Colon Cancer Flashcards
What is important to know about Colon Cancer?
- 3rd most common cause and death in men and women
- 91% suvival - caught early
What are some of the risk factors for Colon Cancer?
- Age
- Family Hx [HNPCC]
- Diet/Lifestyle
- Polyps [FAP]
- Colitis or Crohns
What is the reason that Colitis or Crohns may have an impact of Colon Cancer?
- The CONSTANT inflammation
What is the importance of polyps within Colon Cancer?
- Familial Adenomatous Polyposis [FAP]
- When there is a lot of polyps = 100% of Colon Cancer
What is Hereditary Nonpolyposis Colorectal Cancer [HNPCC]?
- 80% of getting Colon Cancer
- INCREASED risk of getting endometrial, stomach or ovaran cancers too
What is the pathophysiology of Colon Cancer?
- Polyps will grow in the membrane [can spread]
- ADENOCARCINOMAS
What are some of the warning signs and symptoms of Colon Cancer?
- Constipation or Diarrhea
- Bloody stools
- Tender belly
- Weight loss
- Fatigue
What is one work up strategy that is used to help determine the treatment in Colon Cancer?
- DNA Mismatch Repair [dMMR] –> Test for Mircosatellite Instability [MSI]
- MSS, MSI-L, MSI-H, pMMR, dMMR
What are the goals of treatment for EARLY stage [I, II, III] Colon Cancer?
- Curable
- Surgery [WANT to do] & Chemo [no Rads - helps pain]
Which EARLY stages and MMR of Colon Cancer is Chemo used in?
- Stage II WITH MSI-H: Decreased benefit from Chemo
- Stage III WITH MSI-H: Increase benefit from Chemo
What is the localized treatment therapy for EARLY stage Colon Cancer?
- Surgery is the definitive therapy
- Chemo can be used in High risk patients
What are the chemo regimens that are used in EARLY stage [II] Colon Cancer/
- FOLFOX
- CapeOX
What is FOLFOX?
- 5-FU, Leucovorin, Oxaliplatin
What is CapeOX?
- Capectiabine, Oxaliplatin
What is the treatment for EARLY Stage [III] Colon Cancer?
- Chemo is indicated [Bevacizumab, Cetuximab, Panitumumab, Irinotecan are ONLY used in Stage IV]
What was the trial that gave us the recommendations on Chemotherapy in Colon Cancer?
- IDEA: CapeOX for 3 months was good & FOLFOX for 6 months was good
If your a LOW RISK patient in Stage III Colon Cancer was is the preferred treatment?
- CapeOX for 3 months [FOLFOX for 6 months]
If your HIGH RISK patient in Stage II Colon Cancer was is the perferred treatment?
- FOLFOX for 6 months [CapeOX for 6 months]
What are some fo the main differences between FOLFOX and CapeOX in Colon Cancar?
- FOLFOX: Port, Increased Myelosuppression
- CapeOX: NO Port, Increased Hand Foot syndrome, $$$
What are the treatments options that could be used in Metastatic [Stage IV] Colon Cancer?
- Chemo [main]
- Surgery and Rads not really used
What is important to remember when starting a patient on Chemo in Metastatic Colon Cancer?
- Co-Morbidities?
- If neuropathy: NO platins
- If UGT1A1 issues: NO tecan
When might PD-L1 [Immunotherapy] be used in Metastatic Colon Cancer?
- Used in BOTH Unresectable or Metastatic WITH MSI-H after FOLFOX or FOLFIRI
- Pembrolizumab and Nivolumab
What are some of the predictive biomarkers that we should look at for Metastatic Colon Cancer?
- EGFR: dosent matter
- KRAS: Mutation = NO cetuximab or panitumumab
- BRAF: Test all in metastatic
What are some of the 1st line treatments that are used in Metastatic Colon Cancer?
- FOLFOX [+/- Bevacizumab or Cetuximab or Pantiumumab]
- CapeOX [+/- Bevacizumab or Cetuximab or Pantiumumab]
- FOLFIRI [+/- Bevacizumab or Cetuximab or Pantiumumab]
What is in FOFIRI?
- Irinotecan + Leucovorin + 5-FU
When someone can not tolerate Chemo, what is the 1st line treatment in Metastatic Colon Cancer for them?
- Remove the Chemo: 5-FU + Leucovorin
What would be the 2nd line treatment for Metastatic Colon Cancer?
- If failed FOLFOX, switch to FOLFIRI and vice versa
What is the 3rd line treatment for Metastatic Colon Cancer?
- ORAL agents: Regorafenib or Trifluridine
- LOTS of side effects
What is 5-FU?
- converts into FUTP & FdUMP –> binds to thymidylate synthase [TS] and reduces DNA synthesis, replication and repair
- Metabolized by DPD: deficiency in DPD = toxicities [diarrhea, fatigue]
What is Leucovorin?
- Used in Combo with 5-FU
- Helps increase the efficacy of 5-FU by acting as a folate = more TS
What is Irinotecan?
- Prodrug of SN38 –> Inhibits topo I
- Metabolized by UGT1A1: deficiency in UGT1A1 will increase tocixities –> DIARRHEA [give atropine]
What is Oxaliplatin?
- 3rd gen Platinum that inhibits DNA replication via cross-links
- Part of FOLFOX
- COLD INTOLERANCE
What is Capecitabine?
- Prodrug of 5-FU
- Hand-Foot syndrome and diarrhea
What is Cetuximab & Panitumuab?
- Binds to EGFR
- ONLY used in NORMAL KRAS
- Acne rash and Hypomagnesemia
What is Beveacizumab?
- Binds to VEGF and decreases angiogenesis
- Given with FOLFIRI
- BLACKBOX WARNINGS
What is Regorafenib?
- Mutli-kinase inhibitor that targets angiogenesis [VEGF, BRAF…]
- Can cause Squamous cell carcinoma
- 3A4
