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77 Colon Cancer Flashcards

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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
Invasive cancers develop more frequently in what type of polyp
sessile, serrated
26
What are the histologic types of adenomatous pol
Histologically, adenomatous polyps may be tubular, villous (i.e., papillary), or tubulovillous.
27
histologic type of polyp which become malignant more than three times as often
Villous adenomas
28
True or false. The likelihood that any polypoid lesion in the large bowel contains invasive cancer is related to the size of the polyp.
True.
29
Size of lesion associated with 10% chance of being malignant
polyp more than 2.5 cm in size
30
True or false. Adenomatous polyps are thought to require >5 years of growth before becoming clinically significant;
True
31
True or false. The etiology for most cases of large-bowel cancer appears to be related to environmental factors
True.
32
growth factor which appears to stimulate proliferation of the intestinal mucosa
insulin-like growth factor type I (IGF-I)
33
Two main groups of Inherited large-bowel | cancers
uncommon polyposis syndromes | more common nonpolyposis syndromes
34
Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes. Presents with Osteomas, fibromas, lipomas, epidermoid cysts, ampullary cancers, congenital hypertrophy of retinal pigment epithelium
Gardner’s syndrome
35
Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes. Affects large intestines and presents with brain tumors
Turcot’s syndrome
36
Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes. Associated with endometrial and ovarian tumors (most frequently) gastric, genitourinary, pancreatic, biliary cancers less frequently)
Nonpolyposis syndrome (Lynch’s syndrome)
37
Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes. Associated with mucocutaneous pigmentation; tumors of the ovary, breast, pancreas, endometrium
Peutz-Jeghers syndrome
38
Hereditable (Autosomal Dominant) Gastrointestinal Polyposis Syndromes. Associated with various congenital abnormalities
Juvenile polyposis
39
Polyposis coli is associated with a deletion in
long arm of chromosome 5 (including the APC gene) in both neoplastic (somatic mutation) and normal (germline mutation) cells.
40
The appearance of malignant tumors of the central nervous system accompanying polyposis coli defines what syndrome
Turcot’s syndrome
41
Remains the primary therapy/prevention in polyposis coli
Colectomy
42
What is the surveillance schedule for offspring of patients with polyposis coli
carefully screened by annual flexible sigmoidoscopy until age 35
43
True or false. In polyposis coli, testing for occult blood in the stool is an inadequate screening maneuver.
True.
44
Rare autosomal recessive syndrome caused by a biallelic mutation in the MUT4H gene.
MYH-associated polyposis (MAP)
45
What is the surveillance for MYH associated polyposis
annual to biennial colonoscopic surveillance is generally recommended starting at age 25–30
46
True or false. Large-bowel cancer is increased in incidence in patients with long-standing inflammatory bowel disease (IBD).
True.
47
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
Streptococcus bovis
48
True or false. Cigarette smoking is linked to the development of colorectal adenomas,
True
49
True or false. About 50% of patients with documented colorectal cancers have a negative fecal occult blood test
True
50
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
True.
51
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.
True
52
Cancer from where area present with anemia
ascending colon
53
Cancer in this area is often associated with hematochezia, | tenesmus, and narrowing of the caliber of stool;
rectosigmoid
54
Colon Cancer Stage I T1 vs T2
submucosa (T1) | muscularis (T2)
55
Colon cancer Stage where tumors that penetrate through the muscularis but have not spread to lymph nodes
Stage II
56
Predictors of Poorer Outcomes Following Total Surgical | Resection of Colorectal Cancer
``` 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
serologic test which predicts eventual tumor recurrence
carcinoembryonic antigen (CEA)
58
True or false. Tumors arising in the left colon are associated with a better prognosis than those appearing in the right colon
True
59
Cancers of the large bowel generally spread to regional lymph nodes or to the liver via what pathway
portal venous circulation
60
in what can primary tumors in the distal rectum spread to the lungs
tumor cells may spread through the paravertebral venous plexus, escaping the portal venous system
61
What is the optimal treatment when a malignant lesion is detected in the large bowel
Total resection of tumor
62
What additional tests are need prior to doing colorectal cancer?
measurement of the plasma CEA level, and a CT scan of the chest, abdomen, and pelvis
63
How often should CEA be monitored after surgery
3 months interval
64
Monoclonal antibodies used in colon cancer which is directed against the epidermal growth factor receptor (EGFR),
Cetuximab (Erbitux) and panitumumab (Vectibix)
65
monoclonal antibody used in colon cancer directed against the vascular endothelial growth factor (VEGF) and is thought to act as an antiangiogenesis agent.
Bevacizumab
66
account for 1–2% of the malignant tumors of the large bowel
Cancers of the anus
67
histology of malignancies arising distal to the pectinate line
squamous histology
68
Carcinomas arising proximal to the pectinate line are known as
basaloid, cuboidal, or cloacogenic tumors
69
development of anal cancer is associated with infection
infection by human papillomavirus
70
True or false. The risk for anal cancer is increased among homosexual males, presumably related to anal intercourse.
True
71
Treatment option for anal cancer
``` external beam radiation therapy with concomitant chemotherapy (5-FU and mitomycin C) ```

Oncology (7 decks)

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