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PHRM 864 > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

how common is colorectal cancer

A

3rd most common in men and women

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2
Q

what disease states increasee risk of colorectal cancer

A

Crohns and ulcerative collitis

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3
Q

risk factors for colorectal cancer

A

family hx
fatty diet , low fiber
increases risk after 40
alcohol, obesity, smoking

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4
Q

hereditary predisposal with 100% chance of getting

A

Familial Adenomatous Polyposis (FAP)

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5
Q

what does Hereditatry Nonpolyposis Colorectal Cancer put pts at rrisk of

A

other cancers like endometrial, stomach, and ovarian

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6
Q

most colorectal cancers are what type

A

95% adenocarcinoma

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7
Q

symptoms and presentation

A

can be asymptomatic
rectal bleeding
change in bowel habits
N/V
20-25% will have metastatic disease

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8
Q

what is dMMR

A

defective DNA mismatch repair

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9
Q

which mutations are defective

A

dMMR
MSI-H

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10
Q

what is MSI-H

A

high level of microsatelite instability

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11
Q

patients with MSI-H or dMMR can benefit in what stage with 5-FU

A

Stage III, not stage II

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12
Q

what stages are curable in colorectal cancer

A

I-III potentially

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13
Q

stage I and II treatment

A

surgery is definitive
(can do chemo in 2)

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14
Q

who should get chemo in stage II

A

not reccomended unless high risk of recurrence

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15
Q

what is FOLFOX

A

5-FU (2 day infusion)
leucovorin
oxaliplatin

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16
Q

what is CapeOX

A

capecitabine (orally)
oxaliplatin

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17
Q

which treatment has chemo pod

A

FOLFOX every 2 days
FOLFIRI

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18
Q

how often to repeat folfox

A

every 14 days

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19
Q

how often to repeat capeox

A

every 21 days

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20
Q

low risk pts get which regimen for how long

A

capeox 3 months
folfox 3-6 months

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21
Q

high risk pts get what drugs for how long

A

capeox 3-6 months
folfox 6 months

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22
Q

oxaliplatin big side effect

A

neuropathy

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23
Q

capeox side effects

A

increased hand foot syndrome
diarrhea

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24
Q

which regimen do we think about adherence with

A

capeox
(oral agent) - make sure they are taking

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25
Q

if pt has a KRAS mutation what not to use

A

cetuximab
panitumumab

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26
Q

KRAS mutations predict poor response to what kind of drugs

A

anti-EGFR

27
Q
A
28
Q

1st line metastatic disease options chemo

A

FOLFOX
CapeOx
FOLFIRI
FOLFIRINOX
+ bevacizumab
if no KRAS (cetux /panit)

29
Q

which drug has big neuropathy

A

oxaliplatin

30
Q

which regimen if they have neuropathy

A

folfiri

31
Q

if pt cant tolerate intense chemo what can we give

A

5-FU
leucovorin

32
Q

second line therapies: if disease progression with oxaliplatin first

A

use folfiri

33
Q

second line therapies: if disease progression with ironotecan first

A

use FOLOFX/CapeOx

34
Q

screenings that primarily detect cancer

A

fecal blood test (FOBT)
fecal immunohistochemical test (FIT)

35
Q

screenings that detect cancer and lesions

A

endoscopic and radiologic exams
Ex. scopes and colonoscopys

36
Q

FOBT effectiveness

A

high false pos - avoid red meat / veggies
high false neg - avoid vit c

37
Q

fecal immunochemical test (FIT) advantages

A

not as many restrictions and false negatives

38
Q

FIT DNA test is what

A

takes DNA from stool (cologuard)

39
Q

gold standard for screening

A

colonoscopy

40
Q

when should you be screened in colon cancer

A

> 45

41
Q

options for screening timelines
how frequently do they reccomend

A

1 year annual FOBT/FIT
10 year colonoscopy

42
Q

family history what age to screen

A

40 or 10 years younger than the age of diagnosis

43
Q

what age to screen if HNPCC

A

20-25 or 10 year younger

44
Q

what age to screen FAP

A

10-12

45
Q

dietary prevention with what foods

A

high fiber
low fat
high calcium

46
Q

which agents can be prevenative in colorectal cancer

A

NSAIDs
aspirin

47
Q

5-FU and fDUMP binds what

A

thymidylate synthase

48
Q

patients with a deficiency in what might have 5-FU toxicities

A

DPD

49
Q

what is a synergist with 5-FU

A

leucovorin

50
Q

side effects with 5-FU

A

diarrhea
mucositis

51
Q

ironotecan side effect

A

diarrhea (i run to the can)

52
Q

what class is ironotecan

A

topoisomerase I inhibitor

53
Q

what is late onset diarhhea and what can increase the toxicity for it

A

UGT1-A1 deficiency
3-5 days and can be fata;

54
Q

UGT1A1 deficiency can have toxicity in what drug

A

ironotecan

55
Q

oxaliplatin side effects

A

cold intolerance
neuropathy

56
Q

capcitabine side effect

A

hand-foot syndrome
diarrhea

57
Q

cetuximab is what class

A

EGFR inhibitor

58
Q

cetuximab and panitumumab cannot be used with what mutation

A

KRAS

59
Q

cetuximab and panitumumab side effects

A

acne rash
hypomagnesia
(premedicate with H1)

60
Q

bevacizumab is what class

A

VEGF inhibitor

61
Q

bevacizumab toxicities - significant

A

hypertension!!!
bleeding
caution with surgery

62
Q

which drug will we check pts HTN for before

A

bevacizumab

63
Q

what drug do we check protein in urine and BP

A

bevacizumab

64
Q
A

PHRM 864 (23 decks)

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