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Oncology > Colon Cancer > Flashcards

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
Q

What is treatment for stage 3?

A

surgery + adjuvant chemo for 6 months

26
Q

What agents are used for chemo in stage 3?

A

FOLFOX (5-FU + leucovorin + oxaliplatin if tolerated)
OR
CapeOx (capecitabine + oxaliplatin)

27
Q

What is the MOA of 5-FU?

A

inhibits thymidylate synthase

28
Q

Why is leucovorin used with 5-FU?

A

results in increased cell kill, increases activity by tightening binding between thymidylate synthase and 5-FU

29
Q

What are the side effects with 5-FU?

A

myelosuppression
N/V/D
hand-foot syndrome
mucositis

30
Q

What is the MOA of Capecitabine?

A

inhibits thymidylate synthase; prodrug of 5-FU

31
Q

What are side effects with capecitabine?

A

mucositis
diarrhea
hand-foot syndrome
drug interactions due to oral route

32
Q

What is the MOA of oxaliplatin?

A

platinum alkylating agent; cross-linking of DNA causes strands to break

33
Q

What are side effects with oxaliplatin?

A

neuropathy of the face, exacerbated by cold
cumulative peripheral neuropathy
myelosuppression
N/V
anaphylaxis/ infusion reactions

34
Q

What is treatment of stage 4?

A

palliative chemo
surgery only if bowel obstruction

35
Q

What agents are used for chemo in stage 4?

A

FOLFOX
or
CapeOx
or
FOLFURI
+/- monoclonal antibodies

36
Q

What is FOLFURI?

A

5-FU
leucovorin
irinotecan

37
Q

What is the MOA of irinotecan?

A

inhibits topoisomerase 1; prevents DNA unwinding

38
Q

What are side effects with irinotecan?

A

Diarrhea [early (24h) and late (10-14 days after)]
myelosuppression
N/V
hepatotoxicity

39
Q

What is diarrhea such a severe side effect with irinotecan?

A

cholinergic response

40
Q

What is the 1st line regimen for stage 4?

A

based on expected tolerability; will eventually use all of them

41
Q

What is the treatment after a complete response is achieved?

A

6 more months of chemo

42
Q

What is a partial response? How is it treated?

A

decrease 30% in size of largest diameter
6 more months of chemo

43
Q

What is stable disease? How is it treated?

A

does not meet criteria
6 more months of chemo

44
Q

What is progressive disease? How is it treated?

A

20% increase of largest diameter
change regimen and 6 more months of chemo

45
Q

When can VEGF and EGFR inhibitors be used?

A

stage 4 only

46
Q

What is the MOA of VEGF inhibitors?

A
  1. inhibition of tumor angiogenesis
  2. normalization of tumor vasculature
  3. facilitation of chemotherapy to tumor site
47
Q

What are the side effects of Bevacizumab (VEGF inhibitor)?

A
  1. body wide vasoconstriction–> HTN–> headache
  2. proteinuria
  3. wound healing complications
  4. thromboembolic events
  5. GI proliferation
48
Q

When should Bevacizumab be used?

A

1st/ 2nd line in combination with 5-FU based chemo for metastatic disease

49
Q

What does increased EGFR expression indicate in colon cancer?

A

poor prognosis and increased metastatic disease

50
Q

What predicts a good response to anti-EGFR therapy?

A

KRAS wild-type

51
Q

What is the MOA of EGFR inhibitors?

A

binding of mab to extracellular domain of EGFR inhibits cell growth, promotes apoptosis
decreases production of growth factors

52
Q

What 2 EGFR inhibitors are used in colon CA?

A

Cetuximab
Panitumumab

53
Q

What are side effects of Cetuximab?

A
  1. infusion-related reactions
  2. acneform skinrash
  3. hypomagnesemia
  4. diarrhea
54
Q

What are side effects of Panitumumab?

A
  1. infusion-related reactions (less)
  2. acneform skinrash
  3. hypomagnesemia
  4. diarrhea
55
Q

FOLFOX

A

5-FU + leucovorin + oxaliplatin

56
Q

CapeOX

A

capecitabine + oxaliplatin

57
Q
A

Oncology (22 decks)

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