colorectal cancer

Question 1

Dukes staging

Answer 1

Stage A: correlates to stage 1 in TNM
Limited to muscularis propria; nodes not involved

Stage B: Stage 2
Extending beyond muscularis propria; nodes not involved

Stage C: Stage 3
Regional lymph nodes nodes involved

Stage D: Stage 4
Distant metastatic spread

Question 2

Small intestine treatment

Answer 2

GIST - Imatinib

Adenocarcinomas - like colorectal 5-FU, Irenotecan and Oxaliplatin.

Question 3

Colon cancer treatment

Answer 3

Curative treatment is resection for in situ or T1, only in submucosa. Endoscopic mucosal or submucosal resection.
Note there is high risk of perforation after submucosal resection.

All other stages up to M0 => radical resection with entire arterial section of colon and lymph nodes.
Plus adjuvant chemotherapy.

For M1 used combination chemotherapy and then if there is a good response, can be followed by radical surgery.
Bad response -> radiation for palliation or resection in the case of obstruction or severe bleeding.

Question 4

Chemo drugs used in colon cancer

Answer 4

5-FU
Irinotecan
Oxaliplatin.

EGFR inhibitors if no KRAS
VEGFR inhibitors

Give Folinic acid (leucovorin) along with 5-FU.

Question 5

Treatment of RECTAL cancer.

Answer 5

Excision.
Dixon method with preserved sphincter for upper rectal tumors without metastasis.

Abdominoperineal rectal exterpation -
Miles procedure for those near the lower 3rd of rectum.

Neoadjuvant radiochemotherapy for locally advanced tumors.

Always followed by adjuvant chemo and biologics. Usually anti EGFR and VEGFR.

Chemo agents:
FOLFOX - 5-FU, oxaliplatin, leucovorin, PLUS irenotecan
CAPEOX - Capecitabine and Oxaliplatin.