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703 > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

What are risk factors of colorectal cancer?

A
  • PHM of polyps
  • IBD
  • Family history
  • Smoking
  • Heavy alcohol use (folic acid stores)
  • Physical inactivity
  • Genetic predisposition
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2
Q

How many patients with FAP will develop CRC by their early 40’s if left untreated?

A

100%

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3
Q

Which condition is caused by mutations in DNA mismatch repair?

A

Hereditary non-polyposis colorectal cancer or Lynch Syndrome

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4
Q

What are risk factors for colorectal cancer?

A
  • Low socioeconomic status
  • Age
  • Race (black, native)
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5
Q

What are S/S of colorectal cancer?

A
  • Blood in stool
  • Change in bowels
  • Fatigue
  • N/V
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6
Q

What are prevention strategies for colorectal cancer?

A
  • Fiber supplementation
  • Dietary fat reduction
  • COX2 inhibitors?
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7
Q

What is the gold standard for diagnosis of CRC?

A

Colonoscopy

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8
Q

Which enzyme do we need to pay attention to before giving 5-FU?

A

DPD - deficient patients are at higher risk for toxicities

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9
Q

How can we reduce side effects of 5-FU?

A

Slow infusion over 46 hours

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10
Q

What are considerations of capecitabine that 5-FU does not have?

A
  • Hyperbilirubinemia
  • Diarrhea
  • Hand-foot syndrome
  • Renal dose adjustment
  • Can be a radiosensitizer
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11
Q

Which drugs are contraindicated in DPD deficiency?

A
  • 5-FU
  • Capecitabine
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12
Q

What are side effects of oxaliplatin?

A
  • Peripheral neuropathy (cumulative dosing)
  • Cold intolerance/sensitivity
  • Myelosuppression
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13
Q

What are the main side effects of irinotecan?

A
  • Diarrhea*
  • Fatigue
  • Alopecia
  • Myelosuppression/neutropenia
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14
Q

How do you treat the acute (<24h) phase of irinotecan diarrhea?

A

Atropine

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15
Q

How do you treat the chronic phase of irinotecan diarrhea?

A

Loperamide

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16
Q

What is the first line targeted adjuvant with chemotherapy for CLC?

A

Bevacizumab

17
Q

What are precautions for bevacizumab?

A
  • Contraindicated in uncontrolled HTN
  • Avoid <4 weeks of surgery (delayed wound healing)
  • Proteinuria
  • Hemorrhage
  • VTE
18
Q

What adjuvant VEGFR2 inhibitor can we use with FOLFIRI for refractory disease?

A

Ramucirumab

19
Q

Patients must be KRAS _____ in order to use EGFR inhibitors

A

Wild-type (no mutation)

20
Q

Which EGFR inhibitor has a lower chance of infusion reactions?

A

Panitumumab (fully humanized) < cetuximab

21
Q

How can we prevent skin reactions on EGFR inhibitors?

A
  • Limit sun exposure, use sunscreen
  • Avoid over-drying the skin
  • Moisturize skin
  • Avoid OTC acne products
22
Q

How can we treat EGFRi rashes?

A

Steroids and antibiotics

23
Q

When do we consider holding or discontinuing EGFR inhibitors?

A

Grade 3 rash (hold)
Grade 4 rash (D/C)

24
Q

What is the BBW for the last-line CRC therapy, regorafenib?

A

Hepatotoxicity

25
Q

What can we use for HER2 expression in CRC?

A

Trastuzumab based therapies

26
Q

What is the later-line chemotherapy treatment for CRC that causes major myelosuppression?

A

Trifluridine + Tipiracil

27
Q

When can we use immunotherapy for CRC?

A

MSI-H tumors, typically stage IV

28
Q

What are the immunotherapy agents we use for CRC?

A

Pembrolizumab and nivolumab

29
Q

Which treatment do we use for the BRAF mutation?

A

Cetuximab + Encorafenib

30
Q

What is the general first-line treatment for CRC?

A

Surgery

31
Q

How do we treat stage 2 CRC requiring adjuvant chemo?

A
  • Single agent capecitabine*
  • 5-FU/leucovorin
    High risk:
  • FOLFOX
  • CapeOx
32
Q

What do we give for low risk stage 3 CRC?

A

3 months CapeOx*

33
Q

What do we give for high risk stage 3 CRC?

A
  • FOLFOX 6 months
  • CapeOx 3-6 months
34
Q

When can we consider surgery in metastatic patients?

A
  • Resectable liver-only or lung-only metastases

After chemo

35
Q

What is first-line for unresectable metastatic CRC?

A

FOLFOX + bevacizumab

703 (12 decks)

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