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Solid Tumor Oncology > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Mutation and inheritance in familial adenomatous polyposis

A

AD mutation in APC gene

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2
Q

Who should be tested for HNPCC/Lynch syndrome?

A

All CRC patients, regardless of stage or age

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3
Q

How do you screen for HNPCC?

A

Mismatch repair protein ICH or MSI testing (PCR)

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4
Q

What genes are implicated in HNPCC? (4)

A

MSH2
MSH6
MLH1
PMS2

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5
Q

What is difference about MLH1 mutations compared to other mutations seen in MMR-deficient CRC?

A

MLH1 mutation can be sporadic. If it is seen in MLH1 hypermethylation or BRAF mutation, then it is sporadic, not germline

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6
Q

At what age should CRC screening begin?

A

45

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7
Q

T stage in colorectal cancer

A

T1: submucosal invasion
T2: Invasion muscularis propria
T3: Invades through muscularis propria or subseroa
T4: Directly invades other structures

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8
Q

N stage in CRC

A

N1: 1-3 LNs
N2: 4+ LNs

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9
Q

Adjuvant treatment for intermediate risk stage III CRC

A

3 months CAPEOX
6 months FOLFOX

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10
Q

Adjuvant treatment for high risk stage II CRC?

A

3 months CAPEOX
6 months FOLFOX
6 months 5-FU or Cape

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11
Q

What designates someone as high risk Stage III?

A

T4 and/or N2

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12
Q

Adjuvant treatment for high-risk stage III CRC? (2)

A

6 months CAPEOX
6 months FOLFOX

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13
Q

Adjuvant Treatment for low-risk stage III CRC

A

3 months CAPEOX
3-6 months FOLFOX
if can’t tolerate doublet, 6 months 5-FU or Cape

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14
Q

What classifies someone as high risk stage II CRC (6)

A

T4
Less than 12 LNs
Obstruction/perforation
LVI
PNI
Poor differentiation

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15
Q

Adjuvant treatment for a patient with stage II MSI-H/MMR-D CRC?

A

No adjuvant chemotherapy, unless high risk features

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16
Q

For stage T3Nx rectal cancer, what is the preferred treatment paradigm?

A

Preoperative chemoradiation with 5-FU, then surgery, then adjuvant chemotherapy with CAPEOX or FOLFOX maybe

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17
Q

What is the benefit of preoperative chemoRT compared to postoperative RT in rectal cancer?

A

Less toxic, less local recurrence, more sphincter sparing surgeries, no change in distant mets

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18
Q

For rectal cancer, what is the difference in short course preoperative radiation compared to chemoRT?

A

short course radiation had more locoregional recurrence

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19
Q

In patients with upper rectal cancer who wish to avoid radiation, what is their option?

A

Preoperative FOLFOX can allow people to avoid chemoRT 90% of the time

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20
Q

Management of T1N0 rectal cancer

A

Local transanal excision

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21
Q

Management of T2N0 rectal cancer

A

upfront resection

22
Q

High T2N0 rectal cancer management

A

Upfront surgery

23
Q

What does a KRAS mutation mean for treatment of metastatic CRC?

A

They will not respond to EGFR inhibitors

24
Q

What is the definition of left sided colon cancer?

A

Splenic flexure to rectum

25
Q

What sided colon cancers respond well to EGFR inhibitors?

A

Left

26
Q

Treatment for left sided KRASwt metastatic colon cancer? (2)

A

FOLFOX + Cetuximab/Panitumumab
FOLFIRI + Cetuximab/Panitumumab
Could do Bev instead of EGFR mAb

27
Q

Treatment for right sided KRASwt metastatic colon cancer?

A

FOLFOX + Bev
FOLFIRI + Bev

28
Q

Right sided colon cancer should NOT receive what type of systemic therapy?

A

EGFR inhibitors

29
Q

Who should not receive EGFR inhibitors? (2)

A

Right sided cancer
RAS/BRAF mutated
-Also those who have resectable liver mets

30
Q

BRAF V600E mutations have what prognosis in metastatic colon cancer?

A

Poor

31
Q

What is the indication for encorafenib and cetuximab in colon cancer?

A

2nd line metastatic BRAF V600E mutated

32
Q

What is the indication for Trastuzumab + Tucatinib?

A

2nd line or later mCRC with HER2 amplification

33
Q

What is the specific metastatic pattern for BRAF mutated CRC?

A

RP LNs and peritoneum

34
Q

3rd line treatment options for mCRC without driver mutations (3)

A

Regorafenib
Tirpacil fluoracil (Lonsurf) +/- Bevacizumab
Fruquitinib

35
Q

Treatment for 1L MSI-H/dMMR mCRC?

A

Pembrolizumab

36
Q

Treatment for 2L MSI-H/dMMR mCRC? (2)

A

Pembrolizumab
Nivolumab
Ipi/Nivo
Dostarlimab

37
Q

Treatment paradigm for liver-only mCRC?

A

Perioperative FOLFOX (3 months prior), surgery, then 3 months adjuvant FOLFOX

38
Q

What are poor prognostic signs in anal cancer (4)

A

Tumor >5 cm
LN mets
Male
HPV ctDNA + after chemoRT

39
Q

Standard of care for locally advanced anal cancer?

A

Concurrent 5-FU/Mitomycin + RT

40
Q

Treatment of 1L metastatic anal cancer?

A

Carboplatin + Paclitaxel

41
Q

Treatment of 2L metastatic anal cancer?

A

Nivolumab
Pembrolizumab

42
Q

Treatment for perianal cancer T1 or T2 that doesn’t involve the anal sphincter?

A

Surgical excision

43
Q

Treatment of perianal cancer that is T1N0 and poorly differentiated

A

5-FU/Mitomycin + Rt

44
Q

Treatment of perianal cancer that is T2-T4 or N+

A

5-FU/MItomycin + RT

45
Q

Preferred treatment for locoregional recurrence of anal cancer after chemoRT?

A

Surgical resection (APR), though could consider IO prior to surgery

46
Q

Patient with T2N0 rectal cancer undergoes up front resection and surgery upstages them to T3. What now?

A

Adjuvant CAPEOX or FOLFOX then chemoRT
or vice versa

47
Q

Preferred treatment paradigm for locally advanced rectal cancer

A

Total neoadjuvant therapy
ChemoRT, then FOLFOX or CAPEOX x3-4 months, then restage. If a great response, can observe and avoid surgery.

48
Q

Indications for ICI in rectal cancer?

A

In dMMR/MSI-H rectal cancer:
T3Nany
T1-2, N1-2
T4Nx
Locally unresectable
Medically inoperable

49
Q

In what patient population can you safely omit oxaliplatin from adjuvant therapy?

A

Stage II, Older than 70
Low risk stage III older than 70

50
Q

T2N0 is what stage colon cancer?

A

Stage I

51
Q

Treatment for BRAF mutated metastatic colon cancer that has progressed on FOLFOX + Bev?

A

Encorafenib + Cetuximab (or Panitumumab)

Solid Tumor Oncology (20 decks)

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