Colon Cancer Flashcards
what is the most important factor of colon cancer survival
early detection
unmod factors of CRC
age, personal and family fx, inherited disorders, IBD
mod factors of CRC
diabetes, obesity/ waist circ, lifestyle
CRC screening normal
50-74yrs = FIT test q1-2yrs, colonoscopy if +, if colonoscopy - = fit test in 10 yrs (5 if sus)
CRC screening over 75yrs
individualized
CRC screening for one first degree relative with CRC =>60yrs
FIT test q1-2yrs at 40yrs
CRC screening for one first degree relative with CRC <60yrs or 2 first degree relatives of any age
colonoscopy at 40yrs or 10yrs before age of index case, whichever is earlier
CRC screening for Personal hx of CRC, colonic adenomas, or IBD
ongoing Mfu with colonoscopy
CRC screening for high risk such as lynch syndrome or FAP
closely monitor by local CRC program, not just FIT
how does the fit test work
home stool test that uses antibodies for human blood to find trace amounts of blood, do not need to change diet, can reduce CRC mortality by 25-45%
alt to FIT test
guaiac fecal occult blood testing
S/S of CRC
changes to bowel habits, stool shape changes, tenesmus, melena, pallor, weight loss, ileus blockage
CRC workup
colonoscopy to rule out other masses, CT of chest, abdomen, pelvis to rule out metastasis, preop CEA
goals of CRC based on stage
1-3 = cure
4 = possibly cure if emtastasis in lungs/ liver + limited and resectable, likely not curable
stage 1 CRC tx
surgical resection, colonoscopy at 1yr, 3, 5
stage 2 CRC tx
no adjuvant unless perf/obstruction, poorly diff/ high grade tumors, lymphovascular invasion, close surgical margins
stage 3 CRC tx
adjuvant FLOFOX6 or CAPOX or capecitabine
FLOFOX6 regimen
q2wks for 6-12 cycles (3-6mths)
oxiplatin and leucovorin, then 5FU
CAPOX regimen
q3wks for 4-8 cycles of oxiplatin then capecitabine
capecitabine for stage 3 CRC regimen
for 8 cycles at 3 weeks each = 6mths
oxiplatin AEs
neuropathy, thrombocytopenia, cold dysesthesia, sensory neuropathy
5FU AEs
stomatitis, myelosuppression, handfoot syndrome
leucovorin use in CRC
used with 5FU to increase toxicity
capecitabine MOA
prodrug absorbed through GIT and converted to 5FU
capecitabine AEs
diarrhea, mucositis, handfoot syndrome
CRC usually metastasizes on the
liver and lung
qtreatment of stage 4 CRC
FOLFOX6 or FOLFIRI or CAPOX/CAPIRI + biologics
irinotecan is a
topoisomerase 1 inhibitor
irinotecan interacts with what syndrome? why
gilbert’s syndrome- UGT1A1 polymorphism which worsens toxicities
Irinotecan AEs
neutropenia, diarrhea
early onset irinotecan diarrhea is usually due to
cholinergic syndrome mediated by increased anticholinesterase activity
how to treat early irinotecan diarrhea
atropine
how to treat late irinotecan diarrhea
loperamide 4mg PO ASAP, 2mg q2h until no diarrhea f12h
which is worse, early or late irinottecan diarrhea
late
bevacizumab is a ___ for ______ used in combo with
VEGF-i for metastatic CRC in combo with FLOFOX/CAPEOX/FLOFIRI
bevacizumab AEs
HPT, thromboembolism, impaired wound healing, hemorrhage, proteinuria
2 EGFRs targeting MABs
cetuximab and panitumumab
EGFR Mabs only work on
left sided primary tumors with normal KRAS
