Colon Cancer

Question 1

what are hereditary risk factors for colon cancers?

Answer 1

Hereditary nonpolyposis colorectal cancer (HNPCC) or familial adenatomous polyposis (FAP)

Question 2

What genetic testing should be considered for colon cancer?

Answer 2

dMMR & MSI-H
-decreased 5-FU adjuvant benefit for stage II colon cancers
-increased 5-FU adjuvant benefit for stage III colon cancers

Question 3

What is indicated for high risk stage II or stage III colon cancer?

Answer 3

FOLFOX (5-FU, leucovorin, oxaliplatin)
CapeOX (Capecitabine, oxaliplatin)
FOLFIRI (5-FU, leucovorin, irinotecan)
-surgery

Question 4

What are the toxicities associated with FOLFOX?

Answer 4

myelosuppression
mouth sores
neuropathy -oxalaplatin
cold intolerances -oxalaplatin

Question 5

What are the toxicities associated with capecitabine?

Answer 5

hand-foot syndrome
diarrhea

Question 6

What regimens are indicated for metastatic disease?

Answer 6

-maybe surgery- if disease is isolated
-palliative radiation
-chemo + bevacizumab
-pembrolizumab, nivolumab for dMMR/MSI tumors

Question 7

What can not be used if the patient has a KRAS mutation?

Answer 7

cetuximab, panitumumab
-can be used if KRAS wild type, left sided

Question 8

What are some toxicities associated with irinotecan?

Answer 8

diarrhea

Question 9

What are some toxicities associated with cituximab & panitumumab?

Answer 9

acneform rash, hypomagnesemia

Question 10

What are some toxicities associated with Bevacizumab?

Answer 10

bleeding, hypertension, proteinuria