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Colon Cancer Flashcards

1
Q

What is the median age of colon CA diagnosis?

A

72

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2
Q

What are risk factors for colon CA?

A
  1. age
  2. AA race
  3. genetic predisposition (hereditary nonpolyposis colon cancer, familial adenomatosis polyposis)
  4. other GI conditions
  5. western diet
  6. physical inactivity
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3
Q

What are lifestyle modifications to prevent colon CA?

A
  1. diet (high fiber, low fat, decreased processed/ grilled red meat, increased antioxidant fruits and vegetables)
  2. physical activity
  3. limit alcohol
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4
Q

What is recommended to prevent colon CA if there is a genetic mutation?

A

NSAIDs
COX-2 inhibitors

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5
Q

What is FDA approved to decrease the number of polyps in patients with familial adenomatosis polyposis?

A

Celecoxib

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6
Q

What drug is used to prevent colon CA in patients that also require cardiovascular disease prevention?

A

Aspirin

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7
Q

What is the gold standard for colon CA screening?

A

colonoscopy

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8
Q

What are options for colon CA screening?

A
  1. endoscopy (flexible sigmoidoscopy, colonoscopy)
  2. stool DNA test
  3. fecal occult blood test (FOBT)
  4. Digital rectal exam (DRE)
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9
Q

Which screening method is associated with high false negative rate?

A

FOBT

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10
Q

How often should someone at average risk get a colonoscopy?

A

every 10 years

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11
Q

When should screening begin for someone at average risk?

A

45 years

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12
Q

How often should someone at average risk get a flexible sigmoidoscopy?

A

5 years

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13
Q

How often should someone at average risk get a stool DNA test?

A

1-3 years

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14
Q

What are signs and symptoms of colon CA?

A
  1. change in bowel habits
  2. black or red stool
  3. anorexia
  4. abdominal pain/ fullness
  5. weight loss
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15
Q

What are the sites of metastases?

A
  1. lymph nodes
  2. liver
  3. lung
  4. brain (rare)
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16
Q

What is required for diagnosis?

A
  1. biopsy
  2. staging scans
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17
Q

Describe stage 1

A

Local disease;
no invasion into muscular mucosa

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18
Q

Describe stage 2

A

Invasion into muscular mucosa;
no spread outside of colon

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19
Q

Describe stage 3

A

lymph node involvement

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20
Q

Describe stage 4

A

metastatic disease

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21
Q

What is treatment for stage 1?

A

surgery followed by surveillance
(NO adjuvant chemo/ radiation!)

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22
Q

What is treatment for stage 2?

A

surgery +/- chemo

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23
Q

When is chemo utilized in stage 2?

A

poor prognostic factors (large tumor, lymphovascular invasion)

24
Q

What agents are used for chemo in stage 2?

A

5-FU + leucovorin
OR
Capecitabine (oral)

25
What is treatment for stage 3?
surgery + adjuvant chemo for 6 months
26
What agents are used for chemo in stage 3?
FOLFOX (5-FU + leucovorin + oxaliplatin if tolerated) OR CapeOx (capecitabine + oxaliplatin)
27
What is the MOA of 5-FU?
inhibits thymidylate synthase
28
Why is leucovorin used with 5-FU?
results in increased cell kill, increases activity by tightening binding between thymidylate synthase and 5-FU
29
What are the side effects with 5-FU?
myelosuppression N/V/D hand-foot syndrome mucositis
30
What is the MOA of Capecitabine?
inhibits thymidylate synthase; prodrug of 5-FU
31
What are side effects with capecitabine?
mucositis diarrhea hand-foot syndrome drug interactions due to oral route
32
What is the MOA of oxaliplatin?
platinum alkylating agent; cross-linking of DNA causes strands to break
33
What are side effects with oxaliplatin?
neuropathy of the face, exacerbated by cold cumulative peripheral neuropathy myelosuppression N/V anaphylaxis/ infusion reactions
34
What is treatment of stage 4?
palliative chemo surgery only if bowel obstruction
35
What agents are used for chemo in stage 4?
FOLFOX or CapeOx or FOLFURI +/- monoclonal antibodies
36
What is FOLFURI?
5-FU leucovorin irinotecan
37
What is the MOA of irinotecan?
inhibits topoisomerase 1; prevents DNA unwinding
38
What are side effects with irinotecan?
Diarrhea [early (24h) and late (10-14 days after)] myelosuppression N/V hepatotoxicity
39
What is diarrhea such a severe side effect with irinotecan?
cholinergic response
40
What is the 1st line regimen for stage 4?
based on expected tolerability; will eventually use all of them
41
What is the treatment after a complete response is achieved?
6 more months of chemo
42
What is a partial response? How is it treated?
decrease 30% in size of largest diameter 6 more months of chemo
43
What is stable disease? How is it treated?
does not meet criteria 6 more months of chemo
44
What is progressive disease? How is it treated?
20% increase of largest diameter change regimen and 6 more months of chemo
45
When can VEGF and EGFR inhibitors be used?
stage 4 only
46
What is the MOA of VEGF inhibitors?
1. inhibition of tumor angiogenesis 2. normalization of tumor vasculature 3. facilitation of chemotherapy to tumor site
47
What are the side effects of Bevacizumab (VEGF inhibitor)?
1. body wide vasoconstriction--> HTN--> headache 2. proteinuria 3. wound healing complications 4. thromboembolic events 5. GI proliferation
48
When should Bevacizumab be used?
1st/ 2nd line in combination with 5-FU based chemo for metastatic disease
49
What does increased EGFR expression indicate in colon cancer?
poor prognosis and increased metastatic disease
50
What predicts a good response to anti-EGFR therapy?
KRAS wild-type
51
What is the MOA of EGFR inhibitors?
binding of mab to extracellular domain of EGFR inhibits cell growth, promotes apoptosis decreases production of growth factors
52
What 2 EGFR inhibitors are used in colon CA?
Cetuximab Panitumumab
53
What are side effects of Cetuximab?
1. infusion-related reactions 2. acneform skinrash 3. hypomagnesemia 4. diarrhea
54
What are side effects of Panitumumab?
1. infusion-related reactions (less) 2. acneform skinrash 3. hypomagnesemia 4. diarrhea
55
FOLFOX
5-FU + leucovorin + oxaliplatin
56
CapeOX
capecitabine + oxaliplatin
57

Oncology (22 decks)

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