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Medical Oncology SCE > Colorectal and Anal Cancer > Flashcards

Colorectal and Anal Cancer Flashcards

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USMLE® Step 1 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
Q

What percentage of CRC are RAS/RAF WT?

A

40%

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26
Q

What percentage of CRC are RAS mutant?

A

50%

27
Q

What percentage of CRC are BRAF V600E mutant?

A

10% (associated with poor prognosis)

28
Q

When does ESMO suggest we should test for HER2?

A

If KRAS/BRAF WT

29
Q

Are left or right sided tumours more common?

A

Left sided more common, 70%

30
Q

Are left or right sided tumours more likely to be BRAF mutated?

A

Right sided tumours. Often presenting in young age group at more advanced stage.

31
Q

What first line treatment would be recommended in RASm right sided CRC?

A

Likely triplet chemotherapy with FOLFOXIRI

32
Q

What first line treatment would be recommended in RAS WT right sided CRC?

A

Doublet or triplet chemotherapy

33
Q

What first line treatment would be recommended in RAS WT left sided CRC?

A

Doublet chemotherapy with anti-EGFR

34
Q

What first line treatment would be recommended in RASm left sided CRC?

A

Triplet chemotherapy with FOLFOXIRI

35
Q

Where is the boundary between right and left sided tumours?

A

Right sided tumours proximal to splenic flexure.

36
Q

First line treatment in MSI high CRC

A

Pembrolizumab

37
Q

Preferred second line treatment in BRAF mutation?

A

Encorafenib plus cetuximab.

38
Q

Treatment for MSI high patients who have received chemotherapy in the first line?

A

Ipi/Nivo in second line.

39
Q

What two treatments are currently licensed in the 3rd line for CRC?

A

Regorafenib (oral kinase inhibitor). Lonsurf +/- bevacizumab

40
Q

When is NTRK testing recommended in CRC?

A

In patients with no satisfactory treatment options who would be suitable for treatment with entrectinib and larotrectinib.

41
Q

Recommendations for management of T1, N0 rectal cancer?

A

Local excision with transanal endoscopic microsurgery (TEM) if no adverse features (G3 or LVI)

42
Q

Recommendations for management of T1-T2, T3a/b N0 rectal cancer?

A

TEM or CRT with TEM following

43
Q

Recommendations for management of T3c/d, N1-N2, EMVI rectal cancer?

A

Short course radiotherapy or chemoradiotherapy followed by TME.

44
Q

Recommendations for management of T4, EMVI or any involvement of mesorectal fascia rectal cancer?

A

Neoadjuvant long course chemoradiotherapy or short course RT followed by 12-16 weeks of doublet chemotherapy (consider triplet for T4 N+)

45
Q

What pharmacological measure is suggested to reduce risk of CRC in Lynch syndrome?

A

600mg Aspirin OD for 2 years

46
Q

Describe the inheritance of Lynch syndrome?

A

Autosomal dominant

47
Q

Lynch syndrome is caused by mutations in which genes?

A

One of the MMR genes- MLH1, PMS2, MSH2, MSH6

48
Q

Excluding CRC, which other malignancies are associated with Lynch syndrome?

A

Endometrial
Urinary tract
Stomach
Some specific skin tumours

49
Q

What percentage of CRC’s are linked to Lynch syndrome?

A

2-6%

50
Q

A mutation in which gene would exclude a Lynch associated colorectal cancer?

A

BRAF-V600E as suggests a sporadic origin of disease.

51
Q

Insensitivity to EGFR inhibitors is associated with which RAS mutation?

A

All of them HRAS, KRAS and NRAS

52
Q

What is the 5yr OS rate for colon cancer with resected liver mets?

A

Previously around 40%, recent studies suggest closer to 50-60%

53
Q

What is the 5yr OS rate for colon cancer with resected liver mets?

A

Previously around 40%, recent studies suggest closer to 50-60%

54
Q

When should colonoscopy surveillance start in UC?

A

8 years post diagnosis or 10 years before the age of diagnosis of FDR with CRC

55
Q

When should colonoscopy surveillance start in UC?

A

8 years post diagnosis or 10 years before the age of diagnosis of FDR with CRC

56
Q

When would it be appropriate to give 6 months adjuvant CAPOX following resection?

A

T4 or N2 disease

57
Q

What is the definition of N2 disease in CRC?

A

> 4 lymph nodes affected

58
Q

When is WLE appropriate for the management of anal cancer?

A

T1N0M0

59
Q

What is the preferred screening method for UC?

A

High definitive white light video colonoscopy with narrow band imaging

60
Q

What is the preferred screening method for IBD?

A

High definitive white light video colonoscopy with narrow band imaging

61
Q

In the finding of tubular adenoma with low grade dysphasia <1cm what is the interval before next colonoscopy?

A

5-10 years

62
Q

What is the distinction between colon and rectal cancers

A

> 15cm from anal margin is rectal cancer

63
Q

In the SCOT trial what was the % of G2 or higher neuropathy in 3 vs 6m CAPOX

A

25% vs 58%

Medical Oncology SCE (27 decks)

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