Colorectal Cancer

Question 1

risk factors for developing colorectal cancer

Answer 1

increases with age 
more common in industrialized world - western diet?
diet high in fats, red meats
inadequate intake of fiber fruits and vegetables
family history 
alcohol intake
smoking 
obesity 
inflammatory bowel disease

Question 2

rectal cancer is defined as

Answer 2

arising below peritoneal refection of <12cm from the anal verge

Question 3

colon cancer is more common than

Answer 3

rectal cancer

Question 4

most common colorectal cancer

Answer 4

sigmoid colon/rectum

Question 5

pathophys

Answer 5

colorectal adenocarcinomas remain superficial for a long time and slowly invade the deeper layers of the intestinal wall
extension through the bowel wall into the pericolonic fat
more distant spread can take place to the liver and lungs

Question 6

signs and symptoms

Answer 6

changes in bowel habits
diarrhea or constipation 
blood in stool 
narrow stools
ab and gas pain 
weight loss
tenesmus(inclination to evacuate the bowels)

Question 7

why should people get screened

Answer 7

survival rate much better in the beginning
very bad by stage 4
decreases the risk of dying

Question 8

screening tests

Answer 8

stool blood guaiac test to detect blood in stools
sigmoidoscopy
barium enema 
colonoscopy 
carcinoembryonic antigen

Question 9

screening is effective because

Answer 9

we can detect precancerous early stage cancers in people who dont show symptoms
can confirm and more easily treat cancer in early stages

Question 10

who should be tested and how often

Answer 10

> 50 evaluated annually with fecal occult blood testing unless high risk

Question 11

primary curative procedure for stages 1-3

Answer 11

surgery

resection of the bowel

Question 12

why do we do radiation to tumor bed and surgically inaccessible areas of tissue

Answer 12

to decrease local recurence

can be used for lessening symptoms

Question 13

stage 1

Answer 13

local diseas eno invasion of muscular mucosa

Question 14

stage 2

Answer 14

invasion of muscular mucosa

Question 15

stage 3

Answer 15

lymph node involvment

Question 16

stage 4

Answer 16

metastatic disease

Question 17

application of chemo in colorectal cancer

Answer 17

adjuvant after surgery in stage 2 and 3

primary therapy of metastatic colon and rectal cancers

Question 18

most commonly used agent in colorectal cancer

Answer 18

fluorouracil

Question 19

fluorouracil toxicity based on type of admin

Answer 19

bolus - grade 3 and 4 hematological toxicity

continuous infusion - hand foot syndrome

Question 20

what is hand foot syndrome

Answer 20

paiful reddening of skin
should report any changes to palms and soles asap
prevent by moisturizing and avoiding heat and friction

Question 21

treatment of hand foot syndrome

Answer 21

topical anesthetics
cold
oral analgesic

Question 22

FU use

Answer 22

adjuvant and metastatic

Question 23

irinotecan mechanism and use

Answer 23

top 1 inhibitor
metastatic or FU resistance
first line for metastatic colorectal in combo with FU and leucovorin

Question 24

irinotecan problem

Answer 24

diarrhea early and late onset

Question 25

oxaliplatin class and use

Answer 25

third gen platinum analog | adjuvant and metastatic

Question 26

oxaliplatin SE

Answer 26

peripheral neuropathy laryngeal spasm cold intolerance

Question 27

raltitrexed class and use

Answer 27

thymidilate synthetase inhibitor | metatstatic

Question 28

capecitabine use and class

Answer 28

fluoropyrimdine - can be delivered at hom e | adjuvant and metastatic

Question 29

capecitabine metabolized to

Answer 29

fluorouracil | investigated in combos as an alternative to infusional FU

Question 30

dosing of capecitabine

Answer 30

twice daily oral for 14 days then 7 day rest period

Question 31

capecitabine AE

Answer 31

palmar plantar erythrodysesthesiia (hand foot) diarrhea stomatitis

Question 32

bevacizumab class and use

Answer 32

monoclonal antibody directed against vascular endothelial growth factor metastatic not adjuvant

Question 33

use of vascular endothelial growth factor

Answer 33

promotes growth of vascular endothelial cells derived from arteries and veins promotes endothelial cell survival

Question 34

bevacizumab toxicity

Answer 34

perforation hypertension bleeding thromboembolism

Question 35

mechanism of cetuximab

Answer 35

chimeric monoclonal antibody directed at cancer cells overexpressing the epidermal growth factor receptor frequently seen in colorectal cancers

Question 36

cetuximab AE

Answer 36

weakness, malaise, fever, headache, acneiform rash

Question 37

what is panitumumab and its use

Answer 37

fully human EGFR antibody | survival benefit late line therapy***

Question 38

disease free survival as a primary end point

Answer 38

allows to make a quicker decision of efficacy so drug development time can be shortened and better therapy available to patients quicker

Question 39

is adjuvant therapy for stage 2 required

Answer 39

still unknown

Question 40

stage 2 colon cancer who should be treat (adjuvantly??)

Answer 40

``` no molecular low risk factors <60yoa less than 9 nodes removed T4 tumors perforation ```

Question 41

stage 3 colon cancer standard adjuvant

Answer 41

6 months of oxaliplatin based therapy

Question 42

stage 2 colon cancer treatment

Answer 42

6 months capecitabine

Question 43

adjuvant in rectal

Answer 43

during radiation fluorouracil 200mg/m2/day preoperative fluorouracil with radiation 4 months of post op oxaliplatin based therapy

Question 44

FU mechanism

Answer 44

pyrimidine antagonist

Question 45

how leucovorin increased survival with FU

Answer 45

enhances binding of FdUMP to target enzyme

Question 46

route to improve survival and decrease toxicity with FU

Answer 46

continuous infusion

Question 47

irinotecan vs oxaliplatin

Answer 47

same efficacy choice depends on toxicity irinotecan: no neuropathy, dose reduction for hepatic dysfunction oxaliplatin: less alopecia, mucositis, and nausea, safer in hepatic dysfunction

Question 48

risk factor for oxaplatin persistent neurotoxicity

Answer 48

total cumulative dose | all patients will experience sensory neuropathy after 4 cycles

Question 49

acute oxaliplatin neurotoxicity

Answer 49

in 2-48 hrs | rapid and complete recovery

Question 50

persistent oxaliplatin neurotoxicity

Answer 50

affects fingertips and toes then hands and feet persists between cycles increases in duration and intensity slow recovery