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Oncology boards > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

What is the effect of leucovorin and mechanism?

A
  • enhances effect of 5-Fu by stabilizing and binding to thymydilate synthase , preventing bolus 5-Fu from being metabolized
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2
Q

DPD deficiency inheritance pattern

A

autosomal recessive

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3
Q

1) Management of patient with DPD who’s symptomatic after 5-Fu 2) mechanism of drug

A
  • uridine triacetate
  • competitive inhibitor of 5-Fu
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4
Q

CrCl precluding capecitabine

A

less than 30

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5
Q

Oxaliplatin and renal insufficiency?

A

Requires renal dosing for crcl less than 30

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6
Q

Oxaliplatin SE’s

A

hypersensitivity reactions (after sensitization)

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7
Q

Irinotecan mechanism

A

topoisomerase I inhibitor

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8
Q

Gene deficiency associated with irinotecan metabolization

A

UGT1A1

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9
Q

UGT1A1 inheritance pattern

A

autosomal recessive

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10
Q

Tumors on which side are more aggressive?

A

Right sided

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11
Q

Cetuximab/EGFR SE’s

A

diarrhea
rash
*long eyelashes
hypersensitivity reactions

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12
Q

Second line for BRAF mutant mCRC

A

encorafenib + cetuximab (it’s MEK + EGFR)

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13
Q

1) Second line HER2 regimens in mCRC 2) Preferred regimen

A

Tucatinib + trastuzumab (Preferred - MOUNTAINEER – ORR 38%, PFS 8.2 mo) (Multiple HER2 regimens without head to head comparison, Best CNS penetration)
trastuzumab + lapatinib
trastuzumab + pertuzumab.

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14
Q

NTRK targeted drugs

A

Larotrectinib
Others

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15
Q

regorafenib SE’s

A
  • hand foot syndrome
  • diarrhea
  • HTN
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16
Q

Fruquintinib mechanism

A

VEGF inhibition

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17
Q

How long bev needs to be held prior to surgery

A

At least 6 weeks

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18
Q

Which regimens in mCRC can you substitute capecitabine for 5-Fu?

A

Capeox
*CapeIRI not used in

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19
Q

Age for screening of CRC now

20
Q

Pattern of MSI testing suggestive of sporadic MSI-H in which you need to send BRAF

A

Loss of MLH1 + PMS2
*Or loss of either of above alone

21
Q

Lymph nodes required for staging of localized disease

22
Q

T4 or N1 disease worse?

A

Depth of invasion is higher risk so some Stage II pts have worse prognosis than stage III

23
Q

High risk features of Stage II

A
  • T4
  • less than 12 lymph nodes examined
  • obstruction
  • perforation
  • LVI
  • PNI
  • poorly differentiated histology
24
Q

Management of localized MSI disease

A

neoadjuvant immunotherapy (now NCCN)

25
Q

Approved adjuvant systemic therapy regimens

A
  • 5-Fu
  • capecitabine
  • oxali
    **not irinotecan or targeted therapies. Boards commonly try to trick you on this point.
26
Q

Clinical benefit of oxaliplatin addition in stage II colon cancer

A

Hasn’t demonstrated OS benefit

27
Q

Indications for adjuvant in Stage II CRC

A

1) T3 AND >2 high-risk features
*IF 1 high-risk features, risk/benefit/individualized decision
2) T4, NO

28
Q

When shorter course Capeox can be used per IDEA trial

A
  • Stage II: high risk stage II (low risk isn’t treated)
  • Low risk Stage III
  • NOt high risk stage III
29
Q

What is low risk localized?

30
Q

Stage I surveillance

A
  • c-scope 1 year after
    IF adenomas, repeat in 1 year, IF none, repeat in 3 years, then 5 years
31
Q

Stage II/III c-scope surveillance interval

A

Colonoscopy in 1 year after surgery except if no preoperative colonoscopy due to obstructing lesion, colonoscopy in 3–6 mo
If advanced adenoma, repeat in 1 y. If no advanced adenoma, repeat in 3 y, then every 5 yrs

32
Q

Recommended scan interval for Stage II/III + duration of imaging screening

A

Chest/abdominal/pelvic CT every 6-12 mo (category 2B for frequency <12 mo) from date of surgery for a total of 5 y

33
Q

Age cutoff at which oxali can be held

34
Q

5-fu mechanism

A

inhibits thymydilate synthesis

35
Q

Benefit of avastin addition in MCRC

A

OS benefit

36
Q

FAP inheritance pattern

A

autosomal dominant

37
Q

4 genes associated with Lynch

A

MSH6
MSH2
MLH1
PMS2

38
Q

Duration for single agent adjuvant

A

Always 6 months, no data for shortening duration

39
Q

Why neoadjuvant CRT is preferred in rectal

A
  • better tolerated
  • lower recurrence rates
  • increased rate of sphincter preserving surgery
40
Q

T1NO rectal management

A

local transanal excsion

41
Q

What is T4 disease (need to know since high risk feature)

A

T4a = invades through peritoneum
T4b = adheres to adjacent structures

42
Q

INdications for TNT

A

T3 any N with clear CRM OR T1-2, N1-2 and low-lying (<5 cm from anal verge)
*Need to know because they will just say distance from anal verge

43
Q

What is stage I CRC?

A

T1-2NO
*T3 thus = Stage II

44
Q

Board answer to young fit pt with metastatic right sided CRC

A

triple w/ bev (FOLFOXIRI)

45
Q

What is stage II CRC?

46
Q

Regorafenib lab monitoring

Oncology boards (41 decks)

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