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Oncology > 77 Colon Cancer > Flashcards

77 Colon Cancer Flashcards

1
Q

Backbone treatment for colon cancer

A

5 FU

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2
Q

5 FU target enzyme

A

Thymidylate synthase

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3
Q

Oral form of 4 FU

A

Capecitabine (Xeloda)

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4
Q

Added to 5 FU to improve efficacy

A

Folinic acid (Leucovorin)

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5
Q

Topoisomerase 1 inhibitor added to 5 FU and LV with resultant improvement in response and survival rates in patients with metastatic colon cancer. What is this regimen?

A 
Irinotecan (CPT 11)
Folinic acid
Flourouracil
Irinotecan
FOLFIRI
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6
Q

Major side effect of irinotecan

A

Diarrhea

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7
Q

Platininum analogue added to 5 FU and LV as initial treatment for colon cancer with metastatic disease. What is this regimen?

A 
Oxaliplatin
Folinic acid
Flurouracil
Oxaliplatin
FOLFOX
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8
Q

True or false: FOLFIRI and FOLFOX are equal in efficacy

A

True

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9
Q

Most frequent visceral site of metastasis in colon cancer

A

Liver

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10
Q

Median survival after detection of distant metastases in colon cancer

A

27-30 months

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11
Q

Monoclonal antibodies against EGFR used in colon cancer

A

Cetuximab and panitumumab

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12
Q

Chromosomal aberration in colon cancer that predicts higher risk for metastatic spread

A

b-raf

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13
Q

Monoclonal antibodies are not effective in subset of colon cancer with mutations in what genes?

A

ras or b-raf

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14
Q

EGFR tyrosine kinase not effective in colon cancer

A

Erlotinib and sunitinib

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15
Q 
53M with no family history of colorectal cancer had his first screening colonoscopy. He was found to have less than 1 cm tubular adenoma with low grade dysplasia. When should he schedule his next colonoscopy?
A.	1 year
B.	3 years
C.	5 years
D.	10 years
A

C. 5 years
FOBT yearly
Proctosigmoidoscopy every 3 years
Colonoscopy every 5 years

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16
Q 
50M asks advise regarding screening for colon cancer. He is asymptomatic and has no family history of colon cancer. What is recommended by ACS to be done annually?
A. Sigmoidoscopy
B. FOBT
C. Colonoscopy
D. CT colonography
A

B. FOBT

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17
Q

rare condition characterized by the appearance of thousands of adenomatous polyps throughout the large bowel

A

Polyposis coli

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18
Q

Most colorectal cancers, regardless of etiology, arise from

A

adenomatous polyps

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19
Q

what are the three classification of polyp

A

nonneoplastic hamartoma
hyperplastic mucosal proliferation
adenomatous polyp

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20
Q

True or false. Only adenomas are clearly premalignant, and only a minority of adenomatous polyps evolve into cancer.

A

True

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21
Q

True or false. Ingestion of animal fats found in red meats and processed meat leads to an increased proportion of anaerobes in the gut microflora, resulting in the conversion of normal bile acids into carcinogens.

A

True.

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22
Q

Most common carcinogensis in colorectal cancer

A

point mutations in the K-ras protooncogene

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23
Q

probability of an adenomatous polyp becoming a cancer depends on

A

depends on the gross appearance of the lesion, its histologic features, and its size

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24
Q

What are the types of polyp based on gross anatomy

A

Polyps may be pedunculated (stalked) or sessile (flat-based), adenomatous or serrated.

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25
Q

Invasive cancers develop more frequently in what type of polyp

A

sessile, serrated

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26
Q

What are the histologic types of adenomatous pol

A

Histologically, adenomatous polyps may be tubular, villous (i.e., papillary), or tubulovillous.

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27
Q

histologic type of polyp which become malignant more than three times as often

A

Villous adenomas

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28
Q

True or false. The likelihood that any polypoid lesion in the large bowel contains invasive cancer is related to the size of the polyp.

A

True.

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29
Q

Size of lesion associated with 10% chance of being malignant

A

polyp more than 2.5 cm in size

30
Q

True or false. Adenomatous polyps are thought to require >5 years of growth before becoming clinically significant;

31
Q

True or false. The etiology for most cases of large-bowel cancer appears to be related to environmental factors

32
Q

growth factor which appears to stimulate proliferation of the intestinal mucosa

A

insulin-like growth factor type I (IGF-I)

33
Q

Two main groups of Inherited large-bowel

cancers

A

uncommon polyposis syndromes

more common nonpolyposis syndromes

34
Q

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes.
Presents with Osteomas, fibromas, lipomas, epidermoid cysts, ampullary cancers, congenital hypertrophy of retinal pigment epithelium

A

Gardner’s syndrome

35
Q

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes.
Affects large intestines and presents with brain tumors

A

Turcot’s syndrome

36
Q

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes.
Associated with endometrial and ovarian tumors (most frequently) gastric, genitourinary, pancreatic, biliary cancers less frequently)

A

Nonpolyposis syndrome (Lynch’s syndrome)

37
Q

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes.
Associated with mucocutaneous pigmentation; tumors of the ovary, breast, pancreas, endometrium

A

Peutz-Jeghers syndrome

38
Q

Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes.
Associated with various congenital abnormalities

A

Juvenile polyposis

39
Q

Polyposis coli is associated with a deletion in

A

long arm of chromosome 5 (including the APC gene) in both neoplastic (somatic mutation) and normal (germline mutation) cells.

