Colorectal

Question 1

Deadliest cancer in 2021?

a. breast
b. lung
c. prostate
d. colorectal
e. urinary bladder

Answer 1

b. lung

Question 2

Highest incidence in 2021?

a. breast
b. lung
c. prostate
d. colorectal
e. urinary bladder

Answer 2

a. breast

Question 3

> __ year pack history of smoking is risk factor for colorectal cancer

Answer 3

35

Question 4

__ syndrome is risk factor for colorectal cancer

Answer 4

Lynch

Genetic:

• 20% associated with familiar clustering
• Lynch syndrome, familial adenomatous polyposis

Question 5

Colorectal screening per NCCN guidelines is recommended at what age?

Answer 5

> = 50

Question 6

Colorectal screening per ACS guidelines is recommended at what age?

Answer 6

> = 45

Question 7

3 labs for colorectal cancer diagnosis?

Answer 7

CBC
LFTs
CEA

Question 8

Tumor invades the submucosa or muscular propia

a. stage I
b. stage II
c. stage III
d. stage IV

Answer 8

a. stage I

Question 9

Tumor invades through the muscular propia in to the pericolorectal tissues, or the visceral peritoneum or adheres to adjacent organ or structure

a. stage I
b. stage II
c. stage III
d. stage IV

Answer 9

b. stage II

Question 10

Lymph node involvement occurs during what stage?

a. stage I
b. stage II
c. stage III
d. stage IV

Answer 10

c. stage III

Question 11

Metastases present in what stage?

a. stage I
b. stage II
c. stage III
d. stage IV

Answer 11

d. stage IV

Question 12

Radiation is common in metastatic setting

a. true
b. false

Answer 12

b. false

rare in metastatic setting

Question 13

Radiation has minimal role in colon cancer.

a. true
b. false

Answer 13

a. true

Question 14

Radiation is utilized in __ cancer in combo with neoadjuvant, adjuvant Tx in localized setting

Answer 14

rectal

Question 15

What does FOLFOX treatment consist of?

Answer 15

folinic acid (leucovorin) + 5FU + oxaliplatin

Question 16

What does FOLFIRI treatment consist of?

Answer 16

folinic acid (leucovorin) + 5FU + irinotecan

Question 17

What does CAPOX treatment consist of?

Answer 17

capecitabine + oxaliplatin

Question 18

What does FOLFOXIRI treatment consist of?

Answer 18

folinic acid (leucovorin) + 5FU + oxaliplatin + irinotecan

Question 19

What stage receives surgery + observation?

a. stage I
b. stage II
c. stage III
d. stage IV

select all that apply

Answer 19

a, b

Question 20

High risk stage II receives what treatment ?

Answer 20

surgery + adjuvant chemotherapy

Question 21

Stage III receives what treatment?

Answer 21

surgery + adjuvant chemotherapy

CAPOX or FOLFOX for 3-6 months

Question 22

Which stage receives chemotherapy?

Answer 22

stage IV

Question 23

Metastatic chemotherapy regimens:

5FU/leucovorin +/- ___

Answer 23

bevacizumab

Question 24

Metastatic chemotherapy regimens:

FOLFOX +/- ___

Answer 24

cetuximab

Question 25

Metastatic chemotherapy regimens: CAPOX +/- ___

Answer 25

panitumumab

Question 26

What is the goal of surgically resectable stage IV?

Answer 26

cure

Question 27

Important labs for colorectal cancer?

Answer 27

``` CBC CMP - calcium - magnesium - SCr - hepatic panel CEA ```

Question 28

What is the rate limiting enzyme in 5FU catabolism?

Answer 28

dihydropyrimidine dehydrogenase (DPD) DPD deficiency leads to accumulation of 5FU and toxicity

Question 29

5FU dose reduction for partial DPD deficiency?

Answer 29

50%

Question 30

5FU dose reduction for complete DPD deficiency?

Answer 30

90%

Question 31

What is the irinotecan active metabolite?

Answer 31

SN-38 UGT1A1 glucuronidates SN-38 in the liver to sN38G SN-38G is eliminated via biliary excretion

Question 32

Irinotecan: There is decreased activity of UGT1A1 with what polymorphism?

Answer 32

*28

Question 33

Irinotecan dose reduction is recommended for pts who are ___ homozygous

Answer 33

UGT1A1*28 accumulation of SN-38 causes significant neutropenia and diarrhea

Question 34

Oral chemotherapy: capecitabine dose?

Answer 34

1000mg/m2 PO BID x 14 days (21 day cycle) take with food or 30 mins after food 150mg and 500mg tablets

Question 35

Oral chemotherapy: Capcetiabine AE hand foot syndrome treatment?

Answer 35

lotion/urea based cream avoid friction and extremes in temp

Question 36

Oral chemotherapy: trifluridine + tipiracil dose?

Answer 36

35mg/m2 PO BID

Question 37

Oral chemotherapy: What is the reason to check CBC with trifluridine + tipiracil?

Answer 37

to check for toxicity

Question 38

How to manage trifluridine + tipiracil myelosuppression AE?

Answer 38

dose adjustment ANC < 0.5 platelets < 50

Question 39

Oral chemotherapy: Regorafenib dose?

Answer 39

160mg PO daily x 21 days (28 days)

Question 40

Oral chemotherapy: Avoid co-administration with strong inducers/inhibitors of what CYP with regorafenib?

Answer 40

3A4

Question 41

Oral chemotherapy: Regorafenib is a ___ inhibitor, and will increase exposure to fluvastatin and atorvastatin

Answer 41

BCRP

Question 42

Colorectal cancer is the ___ leading cause of cancer death in the US a. 1st b. 2nd c. 3rd d. 4th

Answer 42

b. 2nd