Colorectal cancer Flashcards
Risk factors
age - increased risk at age 40 and even greater risk after age 50
family history of colorectal cancer
diet
polyp formations - a small % will turn into cancer
Alcohol, smoking, obesity
crohns disease or ulcerative colitis
Hereditary syndrome
Warning signs of colon cancer
constipation, diarrhea, blood in stools, narrow stools, unexplained anemia, tender abdomen or abdominal pain, unexplained weight loss, weakness and fatigue
Clinical presentation
may be symptomatic, rectal bleeding, anemia, change in bowel movements, nausea and vomiting
Treatment goals
Stage I, II, III
- considered potentially curable
- intent of eradicating known and micrometastatic tumor sites
- achieve remission and avoid disease recurrence
Stage IV
- incurable/ palliation
- decrease symptoms, avoid disease related complications
Testing work up
Defective DNA mismatch repair (dMMR)
Test for microsatellite instability (MSI) or test for loss of genes invovled in DNA MMR
MSS= Microsatellite stable tumor
MSI-L = Low level microsatellite instability
MSI-H = high level microsatellite instability
pMMR = proficient mismatch repair
dMMR = Defective mismatch repair
Localized therapy Stage I and II
Surgery - partial or total colectomy and lymph nodes
can do surgery and chemotherapy if the patient is at high risk but no real evidence to say doing both is beneficial
if MSI-H or dMMR then will not benefit from chemotherapy for stage II disease
Stage II disease chemotherapy
reasonable for high risk or intermediate risk stage II patients ONLY
FOLFOX - 5-FU, leucovorin, and oxaliplatin
CapeOX - Capecitabine, oxaliplatin
Stage III colon cancer LOW risk
CapeOx for 3 months
FOLFOX for 6 months (oral) or 3 months with pump
Stage III colon cancer HIGH risk
CapeOx for 6 months or 3 months
FOLFOX for 6 months
FOLFOX regimen
Requires a pump
Day 1 patient comes into the clinic to get the pump and patient gets to leave with 5-fu pump infusion
Day 3 patient will come back to the clinic to get the pump removed
Day 14 patient gets new pump placed
Day 17 patient gets pumped removed
repeat this cycle every 2 weeks for 3 months
Increased myelosuppression and mouth sores
CapeOx regimen
no port required
Day 1 IV oxaliplatin + capecitabine oral for 14 days and off for 7 days
repeat every 3 weeks for 3/6 months
1st line metastatic disease
No mutations: FOLFOX, CapeOx, FOLFIRI
KRAS WT, Left sided: FOLFOX or CapeOx + Cetuximab or Panitumumab
dMMR/MSI-H: Nivolumab + ipilimumab
HER2 positive: Transtuzumab + (pertuzumab or lapatinib
- Describe and apply available cancer screening guidelines to an individual at average
and high risk for developing colon cancer.
Primary detect cancer
- Fecal occult blood test (FOBT) and Fecal immunohistochemical test (FIT)
Avoid red meat and raw vegetables to avoid false positive with FOBT
Avoid vitamin C to avoid false negatives with FOBT
Detect cancer and advanced lesions: endoscopic and radiologic exams
Colonoscapy should be men and women ages 45 and up ever 10 years
start screening at 40 if you have first line family members with disease
- Generate a treatment plan for colon cancer prevention.
Cyclooxygenase inhibitors
400mg BID
NSAIDS or aspirin
Colectomy
Oxaliplatin SIDE effects
Neuropathy and cold intolerance (if you put your hand in the fridge it hurts, if you breath in cold air it hurts)