40
Q

The appearance of malignant tumors of the central nervous system accompanying polyposis coli defines what syndrome

A

Turcot’s syndrome

41
Q

Remains the primary therapy/prevention in polyposis coli

42
Q

What is the surveillance schedule for offspring of patients with polyposis coli

A

carefully screened by annual flexible sigmoidoscopy until age 35

43
Q

True or false. In polyposis coli, testing for occult blood in the stool is an inadequate screening maneuver.

44
Q

Rare autosomal recessive syndrome caused by a biallelic mutation in the MUT4H gene.

A

MYH-associated polyposis (MAP)

45
Q

What is the surveillance for MYH associated polyposis

A

annual to biennial colonoscopic surveillance is generally recommended starting at age 25–30

46
Q

True or false. Large-bowel cancer is increased in incidence in patients with long-standing inflammatory bowel disease (IBD).

47
Q

individuals who develop endocarditis or septicemia from this fecal bacterium have a high incidence of occult colorectal tumors and, possibly, upper gastrointestinal cancers as well

A

Streptococcus bovis

48
Q

True or false. Cigarette smoking is linked to the development of colorectal adenomas,

49
Q

True or false. About 50% of patients with documented colorectal cancers have a negative fecal occult blood test

50
Q

True or false. cancers arising in the cecum and ascending colon may become quite large without resulting in any obstructive symptoms or noticeable alterations in bowel habits

51
Q

True or false. Lesions of the right colon commonly ulcerate, leading to chronic, insidious blood loss without a change in the appearance of the stool.

52
Q

Cancer from where area present with anemia

A

ascending colon

53
Q

Cancer in this area is often associated with hematochezia,

tenesmus, and narrowing of the caliber of stool;

A

rectosigmoid

54
Q

Colon Cancer Stage I T1 vs T2

A

submucosa (T1)

muscularis (T2)

55
Q

Colon cancer Stage where tumors that penetrate through the muscularis but have not spread to lymph nodes

56
Q

Predictors of Poorer Outcomes Following Total Surgical

Resection of Colorectal Cancer

A 
Tumor spread to regional lymph nodes
Number of regional lymph nodes involved
Tumor penetration through the bowel wall
Poorly differentiated histology
Perforation
Tumor adherence to adjacent organs
Venous invasion
Preoperative elevation of CEA titer (>5 ng/mL)
Specific chromosomal deletion (e.g., mutation in the b-raf gene)
Right-sided location of primary tumor
57
Q

serologic test which predicts eventual tumor recurrence

A

carcinoembryonic antigen (CEA)

58
Q

True or false. Tumors arising in the left colon are associated with a better prognosis than those appearing in the right colon

59
Q

Cancers of the large bowel generally spread to regional lymph nodes or to the liver via what pathway

A

portal venous circulation

60
Q

in what can primary tumors in the distal rectum spread to the lungs

A

tumor cells may spread through the paravertebral venous plexus, escaping the portal venous system

61
Q

What is the optimal treatment when a malignant lesion is detected in the large bowel

A

Total resection of tumor

62
Q

What additional tests are need prior to doing colorectal cancer?

A

measurement of the plasma CEA level, and a CT scan of the chest, abdomen, and pelvis

63
Q

How often should CEA be monitored after surgery

A

3 months interval

64
Q

Monoclonal antibodies used in colon cancer which is directed against the epidermal growth factor receptor (EGFR),

A

Cetuximab (Erbitux) and panitumumab (Vectibix)

65
Q

monoclonal antibody used in colon cancer directed against the vascular endothelial growth factor (VEGF) and is thought to act as an antiangiogenesis agent.

A

Bevacizumab

66
Q

account for 1–2% of the malignant tumors of the large bowel

A

Cancers of the anus

67
Q

histology of malignancies arising distal to the pectinate line

A

squamous histology

68
Q

Carcinomas arising proximal to the pectinate line are known as

A

basaloid, cuboidal, or cloacogenic tumors

69
Q

development of anal cancer is associated with infection

A

infection by human papillomavirus

70
Q

True or false. The risk for anal cancer is increased among homosexual males, presumably related to anal intercourse.

71
Q

Treatment option for anal cancer

A 
external beam radiation therapy with
concomitant chemotherapy (5-FU and mitomycin C)

Oncology (7 decks)

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