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Oncology > Colon cancer > Flashcards

Colon cancer Flashcards

1
Q

Treatment of Stage I (T1-2, N0, M0) colon cancer

A

Surgery then surveillance

Adjuvant therapy

  • Start 6-8 weeks post operatively
  • in high risk stage 2 or stage 3/4 (for micro-metastatic disease)
  • FOLFOX (5FU with oxaliplatin) CAPOX (capecitabine + oxaliplatin)
  • MOSAIC trial - better to add oxaliplatin
  • IDEA trial - 3 months not inferior to 6m CAPOX (but not FOLFOX), high risk groups 6 months
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2
Q

Microsatellite instablity (MSI-H)

A

No benefit of adjuvant chemo in stage II CRC

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3
Q

Implications of microsatellite stability in CRC

A
  • Most colon cancers are microsatellite stable (MSS)
  • MSI is measured best by checking for the 4 MMR genes:
    • MLH 1, MSH2, MSH 6, PMS2
  • A deficiency (dMMR) in 1 or more of these genes makes a tumour have microsatellite instability in it (i.e MSI-H = HIGH)
  • MSI-H is seen in Lynch syndrome (HNPCC) but it is commonly seen in sporadic colon cancer as well due to MLH1 hypermethylation
  • Having a MSI-H Stage II tumour confers LACK OF BENEFIT with adjuvant 5FU/capecitabine chemotherapy
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4
Q

Treatment of Stage III CRC

A
  • Standard adjuvant chemotherapy: 6 months of FOLFOX
  • Single agent 5FU should not be used in stage II dMMR CRC
  • Low risk stage III bowel cancer is 3 months of CAPOX, high risk patients 6 months oxaliplatin based chemo (SCOT trial and IDEA analysis)

FOLFOX (5FU with oxaliplatin)

CAPOX (capecitabine + oxaliplatin)

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5
Q

Left or right sided CRC - which agent

A

Left - EGFR (osimetinib, gemfitinib)
Right - Bevacizumab (VEGF)

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6
Q

Colorectal Ca - screening guidelines

A
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7
Q

Colonic polyps surveillance

A
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8
Q

CRC Screening

  • general population
  • high risk, inc what defines high risk
A
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9
Q

Treatment of Colon Cancer

A
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10
Q

Fluorouracil (5FU) Drug info

A
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11
Q

Most common extracolonic manifestation of Lynch syndrome

A

Endometrial cancer!

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12
Q

Recommended Screening in Lynch Syndrome

A
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13
Q

Colorectal Cancer: Risk Factors

A
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14
Q

Management of Early Stage CRC

A

Adjuvant chemotherapy in stage II CRC - limited benefit

  • Consider if high risk:
    • T4 Primary tumour
    • Perforation/obstruction
    • lympho-vascular and perineural invasion
    • poorly differentiated tumou
    • inadequatelt sampled nodes (<12 LN)
    • High pre op CEA?
  • Single agent fluoropyrimidine (5FU or capecitabine)
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15
Q
A
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16
Q

Screening in FAP

A
17
Q

FAP

A
18
Q

Indications for Colectomy in FAP

A
19
Q

Familial CRC syndromes - comparison

A
20
Q
A
21
Q

Surveillance after early stage CRC

A

ASCO guidelines

Main purpose: early detection of asymptomatic recurrence to increase the likelihood of curative surgical resection

  • Several meta-analyses support modest but significant survival benefit from an intensive surveillance after resection of CRC
  • Those who haven’t had a full colonoscopy at diagnosis require one at the conclusion of treatment –> Then at 3 years, then 5 yearly
  • Physical exam, with CEA (expressed in 70% of CRC) 3 monthly for 3 years, then 6 monthly
  • CT CAP annually for 3 years.
22
Q

Bevacizumab
-?requirements for use
-mechanism
-side effects
Cetuximab
-requirements for use
-mechanism
-side effects

A
23
Q
A
24
Q

Management of Stage 3 CRC

A
25
Q

Lynch Syndrome Adenomas vs Sporadic Adenomas

A
26
Q

Treatment of Metastatic CRC

A
27
Q

Aspirin and CRC risk

A
28
Q

What is the most common cause of inherited colorectal cancer? Is it associated with anything else?

A

HNPCC

  • Autosomal dominant, several genes, most families have unique mutations
    • MMR in MLH1, MLH3, MSH2 (most common), MSH6, PMS1, PMS2 (absence on immunohistochemistry staining = diagnosis)
  • Loss of expression of MSH 2nd deletion in EPCAM
  • DNA mismatches occur in regions of repetitive nucleotide sequences called microsatellites
  • Lifetime 70% risk of CRC, usually younger/right sided
  • 7-10% have >1 cancer at dx, 20-60% develop metachronous CRC after initial non-total colectomy

3% of all newly diagnosed CRC

Associated with

  • Endometrial (most common) ~40%
  • Ovarian ~10%
  • Stomach
  • Small bowel
  • Hepatobiliary
  • TCC of renal pelvis and ureter
  • Glioma (Turcot syndrome)
  • Sebaceous neoplasm

Amsterdam criteria

  • 3-2-1 rule. 3 affected, 2 generations, 1 under 50
29
Q

What is the prognosis like in oesophageal cancer? Risk factors? Is chemoradiotherapy of benefit?

A

Risk factors

  • SCC: chronic irritation, low SES, Plummer Vinson Syndrome, non-epidermolytic palmoplantar keratoderma (95% SCC risk by 70yrs)
  • Adenoca: GORD, obesity, Barrett’s
  • Both: smoking, RTx

Poor Prognosis overall

  • depends on stage, like always
  • 10% survival at 5yrs post diagnosis
  • Only 45% totally surgically resectable. 20% survival at 5yrs if they survive the resection
  • Oesophagectomy associated with significant morbidity/mortality (5-12%)

Chemo

  • Mass decrease in 15-25% given single; 30-60% given combo including cisplatin
  • Increased benefit for trastuzumab (herceptin) in the 15% of adenocarcinomas expressing HER2/neu gene
  • Chemoradiotherapy of benefit, especially neoadjuvant
30
Q
A

Oncology (9 decks)

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