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Oncology / Organ Transplant > Colon Cancer > Flashcards

Colon Cancer Flashcards

1
Q

Risk factors

A 
Polyps
IBD
Genetic
 -familial adenomatous polyposis
 -hereditary non-polyp colon cancer
 -family history of cancer
Diet and lifestyle
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2
Q

Types of polyps

A

Hyperplastic - inflammatory

Adenomas - precancerous

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3
Q

Dysplasia

A

Abnormal cells seen with long term IBD

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4
Q

Lifestyle RFs for colon cancer

A 
Obesity
EtOH over 30g / day
Smoking
Diabetes
Western diet - high fat, red meat, low fiber
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5
Q

Colorectal cancer epidemiology

A

3rd most common cancer
Risk increases with age
-greater than 65
Avg lifetime risk of 5%

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6
Q

Recommendation for FAP

A

Yearly screening for polyps is recommended

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7
Q

Chance of cancer if FAP

A

100%

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8
Q

More women develop

A

Right-sided tumors

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9
Q

Two thirds of colon cancers occur in

A

Left colon

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10
Q

High risk syndromes for colon cancer

A 
HNPCC
Polyposis syndromes (FAP or others)
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11
Q

Increased risk items for colon cancer

A

Personal history
-adenomatous, colon cancer, IBD
Positive family history

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12
Q

Colon cancer screening for person with average risk

A

Colonoscopy at 50

-repeat in 10 yrs if negative

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13
Q

Colon cancer screening for person with personal history of curative intent resected colorectal cancer
(Cancer was surgically removed)

A

Colonoscopy in 1 year

(a year after surgery)

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14
Q

Colon cancer screening for person with increased risk

A

Colonoscopy
-repeat more often than q 10 yrs
Based on number polyps

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15
Q

Presentation of right sided tumors

A 
Bleeding
Dull/ill defined abdominal pain
Symptomatic anemia
 -fatigue, weight loss
LESS abdominal pain, constipation
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16
Q

Colon cancer screening for person with personal history of curative intent resected colorectal cancer

A

Colonoscopy in 1 year

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17
Q

Colon cancer screening for person with a personal history of IBD

A

Initial colonoscopy 8-10 yrs after onset of symptoms

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18
Q

Signs of metastatic disease

A 
RUQ pain
Abdominal Distention
Early Satiety (feel full)
Supraclavicular Adenopathy
Periumbilical Nodules
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19
Q

Presentation of left sided tumors

A 
Bleeding
Gas pain
Decrease in stool caliber
Constipation
Colonic obstruction
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20
Q

Frequent initial symptoms of colon cancer

A 
Abdominal pain
Change in bowel habit
Hematochezia or melena 
Weakness
Anemia w/o other GI symptoms
Weight loss
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21
Q

Most common sites of metastases

A

Regional Lymph Nodes
Liver
Lungs
Peritoneum (lining of abdomen)

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22
Q

Signs of metastatic disease

A 
RUQ pain
Abdominal Distention
Early Satiety
Supraclavicular Adenopathy
Periumbilical Nodules
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23
Q

Most cases of colon cancer are

A

Sporadic, not hereditary

Mutations
Oncogenes- KRAS,BRAF
TSGs- P53, APC

24
Q

Percent of colon cancers that are hereditary

25
Q

FAP

A

Rare, 1% of all CRC
Autosomal dominant
Hundreds - thousands of polyps
100% cancer if untreated

***YEARLY screening for polyps

26
Q

HNPCC

A 
Hereditary NonPolyp Colon Cancer
Rare, 1-5% of all CRC
Autosomal dominant
Less than 100 polyps
Lynch Syndrome I
  -CRC at early stage in particular family
Lynch Syndrome II
  -80-85% chance of CRC over lifetime
  -Other cancers usually present
  -Usually diagnosed after cancer
  -Screening and prophylactic 
    surgery recommended in carriers
27
Q

Other high risk population groups

A

IBD

  • UC
  • Crohns (less than UC)
28
Q

Dietary preventative measures for colon cancer

A 
High fiber
Low fat
High antioxidants
Calcium rich diet
Vitamin D
29
Q

Preventative measures for CRC

A 
Diet
NSAIDs and COX-2 inhibitors
 -Celecoxib to reduce polyps in FAP
Aspirin
Postmenopausal hormones
Calcium 1000-1200mg if over 50
Vitamin D 400 IU
Colectomy
30
Q

FDA approved drug used to reduce polyps in FAP

A

Celecoxib

COX-2 inhibitor

31
Q

Only screening method shown to reduce mortality in CRC

A

Fecal Occult Blood Test

32
Q

DRE

A

Digital Rectal Exam
Annually @ Age 40
Detects ~10% of cancers
Only 7-10cm of anus

