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Medical Oncology SCE > Colorectal and Anal Cancer > Flashcards

Colorectal and Anal Cancer Flashcards

1
Q

Which cancer carries the highest relative risk in HIV?

A

Anal cancer (19x more likely than in the general population)

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2
Q

Describe the management of early anal cancer?

A

Treated with definitive chemoradiotherapy with 5FU/capecitabine and mitomycin.

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3
Q

How long can it take to see complete response in anal cancer following definitive chemoRT?

A

Up to 26 weeks, if persistent disease beyond this consider abdomino-perineal resection.

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4
Q

What percentage of colorectal cancers are diagnosed via the UK screening program?

A

10%

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5
Q

What is the increased risk of IBD associated colon cancer?

A

70% increased risk

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6
Q

When should incidentally found appendiceal carcinomas undergo further surgery?

A

If T2 disease (muscle invasive) or high risk features such as poorly differentiated or high grade should undergo staging and right hemicolectomy.

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7
Q

Describe a colorectal T1 tumour

A

Tumour invades into the submucosa

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8
Q

Describe a colorectal T2 tumour

A

Tumour invades into the muscularis propria but not through

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9
Q

Describe a colorectal T3 tumour

A

Tumour invades through muscularis propria into perirectal fat or pericolic tissues.

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10
Q

Describe a colorectal T4 tumour

A

Tumour invades into other organs/structures or causes visceral perforation.

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11
Q

When should neoadjuvant chemotherapy be considered in CRC?

A

T4 or high risk T3 disease. Should not be used in dMMR.

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12
Q

What regime is used for neoadjuvant CRC when appropriate?

A

3 cycles of FOLFOX.

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13
Q

Describe stage 1 CRC

A

T1-T2, N0, M0

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14
Q

Describe stage 2 CRC

A

T3-T4b, N0, M0

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15
Q

Describe features that would make a stage 2 CRC intermediate risk and therefore prompt consideration of adjuvant chemotherapy.

A

LVI or peritoneal invasion or G3 or tumour obstruction or pre-op CEA >5. With microsatellite stability.

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16
Q

Describe features that would make a stage 2 CRC high risk and therefore prompt consideration of adjuvant chemotherapy.

A

pT4, <12 lymph nodes retrieved at surgery, multiple intermediate risk factors. MSI or MSS.

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17
Q

What chemotherapy regimes are used adjuvantly in stage 2 CRC?

A

6 months 5FU or 3 months capecitabine. Oxaliplatin features in ESMO guidelines but did not reach statistical significance. Can consider in high risk but certainly not intermediate risk.

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18
Q

What is the reduction in risk of death with adjuvant chemotherapy in stage 2 CRC?

A

3-5%

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19
Q

What constitutes low risk stage 3 CRC?

A

T1-3, N1

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20
Q

What constitutes high risk stage 3 CRC?

A

pT4 or N2

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21
Q

What is the anticipated reduced risk of death with adjuvant chemotherapy in stage 3 CRC?

A

10-15% with 5FU, additional 4-5% benefit with oxaliplatin.

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22
Q

What chemotherapy regimes should be considered adjuvantly in stage 3 CRC?

A

FOLFOX 6m, CAPOX 3m. In high risk patients could give CAPOX for 6 months but stop oxaliplatin after 3m.

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23
Q

When should surveillance colonoscopy be carried out following curative resection?

A

1 year, if no high risk adenomas found then next one should be in 3 years.

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24
Q

When would you consider 5FU more appropriate than capecitabine as adjuvant treatment?

A

When patient has ileostomy as rates of diarrhoea higher with capecitabine.

