Colon Cancer Flashcards
Colon cancer risk factors
Older age genetic predisposition inflammatory bowel disease polyps diet (2+ drinks per day, high red meat, high fat and carbs bad) family history smoker high BMI decreased phys activity
Screening for colon cancer (3)
Colonoscopy q10
Flex sigmoid q5
Fecal screening tests q1
>50 years old until higher risk
Stage 1 and 2 colon cancer tx
Surgery no chemo
Stage 3 colon cancer tx
Surgery
6 months of chemo
radiation not common
FOLFOX
for stage 3
Gold standard
Leucovorin 5-FU Oxaliplatin every 2 week for 6 months Side effects: peripheral neuropathy, alopecia
D/Cing oxaliplatin because of neuropathy
OK after 3 months of therapy but still need to continue 5-FU and Leucovorin
CAPEOX
for stage 3
Capecitabine
Oxaliplatin
Sid effect: neuropathy and hand-foot syndrome
more toxic than FOLFAX
Single agent capecitabine
for stage 3
Ok for patients that cannot tolerate oxaliplatin
BID for 2 weeks every 21 days. Take with meals
Prodrug of 5-FU
Management of symptoms from stage 3 treatment
Nausea
Diarrhea
Urea cream
Stage 4 liver or liver mets surg removable
Surgery or
Chemo Surg Chemo
or Surg Chemo
Preferred FOLFAX, CapeOx q2-3months
Stage 4 liver or liver mets not removable
Chemo every 2 months FOLFAX CapeOX or FOLFIRI or FOLFOXIRI \+targeted
Irinotecan
topo1 inh causes diarrhea (dose-related) among other cholinergic effects
Diarrhea treatment from irinotecan
acute: diphenoxylate-atropine
delayed: loperamide
at least 2 liters of fluid intake per day
Bevacizumab
aka Avastin
VEG-F inhibitor (anti-angiogenesis) Don't give on first cycle if got colostomy because slows wound healing Don't use as single agent every 2-3 weeks AEs: nose bleeds No pre-meds ACE inhibitors if HTN
EGFR inhibitors (2)
for KRAS/NRAS wild type only!
Cetuximab
Panitimumab
Causes BAD skin toxicity 90%, but treat rash instead of lowering the dose
Use emollients, itch relief, special shampoos, eye drops