33
Q

Fecal Occult Blood Test

A 
Annual or biannual @ 50
***Avoid Red Meat
3 types:
  Guac Dye
  Heme Porphyrin
  Immunochemical Assay
70% False Neg for Cancer
90% False Neg for Polyps
1.5% False Pos - Red meat
34
Q

Flexible Sigmoidoscopy

A

Examines lower third of colon
MAY reduce mortality
Increases detection rate by 2-3 fold

35
Q

Average Risk for CRC

A

Age over 50
No history of adenoma, CRC, or IBD
No family history

36
Q

Four screening tools for CRC

A

Digital Rectal Exam
Fecal Occult Blood Test
Flexible Sigmoidoscopy
Total Colonic Exam (colonoscopy)

37
Q

Poor prognostic factors for CRC

A 
Stage III/IV Disease
T4 Disease
Positive Margins
Lymph node involvement
Pre-op CEA (antigen) greater than 5
Rectal bleeding
Bowel perforation
Bowel obstruction
Grade 3,4 lesion
38
Q

Treatment options for CRC

A 
Surgery
  -colectomy or lymph node resection
Radiation
  -well est for rectal cancer
  -adjuvant radiation has no role in colon cancer
Chemo
  -Neoadjuvant -before surgery
  -Adjuvant -after surgery
  -In metastatic, used for palliation and to prolong survival
39
Q

Radiation in CRC

A

Useful in rectal cancer

***NO ROLE in colon cancer

40
Q

Tx of Stage I CRC

A

Routine surveillance

+/- surgery to remove polyps

41
Q

Tx of Stage II CRC

A 
Consider adjuvant therapy with 
  Capecitabine or
  5-FU/LV
Clinical Trial or Observation
Consider FOLFOX, CapeOx, or FLOX for pts with:
  T4 or
  High risk of recurrence
42
Q

Tx of Stage III CRC

A 
Adjuvant therapy
Preferred:
  FOLFOX or CapeOx
  Category 1: FLOX
  Other: 5FU/LV or Capecitabine
43
Q

Tx of Stage IV CRC

A

Manage with
chemotherapy
surgery
+/- biologic therapy

44
Q

FOLFOX

A

Fluorouracil (bolus and IV)
Leucovorin
Oxaliplatin

45
Q

FLOX

A

Fluorouracil (bolus only)
Leucovorin
Oxaliplatin

46
Q

Leucovorin

A

Increases activity of 5-FU

(also increases 5-FU’s ADEs - esp GI)

47
Q

Panitumumab

A

EGFR Inhibitor
Must check for EGFR and KRAS mutations
Main ADE: acneiform rash

48
Q

Cetuximab

A

EGFR Inhibitor
Must check for EGFR and KRAS mutations
Main ADE: acneiform rash

49
Q

Vascular Endothelial Growth Factor Targeted Therapy

A 
Block angiogenesis and inhibit tumor growth
Agents:
  Bevacizumab
  Ziv-Aflibercept
  Regorafenib
Class related ADEs:
  HTN
  Hematologic (bleeding and thrombosis)
50
Q

Bevacizumab

A

Vascular Endothelial Growth Factor Targeted Therapy

Blocks angiogenesis

ADEs:
HTN
Bleeding
Thrombosis

51
Q

Ziv-Aflibercept

A

Vascular Endothelial Growth Factor Targeted Therapy

Blocks angiogenesis

ADEs:
HTN
Bleeding
Thrombosis

52
Q

Regorafenib

A

Vascular Endothelial Growth Factor Targeted Therapy

Blocks angiogenesis

ADEs:
HTN
Bleeding
Thrombosis

53
Q

Bolus 5-FU ADEs

A

Myelosuppression

  • neutropenia
  • anemia
  • decreased platelets
54
Q

Continuous IV 5-FU ADEs

A 
GI
  -mucositis
  -N/V/D
Hand-foot syndrome
  -hands and feet turn red, raw and dry
55
Q

Capecitabine ADEs

A

Oral prodrug of 5-FU,
so similar to continuous IV 5-FU ADEs
-GI N/V/D

56
Q

5-FU and Capecitabine Associated Diarrhea

A

Caused by abnormal absorption and secretion of fluids and electrolytes.

Prevalence
30-40%
Severe 10-20%

57
Q

Irinotecan ADEs

A

Diarrhea caused by acute cholinergic properties - atropine

Delayed - loperamide or lomotil

Oncology / Organ Transplant (12 decks)

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