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25
What percentage of CRC are RAS/RAF WT?
40%
26
What percentage of CRC are RAS mutant?
50%
27
What percentage of CRC are BRAF V600E mutant?
10% (associated with poor prognosis)
28
When does ESMO suggest we should test for HER2?
If KRAS/BRAF WT
29
Are left or right sided tumours more common?
Left sided more common, 70%
30
Are left or right sided tumours more likely to be BRAF mutated?
Right sided tumours. Often presenting in young age group at more advanced stage.
31
What first line treatment would be recommended in RASm right sided CRC?
Likely triplet chemotherapy with FOLFOXIRI
32
What first line treatment would be recommended in RAS WT right sided CRC?
Doublet or triplet chemotherapy
33
What first line treatment would be recommended in RAS WT left sided CRC?
Doublet chemotherapy with anti-EGFR
34
What first line treatment would be recommended in RASm left sided CRC?
Triplet chemotherapy with FOLFOXIRI
35
Where is the boundary between right and left sided tumours?
Right sided tumours proximal to splenic flexure.
36
First line treatment in MSI high CRC
Pembrolizumab
37
Preferred second line treatment in BRAF mutation?
Encorafenib plus cetuximab.
38
Treatment for MSI high patients who have received chemotherapy in the first line?
Ipi/Nivo in second line.
39
What two treatments are currently licensed in the 3rd line for CRC?
Regorafenib (oral kinase inhibitor). Lonsurf +/- bevacizumab
40
When is NTRK testing recommended in CRC?
In patients with no satisfactory treatment options who would be suitable for treatment with entrectinib and larotrectinib.
41
Recommendations for management of T1, N0 rectal cancer?
Local excision with transanal endoscopic microsurgery (TEM) if no adverse features (G3 or LVI)
42
Recommendations for management of T1-T2, T3a/b N0 rectal cancer?
TEM or CRT with TEM following
43
Recommendations for management of T3c/d, N1-N2, EMVI rectal cancer?
Short course radiotherapy or chemoradiotherapy followed by TME.
44
Recommendations for management of T4, EMVI or any involvement of mesorectal fascia rectal cancer?
Neoadjuvant long course chemoradiotherapy or short course RT followed by 12-16 weeks of doublet chemotherapy (consider triplet for T4 N+)
45
What pharmacological measure is suggested to reduce risk of CRC in Lynch syndrome?
600mg Aspirin OD for 2 years
46
Describe the inheritance of Lynch syndrome?
Autosomal dominant
47
Lynch syndrome is caused by mutations in which genes?
One of the MMR genes- MLH1, PMS2, MSH2, MSH6
48
Excluding CRC, which other malignancies are associated with Lynch syndrome?
Endometrial Urinary tract Stomach Some specific skin tumours
49
What percentage of CRC's are linked to Lynch syndrome?
2-6%
50
A mutation in which gene would exclude a Lynch associated colorectal cancer?
BRAF-V600E as suggests a sporadic origin of disease.
51
Insensitivity to EGFR inhibitors is associated with which RAS mutation?
All of them HRAS, KRAS and NRAS
52
What is the 5yr OS rate for colon cancer with resected liver mets?
Previously around 40%, recent studies suggest closer to 50-60%
53
What is the 5yr OS rate for colon cancer with resected liver mets?
Previously around 40%, recent studies suggest closer to 50-60%
54
When should colonoscopy surveillance start in UC?
8 years post diagnosis or 10 years before the age of diagnosis of FDR with CRC
55
When should colonoscopy surveillance start in UC?
8 years post diagnosis or 10 years before the age of diagnosis of FDR with CRC
56
When would it be appropriate to give 6 months adjuvant CAPOX following resection?
T4 or N2 disease
57
What is the definition of N2 disease in CRC?
>4 lymph nodes affected
58
When is WLE appropriate for the management of anal cancer?
T1N0M0
59
What is the preferred screening method for UC?
High definitive white light video colonoscopy with narrow band imaging
60
What is the preferred screening method for IBD?
High definitive white light video colonoscopy with narrow band imaging
61
In the finding of tubular adenoma with low grade dysphasia <1cm what is the interval before next colonoscopy?
5-10 years
62
What is the distinction between colon and rectal cancers
>15cm from anal margin is rectal cancer
63
In the SCOT trial what was the % of G2 or higher neuropathy in 3 vs 6m CAPOX
25% vs 58%

Medical Oncology SCE (27 decks)

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