Colon Cancer

Question 1

what is the most important factor of colon cancer survival

Answer 1

early detection

Question 2

unmod factors of CRC

Answer 2

age, personal and family fx, inherited disorders, IBD

Question 3

mod factors of CRC

Answer 3

diabetes, obesity/ waist circ, lifestyle

Question 4

CRC screening normal

Answer 4

50-74yrs = FIT test q1-2yrs, colonoscopy if +, if colonoscopy - = fit test in 10 yrs (5 if sus)

Question 5

CRC screening over 75yrs

Answer 5

individualized

Question 6

CRC screening for one first degree relative with CRC =>60yrs

Answer 6

FIT test q1-2yrs at 40yrs

Question 7

CRC screening for one first degree relative with CRC <60yrs or 2 first degree relatives of any age

Answer 7

colonoscopy at 40yrs or 10yrs before age of index case, whichever is earlier

Question 8

CRC screening for Personal hx of CRC, colonic adenomas, or IBD

Answer 8

ongoing Mfu with colonoscopy

Question 9

CRC screening for high risk such as lynch syndrome or FAP

Answer 9

closely monitor by local CRC program, not just FIT

Question 10

how does the fit test work

Answer 10

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%

Question 11

alt to FIT test

Answer 11

guaiac fecal occult blood testing

Question 12

S/S of CRC

Answer 12

changes to bowel habits, stool shape changes, tenesmus, melena, pallor, weight loss, ileus blockage

Question 13

CRC workup

Answer 13

colonoscopy to rule out other masses, CT of chest, abdomen, pelvis to rule out metastasis, preop CEA

Question 14

goals of CRC based on stage

Answer 14

1-3 = cure
4 = possibly cure if emtastasis in lungs/ liver + limited and resectable, likely not curable

Question 15

stage 1 CRC tx

Answer 15

surgical resection, colonoscopy at 1yr, 3, 5

Question 16

stage 2 CRC tx

Answer 16

no adjuvant unless perf/obstruction, poorly diff/ high grade tumors, lymphovascular invasion, close surgical margins

Question 17

stage 3 CRC tx

Answer 17

adjuvant FLOFOX6 or CAPOX or capecitabine

Question 18

FLOFOX6 regimen

Answer 18

q2wks for 6-12 cycles (3-6mths)
oxiplatin and leucovorin, then 5FU

Question 19

CAPOX regimen

Answer 19

q3wks for 4-8 cycles of oxiplatin then capecitabine

Question 20

capecitabine for stage 3 CRC regimen

Answer 20

for 8 cycles at 3 weeks each = 6mths

Question 21

oxiplatin AEs

Answer 21

neuropathy, thrombocytopenia, cold dysesthesia, sensory neuropathy

Question 22

5FU AEs

Answer 22

stomatitis, myelosuppression, handfoot syndrome

Question 23

leucovorin use in CRC

Answer 23

used with 5FU to increase toxicity

Question 24

capecitabine MOA

Answer 24

prodrug absorbed through GIT and converted to 5FU

Question 25

capecitabine AEs

Answer 25

diarrhea, mucositis, handfoot syndrome

Question 26

CRC usually metastasizes on the

Answer 26

liver and lung

Question 27

qtreatment of stage 4 CRC

Answer 27

FOLFOX6 or FOLFIRI or CAPOX/CAPIRI + biologics

Question 28

irinotecan is a

Answer 28

topoisomerase 1 inhibitor

Question 29

irinotecan interacts with what syndrome? why

Answer 29

gilbert’s syndrome- UGT1A1 polymorphism which worsens toxicities

Question 30

Irinotecan AEs

Answer 30

neutropenia, diarrhea

Question 31

early onset irinotecan diarrhea is usually due to

Answer 31

cholinergic syndrome mediated by increased anticholinesterase activity

Question 32

how to treat early irinotecan diarrhea

Answer 32

atropine

Question 33

how to treat late irinotecan diarrhea

Answer 33

loperamide 4mg PO ASAP, 2mg q2h until no diarrhea f12h

Question 34

which is worse, early or late irinottecan diarrhea

Answer 34

late

Question 35

bevacizumab is a ___ for ______ used in combo with

Answer 35

VEGF-i for metastatic CRC in combo with FLOFOX/CAPEOX/FLOFIRI

Question 36

bevacizumab AEs

Answer 36

HPT, thromboembolism, impaired wound healing, hemorrhage, proteinuria

Question 37

2 EGFRs targeting MABs

Answer 37

cetuximab and panitumumab

Question 38

EGFR Mabs only work on

Answer 38

left sided primary tumors with normal KRAS