Colorectal/Bowel Cancer Flashcards

1
Q

What is colorectal cancer?

A

Colorectal cancer is a disease in which cells in the colon or rectum grow out of control
- the colon is the large intestine or large bowel
- the rectum is the passageway that connects the colon to the anus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for colorectal cancer?

A

obesity
lifestyle - diet, exercise, smoking and alcohol consumption
type 2 diabetes

age > 50
longstanding inflammatory bowel disease - Crohn’s or ulcerative colitis

family history of bowel cancer
history of non-cancerous growths (polyps) in the bowel
inherited syndromes linked with colorectal cancers - Lynch syndrome and familial adenomatous polyposis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are preventative measures that can be taken for colorectal cancer?

A

limit the amount of red meat eaten
- 500g or less per week

avoid processed meat

eat plenty of fibre
- wholegrain, pulses, vegetables and fruit

be a healthy body weight

increasing physical activity, avoiding tobacco and limiting alcohol consumption

takin aspirin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs and symptoms of colorectal cancer?

A

changes in bowel habits - diarrhoea, constipation lasting more than a few days

rectal bleeding - bright red blood

blood in stools - stools look dark brown or black

cramping or abdominal pain

weakness and fatigue

unintentional weight loss

feeling that the bowel doesn’t empty all the way during a bowel movement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can colorectal cancer be screened for?

A

home test kit called the faecal immunochemical test (FIT)
- small amount of poo is tested for blood

if positive a colonoscopy is conducted

available to everyone aged 60 to 74 years.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How can colorectal cancer be diagnosed?

A

medical history and physical examination

faecal immunochemical test (FIT)

blood tests - haematology and biochemistry test, tumour markers

diagnostic colonoscopy

proctoscopy - if rectan cancer is suspected

biopsy which includes gene tests - KRAS, NRAS, BRAF genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What imaging tests are used to diagnose colorectal cancer?

A

Computer tomography (CT or CAT scan)

Ultrasound- abdominal, endorectal, intraoperative

Magnetic resonance imaging (MRI) scan

Positron emission tomography (PET) scan

Angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the stages of colorectal cancer?

A

Stage 0 - cancer cells on the surface of the rectal lining (mucosa), sometimes within a polyp

Stage 1 - tumour extending below the rectal mucosa, sometimes penetrating into the rectal wall

Stage 2 - tumour extending into or through the rectal wall, sometimes reaching and growing on or sticking to tissues next to the rectum

Stage 3 - tumour invading lymph nodes next to the rectum as well as structures and tissues outside the rectal wall

Stage 4 - tumour spread to a distant organ or lymph nodes distant to the rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the different treatment options for colorectal cancer?

A

surgery
radiation
chemotherapy
targeted therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the most common types of surgery for colorectal cancer?

A

Right hemicolectomy - removal of the right part of the colon

Sigmoid colectomy - removal of the sigmoid colon (terminal portion prior to the rectum)

Left hemicolectomy - removal of the left part of the colon

Low anterior resection (LAR) - removal of the transverse colon (longest part of the colon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the types of chemotherapy for colorectal cancer?

A

adjuvant chemo - is given AFTER surgery to kill cancerous cells left after surgery

neoadjuvant chemo - is given BEFORE surgery to try to shrink the cancer and make it easier to remove

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What drugs are given for adjuvant treatment of colorectal cancer?

A

5-fluorouracil (5FU)
capecitabine
oxaliplatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mechanism of action of 5-fluorouracil (5FU)?

A

it is an anti-metabolite drug
- inhibits thymidylate synthase (TS) and incorporation of its metabolites into RNA and DNA thereby inhibiting their synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the side effects of 5-fluorouracil?

A

increased risk of infection
bruising and bleeding
anaemia
sore throat and mouth

hair loss
diarrhoea
fatigue

palmar-plantar (hand-foot syndrome) - soreness, redness, and blistering of palms of the hands and soles of feet

heart failure/heart attack (low risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the mechanism of action of capecitabine?

A

Capecitabine is a pro-drug of fluorouracil
- it acts as a pyrimidine antimetabolite
- inhibits thymidylate synthase thereby interferes with DNA synthesis

is tumour selective (mainly activated in the liver and tumours)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the side effects of capecitabine?

A

increased risk of infection
bruising and bleeding
anaemia
sore throat and mouth

hair loss
diarrhoea
fatigue

palmar-plantar (hand-foot syndrome) - soreness, redness, and blistering of palms of the hands and soles of feet

heart failure/heart attack (low risk)

17
Q

What is the mechanism of action of oxaliplatin?

A

Forms cross-linking-adducts (intra and interstrand cross linking), thus blocking DNA replication and transcription

Combination with leucovorin and 5-FU significantly improves response rates

18
Q

What are the side effects of oxaliplatin?

A

myelosuppression - decrease in the ability of the bone marrow to produce blood cells (anaemia, leukopenia or thrombocytopenia)

sensitivity to cold
numbness/tingling in hands and feet

laryngopharyngeal dysesthesia - uncomfortable persistent sensation in the area of the laryngopharynx

hypersensitivity/allergic reactions
nausea and vomiting

19
Q

What is the mechanism of action of irinotecan?
- used for metastatic colorectal cancer

A

inhibits topoisomerase I and prevents religation of the DNA strand
- impedes DNA uncoiling leading to double stranded DNA breaks

is administered with capecitabine or 5FU
- CAPIRI OR FOLFIRI regimens

20
Q

What are the side effects of irinotecan?

A

Myelosuppression - decrease in the ability of the bone marrow to produce blood cells (anaemia, leukopenia or thrombocytopenia)

Diarrhoea - early and late onset
Hair loss - alopecia
Loss of appetite
Nausea / vomiting