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Oncology > Colorectal > Flashcards

Colorectal Flashcards

0
Q

Intake of fiber-rich foods is associated with a higher or lower risk of colorectal cancer.

A

Lower

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1
Q

30% of colorectal cancers develop via a serrated neoplasia pathway which is associated with the following features:

A

BRAF mutations, methylation of CpG islands phenotype, and right-sided colon cancers.

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2
Q

What are the risk factors for colon cancer?

A

Polyposis syndromes (familial polyposis, Peutz-Jeghers syndrome, juvenile polyposis), hereditary nonpolyposis colorectal cancer, IBS, prior colon cancer, prior polyps, first degree relative diagnosed at age < 50, Western diet, alcohol, sedentary lifestyle, obesity, diabetes

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3
Q

What causes familial adenomatous polyposis (FAP)?

A

An inherited mutation in the FAP coli (APC) gene.

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4
Q

What causes HNPCC (Lynch I and Lynch II syndromes)?

A

Mutations in genes coding for DNA mismatch repair enzymes

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5
Q

What is a good way to test MSI in colorectal cancer?

A

IHC

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6
Q

How does HNPCC usually present?

A

Early onset age, proximal location, mucinous histology, higher grade. Usually better prognosis than MSS rumors.

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7
Q

What is Gardner’s syndrome?

A

> 100 colon polyps, diffuse; epidermoid cysts, desmoid tumors, osteomas, fibromas.

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8
Q

What is Turcot syndrome?

A

> 100 colon polyps, diffuse; brain tumors

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9
Q

What are the common DNA mismatch repair genes?

A

MSH-2, MLH1-1, PMS-1, PMS-2, MSH-6

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10
Q

Patients with type II HNPCC, which makes up about 5% of all colorectal cancers, also develop what other cancers?

A

Ovarian, pancreas, breast, biliary, endometrial, gastric, genitourinary, small bowel.

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11
Q

What other cancers do patients with Peutz-Jeghers syndrome have besides colorectal cancer?

A

Ovarian and testicular.

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12
Q

T or F: HNPCC has a lower response rate to 5-FU-based chemo than MSS tumors but a better prognosis.

A

True

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13
Q

Screening for HNPCC patients? For FAP?

A

Colonoscopy every 1-3 years beginning at age 20-25 for HNPCC. Starting at age 10 for FAP.

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14
Q

What’s the general treatment approach to colon cancer?

A

Stage I: surgery. Stage II: surgery with or without chemo. Stage III: surgery with chemo. Stage IV: chemo with or without surgery.

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15
Q

What is the standard adjuvant chemo for stage III colon cancer?

A

Oxaliplatin-containing regimen for 6 mos, not irinotecan-based regimen. However, for patients > 70 yo, 5-FU/LV might be as good as FOLFOX. Bev and cetuximab have no role in the adjuvant setting.

16
Q

Is there a role for adjuvant chemo in stage II colon cancer?

A

Unclear. MSI-high tumors do not need adjuvant chemo.

17
Q

In which selected group of patients with resected colon cancer is aspirin an effective secondary prophylaxis?

A

Those with PIK3CA mutations (exon 9 and 20)

18
Q

What is the response rare to 5-FU/LV in advanced colon cancer?

A

15-25%

19
Q

Is single-agent oxaliplatin effective in advanced colon cancer?

A

No. But it is effective in combination with a fluoropyrimidine.

20
Q

How do the different chemo regimens compare in advanced colon cancer?

A

FOLFOX > IROX > IFL (bolus 5-FU). FOLFOX ~ FOLFIRI. Bev + chemo > chemo. Bev + cetuximab is harmful. Continuing bev with a new chemo regimen after progression is helpful. Cetuximab or panitumumab is helpful in tumors without KRAS exon 2, exon 3, exon 4 or NRAS mutations. BRAF-mutated tumors are bad and might require FOLFOXIRI. FOLFIRI + cetux has better OS than FOLFIRI + bev but same RR and PFS. Aflibercept and regorafenib also have activities

21
Q

Is local excision of T1 rectal cancer without high-risk factors reasonable?

A

Yes. For other stages, total mesorectal excision is preferred.

22
Q

What is the most common radiosensitizing chemo agent as neoadjuvant therapy in rectal cancer?

A

Capecitabine 825 mg/m2 bid or prolonged infusion of 5-FU.

23
Q

What is the data on neoadjuvant vs adjuvant chemorad for stage II or III rectal cancers?

A

German trial: neoadjuvant with rad + 5-FU has lower rate of local recurrence, lower toxicities, and higher sphincter preservation rate than adjuvant chemorad. The addition of oxaliplatin had not been proven to be definitively helpful.

24
Q

What are the risk factors for anal cancer?

A

HPV, venereal infection, condylomata, HSV-1, Chlamydia, gonorrhea, AIDS

25
Q

What is the treatment for anal cancers?

A

Chemorad (with 5-FU plus mitomycin-C). Local excision only for small tumors that are well differentiated.

26
Q

What is MEN1 syndrome?

A

Mutations in MEN1 -> Tumors of pituitary gland, parathyroid gland, pancreatic neuroendocrine tumors.

27
Q

What is MEN2 syndrome?

A

Mutations is RET -> tumors of parathyroid, pheochromocytoma, medullary thyroid.

28
Q

Main treatment for pancreatic neuroendocrine tumors and carcinoid tumors?

A

Surgery. Radiation for symptomatic relief. Octreotide analogues. Chemo has poor response. For pancreatic NET, sunitinib, everolimus

Oncology (12 decks)

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