29. Colorectal Cancer Flashcards

1
Q

true or false: colorectal cancer is the most common malignancy

A

false - third most common

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2
Q

what are some risk factors of colorectal cancer

A
  • age (risk increases > 40, but most cases are > 50)
  • family hx of colorectal cancer
  • personal hx of colorectal cancer
  • IBD
  • lifestyle (smoking, T2DM, western diet, alcohol, obesity)
  • hereditary (hereditary nonpolyposis colorectal cancer - HNPCC and familial adenomatous polyposis - FAP)
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3
Q

what are the early symptoms of colorectal cancer

A
  • blood in stool (hematochezia)
  • black tarry stools (melena)
  • abdominal pain
  • change in bowel habits
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4
Q

what are the common metastatic sites of colorectal cancer

A

liver, lungs and peritoneum

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5
Q

if someone has colon cancer, where are the metastasis most likely to initially present?

A

due to venous drainage of the intestinal tract via the portal system, the first site is usually the liver

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6
Q

if someone has a tumor that arises from the distal rectum, where are the metastasis most likely to initially present?

A

the inferior rectal vein drains into the inferior vena cava therefore usually metastasize to the lungs first

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7
Q

what are the major screening tests used for colorectal cancer

A

FIT test, sigmoidoscopy, barium enema and colonoscopy

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8
Q

how are average risk individuals aged 50 - 74 screened for colorectal cancer?

A

FIT test

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9
Q

explain what test is used to screen high risk individuals for colorectal cancer

A
  • if a patient has ONE first degree relative that was diagnosed with colorectal cancer under the age of 60 -> colonoscopy
  • if a patient has TWO first degree relatives with colon cancer -> colonoscopy
  • if a patient has one family member diagnosed over the age of 60 with colorectal cancer -> FIT test
  • distant family members with colon cancer -> FIT test
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10
Q

the vast majority of colorectal cancers are __________ that arise from the mucosa

A

endoluminal adenocarcinomas

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11
Q

true or false: CEA is used to diagnose colorectal cancers

A

false - CEA has a low diagnostic ability as there are many non-cancer related causes of an elevated CEA

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12
Q

true or false: most colorectal cancer develop in the glandular cells in the inner lining (mucosa) of the colon or rectal wall, either on the wall itself or within a polp

A

true

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13
Q

know the stages of colorectal cancer

A

stage I - confined to bowel mucosa / no bowel wall involvement
stage II - extended through bowel wall / no lymph node involvement
stage III - lymph node involvement
stage IV - distant metastases

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14
Q

the most reliable prognostic factor for colorectal cancer is

A

the stage

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15
Q

fwhat are some negative prognostic factors for colorectal cancer

A
  • high grade
  • increased CEA levels at time of diagnosis
  • degree of tumor perforation through bowel wall
  • > 4 nodes involved
  • rectal cancer has worse prognosis than colon cancer
  • lymphovascular invasion
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16
Q

what is the treatment for stage I colon cancer

17
Q

what is the treatment stage II colon cancer

A

surgery +/- adjunct chemo

18
Q

what is the treatment of stage III colon cancer

A

chemo + adjunct chemo x 6 months

19
Q

what is the treatment of stage IV colon cancer

A

palliative chemo

20
Q

what is the treatment of stage I rectal cancer

21
Q

what is the treatment of stage II rectal cancer

A

surgery + adjuvant chemo x 6 months + rads

22
Q

what is the treatment of stage III rectal cancer

A

surgery + adjuvant chemo x 6 months + rads

23
Q

what is the treatment of stage IV rectal cancer

A

palliative chemo

24
Q

if a patient has high risk stage II or stage III colorectal cancer, when should their chemo be started with regards to when they had they’re surgery

A

start chemo 8 weeks after surgery

25
if a patient has high risk stage II or stage III colorectal cancer, what is the adjuvant chemo regimen used?
FOLFOX q 14 days for 12 cycles (includes Oxaliplatin, Leucovorin and fluorouracil)
26
what is the first line adjuvant chemo treatment for stage IV metastatic colorectal cancer
FOLFIRI and Bevacizumab q 14 days (includes Irinotecan, Leucovorin, Fluorouracil & Bevacizumab)
27
what is the second line adjuvant chemo treatment for stage IV metastatic colorectal cancer
FOLFOX q 14 days (includes Oxaliplatin, Leucovorin and fluorouracil)
28
what is the third line adjuvant chemo treatment for stage IV metastatic colorectal cancer
Pannitumumab (patients must be wild type RAS) q 14 days
29
this is a treatment that may be used for metastatic colorectal cancer; it is a multikinase inhibitor that targets VEGF and PDGF. s/e: increased LFTs (severe), fatigue and hypertension
Regorafenib
30
what are the side effects of fluorouracil
bone marrow suppression
31
what are the side effects of Capecitabine
same a fluorouracil + hand and foor rash
32
true or false: if a patient experiences hand and foot rash while taking Capecitabine, the drug should be decreased which should relieve the rash
false - stop the drug
33
what are the side effects of Oxaliplatin
acute cold sensitivity, peripheral neuropathy
34
what are the side effects of Irinotecan
early and late diarrhea
35
what are the side effects of Bevacizumab
bleeding, ATE, impaired wound healing, GI perforation
36
what are the side effects of Pannitumumab
skin rash, low magnesium