
  • Lynch syndrome: Lynch syndrome is the most common inherited cancer syndrome: a faulty mismatch-repair gene raises lifetime bowel cancer risk to 40-80% and also endometrial and other cancers.
  • Tumour-agnostic (tissue-agnostic) approval: A tumour-agnostic approval lets a drug be used for any cancer carrying a specific molecular feature, regardless of where it started.
  • Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR): Microsatellite instability is the mark of a broken DNA spell-checker (loss of MLH1, MSH2, MSH6 or PMS2) that leaves thousands of mutations, so the tumour displays abnormal proteins that T cells can recognise.

Tests and results to bring

Biomarker results to ask for: Mismatch repair proteins by immunohistochemistry (MLH1, MSH2, MSH6, PMS2), Microsatellite instability by polymerase chain reaction or sequencing, Tumour mutational burden (high), PD-L1 combined positive score (often high), Germline mismatch repair genes where Lynch syndrome is suspected.

Scans and tests linked to this cancer: Germline (hereditary) testing, Liquid biopsy (ctDNA), MRD / molecular residual disease testing.

Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.

The treatments I may be offered

From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.

Answers and next steps

Saved in this browser
What I was told
Agreed next steps, dates and who to call