Colorectal cancer

Question 1

Adjuvant chemotherapy for high risk Stage II CRC

Answer 1

5FU + oxaliplatin OR capecitabine (5FU IV version) monotherapy - for 6 months

Can be 3 months accepting risk of recurrence and in select cases (not for high risk - e.g. T4 +/- N2)

Question 2

Management of rectal adenocarcinoma

Answer 2

Stage I: surgery
Stage II and III: pre-op chemoradiotherapy –> surgery –> post op chemoradiotherapy
OR total neoadjuvant upfront
Stage IV: palliative chemotherapy

Question 3

Treatment for CRC

Answer 3

First line - 5FU/capecitabine + oxaliplatin OR irinotecan

Second line: add on bevacizumab OR eGFR inhibitor (cetuximab, panitumumab)

Immunotherapy (pembrolizumab, nivolumab) - MSI high

Question 4

SE of 5FU or capecitabine

Answer 4

mucositis
diarrhoea
hand-foot syndrome (capecitabine NOT 5FU) –> voltaren gel
rarely myelosuppression and spasms

Question 5

SE of oxaliplatin

Answer 5

peripheral neuropathy (90%)
myelosuppression

Question 6

SE of irinotecan

Answer 6

diarrhoea

Question 7

MOA and SE of bevacizumab

Answer 7

MOA: VEGF inhibitor
SE: HTN, proteinuria, VTE risk and bowel perforation

Question 8

SE EGFR mutation

Answer 8

Acneform Rash (predictive of response)
Paronychia
Diarrhoea
NOT USEFUL in Kras/Nras/Braf mutations (which are downstream)

Question 9

When to use EGFR vs bevacizumab?

Answer 9

If RAS wildtype - no role of EGFR
Right sided - bevacizumab
Left sided - EGFR

Question 10

Liver mets treatment in CRC

Answer 10

Liver resection in liver only mets - resection –> 5 year survival 30-40%

Question 11

Non colonic HNPCC

Answer 11

Endometrial most common

Question 12

Diagnosis of HNPCC

Answer 12

Amsterdam criteria 3:2:1
Clinical clues: R sided , young < 50 yo, mucinous

Question 13

Which MMR genes tested ?

Answer 13

MMR - MLH1, MSH 2,6 PMS2

Question 14

When not to genetic test?

Answer 14

Age >60, isolated, no family hx
Loss of MLH1/PMS2 and BRAFV600E