colon and lung Flashcards
colon cancer risk
1 in 25
colon cancer growth rate
slow
risk factors of colon cancer
- Family history 20%
- IBD
- lifestyle factors
life style risk factors for colon cancer
- smoking
- red/processed meats
- alcohol
- low physical activity
- high BMI
age to start colon cancer screening if no risk factors
50
age to start colon cancer screening if FHx positive
40 or 10 years prior to relatives diagnosis
age to start colon cancer screening if HNPCC
20-25
age to start colon cancer screening if FAP
puberty, 10-12
age to start colon cancer screening if UC or CD
8 years after onset
two types of screening tools for colon cancer
- flexible sigmoidoscopy
- total colonoscopy
flexible sigmoidoscopy features
- removes polyps
- 20 mins
- no sedation
- only examines 60% of colon
- no biopsy
- less bowel prep
total colonoscopy features
-examines whole bowel
-removes polyps
-can biopsy
-not as cost effective
invasive
-intense bowel prep
factors that lead to mutation in colon cancer development
- activation of Wnt
- activation of EGFR and oncogenes
- inactivation of tumor suppressors
most common sites of metastasis for colon cancer
in order:
- liver
- lung
- bone
staging work up needed for colon cancer
- CT or MRI
- diagnostic colonoscopy
- CBC and CMP
- genetic testing
important genetic tests for colon cancer
- Ras
- micro-satellite instability
- mismatch repair
-UGT1A1
curable stages of colon cancer
stage 1 - 3B
general treatment for stage 0 and 1 colon cancer
surgery
surveillance
general treatment for stage 2 colon cancer
surgery
adjuvant chemo?
general treatment for stage 3 colon cancer
surgery?
adjuvant chemo
general treatment for stage liver only metastasis in colon cancer
- chemoembolization
- hepatic arterial infusion chemo
- surgery?
general treatment for stage 4 colon cancer
- palliative chemo
- surgery/radiation?
treatment of choice for stages 1-3 of colon cancer
surgery
what drug do we need to check UGT1A1 for
irinotecan
adjuvant chemo for stage 3 colon cancer
5-FU/leucovorin
adjuvant chemo options for high risk stage 3 or palliative colon cancer
- FOLFOX +/- bevacizumab
- FOLFOX +/- cetuximab/panitumumab
- CAPEOX +/- bevacizumab
- FOLFIRI + cetuximab/panitumumab
duration of therapy for high risk stage 3 colon cancer
6 months
duration of therapy for metastatic colon cancer
until progression or intolerance to therapy
if patient progressed through FOLFOX and FOLFIRI OR can’t tolerate intense therapy, what can we use
- MIS, MMR therapy
- PD-1 therapy (nivolumab/ pembrolizumab)
drugs in mFOLFOX 6 + beva regimen and cycle length
-leucovorin
-oxaliplatin
-5-FU push and cont.
-Beva
14 day cycle, 12 cycles
unique toxicity from oxaliplatin
laryngeal spasms when drinking something cold
how leucovorin works in colon cancer
helps 5-FU bind and stay bound to thymidylate synthase
monitoring for FOLFOX + Bev
- bone marrow, especially platelets
- renal/hepatic function
- neurologic effects
- vascular - VTE
- wound healing
minimum time between bevacizumab treatment and surgical procedures
28 days due to reduced healing
side effects for FOLFOX + bevacizumab
- fatigue
- N/V/D
- infection
- laryngeal spasm/neuropathy
- bruising, bleeding, clotting
lifetime risk of lung cancer
1 in 15
workup and staging of lung cancer
- Hx and physical
- symptoms (coughing blood)
- cbc/cmp
- PET-Ct or MRI
- biopsy
- ECOG
ECOG scale for lung cancer
0 = fully active 1 = restricted from strenuous activity, can do light work 2 = up and about >50% 3 = in bed or chair > 50% 4 = completely disabled 5 = dead
ECOG scores we’re willing to treat aggressively
0-2
general types of lung cancer
- non-small cell lung cancer
- small cell lung cancer
characteristics of small cell lung cancer
- fast doubling time
- high growth fraction
- early development of metastasis
- highly correlated with smoking
- no effective means to screen
most pts diagnosed with SCLC are in which stage
stage 4
upside of treating SCLC
- responsive to chemo
- responsive to radiation
- substantial improvement in QoL
downside of treating SCLC
- metastasis has usually already occurred
- after initial treatment its usually resistant
- abnormal secretions (ACh, prothrombotics)
treatment plan for limited stage SCLC
chemo and radiotherapy to chest
treatment plan for extensive stage SCLC
chemo alone
chemo treatment for SCLC including cycle
etoposide and cisplatin/carboplatin
21 day cycle, 6 cycles
characteristics of non-small cell lung cancer
- moderate doubling time
- low growth fraction
- early development of metastasis
- highly correlated with smoking
- no effective means to screen
staging of SCLC
1-3 confined to ipsilateral hemithorax
4 beyond ipsilateral hemithorax
staging of NSCLC
1 - localized
2 - localized w/lymph
3 - invasion through lung
4 - distant spread
chemotherapy strategy for early stage lung cancer
doublet therapy
chemotherapy strategy for metastatic NSCLC
if we have agents that can be used for targeted therapy use the
otherwise doublet therapy if they can tolerate
doublet therapy regimens for NSCLC
- cisplatin + paclitaxel or gemcitabine or docetaxel
- carboplatin + paclitaxel
mutations important in treatment of NSCLC
ALK
ROS1
KRAS
BRAF
oncogene addiction
mutations that drive the neoplastic phenotype
