Colon Cancer Flashcards
1
Q
Non-modifiable Risk Factors for CC
A
- Family history - Lynch syndrome, FAP, personal/family history of CC
- Inflammatory bowel disease - Crohn’s, ulcerative colitis
- Age - Usually diagnosed at 65-74 y.o.
2
Q
Modifiable Risk Factors for CC
A
- Lack of regular physical activity
- Overweight/obesity
- Diet - low in fiber, fruits, veggies, high in red/processed meat
- Smoking
- Alcohol consumption
- Diabetes
- Metabolic syndrome
3
Q
Lynch Syndrome
A
- Accounts for 2-3% of colorectal cancers
- Autosomal dominant trait
- Lifetime risk of colon cancer goes up to 80% with onset ~43 y.o.
- Increase risk for other malignancies like hepatobiliary, GU, pancreatic, small intestine, and ovarian
- ~60% ovarian cancer risk in women
4
Q
FAP
A
- Familial adenomatous polyposis
- Accounts for ~1% of colorectal cancers
- Autosomal dominant disorder
- Manifests in hundreds to thousands of adenomatous polyps covering the colon/rectum
- 100% will progress to cancer if left untreated, manifests in 40s
5
Q
Average Risk Screen Parameters
A
- Age >= 50 y.o.
- No history of SSP or CRC
- No history of IBD
- No family history of CRC or confirmed advanced adenoma or SSO
6
Q
Average Risk Screen Recommendations
A
- Colonoscopy every 10 years
- Fecal occult blood test or fecal immunohistochemical test every year
- Stool DNA test every 3 years
- CT colonography every 5 years
- Flexible sigmoidoscopy every 5-10 years
7
Q
Increased Risk Screen Parameters
A
- Personal history of adenoma or SSPs
- Personal history of colorectal cancer
- Positive family history for colorectal cancer
- IBS
Screening recommendations varies by parameter pt fits into
8
Q
High Risk Screening Parameters
A
- Lynch syndrome
- FAP family or personal history
- Several other miscellaneous syndromes/risks
Screening recommendations varies by parameter pt fits into
9
Q
CC Signs/Symptoms
A
- Change in bowel habits
- Feeling need to have BM but not relieved by doing so
- Rectal bleeding
- Dark stool/blood in stool
- Cramping/abdominal pain
- Weakness and fatigue
- Unintended weight loss
- Tumor marker elevation (CEA)
10
Q
Early Stage Colon Cancer
A
- I, II, and III
- Goal: Cure
- Treatment options: Surgery, chemo, radiation
- Surgery: resection primary tumor and sampling of lymph nodes, minimum of 12 lymph nodes needed for complete sampling
- Chemo - adjuvant, eradicate micro-metastatic disease, improve disease free survival
- Radiation: minimal role in colon cancer
11
Q
Early CC Chemo Options
A
- Capecitabine
- 5-FU/Leucovorin
- CAPEOX
- mFOLFOX6
12
Q
Early CC Adjuvant Chemo
A
- Typically 4-8 weeks after surgery
- Duration: 6 mo
- Standard of care: 5-FU based treatment
- No role for stage I but reduces risk of recurrence to 2-5% or 25% for stages II/III respectively
13
Q
Stage I Treatment Recommendation
A
- Surgery - remove primary tumor and regional lymph nodes
- Observation/surveillance - no adjuvant therapy
14
Q
Stage II Treatment Consideration: Recurrence High Risk
A
- <12 lymph nodes collected
- Poorly differentiated histology
- Lymphatic/vascular/perineural invasion
- Bowel obstruction
- Localized perforation
- Close, indeterminante, or positive surgical margins
- T4 disease
15
Q
Stage II Treatment Consideration: dMMR
A
- Defective DNA mismatch repair
- Genetic destabilization in DNA repair
- Tests for either mutated genes for DNA repair of MSI (phenotype of cancer)
- Testing recommended in all patients with a personal history of colon or rectal cancer
- Patients with stage II may have better prognosis and do not benefit from 5-FU adjuvant therapy
16
Q
Stage IIA/no High Risk Factors Treatment
A
- Surgery - removal of primary tumor and regional lymph nodes
- Observation/surveillance: no adjuvant therapy or may consider 5-FU/leucovorin or Capecitabine
17
Q
Stage IIA+HRF, IIB, or IIC Treatment
A
- Surgery - removal of primary tumor and regional lymph nodes
- Adjuvant therapy: Capecitabine or 5-FU/Leucovorin
- May also consider mFOLFOX6, CAPEOX, Observation
18
Q
Stage III Low Risk Treatment
A
- Surgery - removal of primary tumor and regional lymph nodes
- Preferred Adjuvant Therapy: CAPEOX (3 mo) or mFOLFOX6 (3-6 mo)
- Other adjuvant therapy: Capecitabine or 5-FU
19
Q
High Risk Stage III Treatment
A
- Surgery - removal of primary tumor and regional lymph nodes
- Same treatment recommendations except use CAPEOX for 3-6 mo or mFOLFOX6 for 6 mo
20
Q
Stage I Follow-up
A
- Colonoscopy year 1
- If advanced adenoma, repeat in 1 year
- If no advanced adenoma, repeat in 3 years and then every 5 years
21
Q
Stage II/III Follow-up
A
- History, physical, and CEA every 3-6 mo for 2 years then every 6 mo for a total of 5 years
- CT of chest, abdomen, pelvis every 6-12 mo for up to 5 years
- CEA every 3-6 mo for 2 years then every 6 mo for a total of 5 years
- Colonoscopy in 1 year except if no preoperative colonoscopy due to obstructing lesion, colonoscopy in 3-6 mo
- Advanced adenoma repeat in 1 year
- If no advanced adenoma, repeat in 3 years then every 5 years
22
Q
Metastatic Colon Cancer
A
- Goal: palliation
- Treatment Options: Surgery, Chemo, Radiation
- Surgery: resection of primary tumor for obstruction or bleeding, resection of solitary liver/lung metastases
- Chemo: palliation of symptoms, 5-FU based, given in sequence with limited breaks
- Radiation: palliation of pain and/or bleeding
23
Q
Treatment Selection Information
A
- Based on toxicities and pt comorbidities
- Capecitabine is equivalent to 5-FU
- Combinations are better then 5-FU alone
- Can use mFOLFOX6 or FOLFIRI first
- FOLFOXIRI impoves response rate, progression free, and overall survival
- Anti-EGFR monoclonal antibodies used in metastatic setting only
- All metastatic colon cancer should be genotyped
- MSI or MMR testing recommended for all pts with personal history of CC or rectal cancer or metastatic colon/rectal cancer
24
Q
Resectable Liver or Lung Metastases
A
- Can go for cure in 20-25% of patients
- Resection of primary tumor and liver/lung metastasis
- Followed by FOLFOX or CapeOX (preferred)
- Neoadjuvant chemo: 2-3 mo to increase curative resection and convert to resectable with mFOLFOX6 or CapeOx
- 6 mo total perioperative treatment
25
Q
Metastatic CC Follow-up
A
- History, physical and CEA every 3-6 mo for 2 years then every 6 mo for a total of 5 years
- CT of chest, abdomen, and pelvis every 3-6 mo for 2 years then every 6-12 mo for up to 5 years
- Colonoscopy in 1 year, repeat based on advanced adenoma
- If no preoperative colonoscopy due to obstructing lesion, then colonoscopy in 3-6 mo
