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Hematology, oncology > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

relevance of RAS in CRC

A

Benefit from MoAbs targeting the EGFR is restricted to patients whose tumors do not contain mutated RAS genes (eg RAS wild type).

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2
Q

microsatelite stability and relationship to prognosis

A

MSS tumors are characterized by changes in chromosomal copy number and show worse prognosis, on the contrary the less common MSI tumors (about 15%) are characterized by the accumulation of a high number of mutations and show predominance in females, proximal colonic localization, poor differentiation, tumor-infiltrating lymphocytes and a better prognosis.

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3
Q

relevance of microsatelite stability and treatment

A

Benefit from PD-1 inhibitors is limited to tumors with MSI-H/dMMR.

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4
Q

significance of Ki-67

A

Prognostic marker in breast cancer. Measure of tumor cell proliferation.

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5
Q

Ki-67 interpretation

A

A result of less than 10% is considered low, 10-20% borderline, and high if more than 20%.
Higher the score = more likely to be aggressive.

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6
Q

her2 positive treatment

A

Trastuzumab + pertuzumab + taxane (docetaxel or paclitaxel)

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7
Q

trastuzumab trade name

A

Herceptin

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8
Q

xeleri is

A

capecitabine plus irinotecan

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9
Q

doxorubicin trade name

A

adriamycin

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10
Q

biomarkers to test for in CRC

A

KRAS + BRAF + MMR/MSS status

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11
Q

relevance of BRAF in CRC

A
  • Negative prognosticator

Moreover, BRAF V600E mutations also appear to predict response to EGFR-targeted agents is unlikely in patients whose tumors harbor BRAF V600E mutations, even if they are RAS wild type.

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12
Q

BRAF pathway?

A

component of the RAS-RAF-MAPK signaling pathway.

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13
Q

why trend CEA

A

A rise in CEA predicts recurrence, so if you see a rise, you should order imaging earlier.

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14
Q

downside to capeox

A
  • wide variability in pricing

- some variation in response based off genetic profile (asians tend to tolerate fluoropyrimidines better)

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15
Q

FOLFOX is

A

Folinic acid “FOL”, Fluorouracil “F”, and Oxaliplatin “OX”.

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16
Q

bevacizumab/avastin SE profile

A

epistaxis, headache, hypertension, rhinitis, proteinuria,
taste alteration, dry skin, rectal hemorrhage, lacrimation disorder, and
exfoliative dermatitis

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17
Q

cetuximab indication

A

KRAS + BRAF wild type and left sided

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18
Q

general SE of pembro and other checkpoint inhibitors

A

most people do well, but they can do anything

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19
Q

why do you give leucovorin with FOLFOX

A

It enhances the activity of 5-FU. It is folinic acid.

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20
Q

Common SE’s of 5-Fu

A

myelosuppression + mucositis + palmar/plantar erythrodysesthesia + diarrhea + cardiotoxicity + neurotoxicity

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21
Q

term for effect on cold liquids of oxaliplatin

A

cold hypersensitivity

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22
Q

RF’s

A

(think of things that are going to cause inflammation in colon)
IBD, drinking, smoking, obesity
Consumption of red and processed meats
Diabetes

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23
Q

Screening colonoscopy recommendation

A

average risk = 50

IF FH – 10 years prior to age of earliest occurrence or beginning at age 40

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24
Q

clinical workup recommended for patients who develop CRC before age 50

A

MSI testing, (test for mismatch repair if MSI high)

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25
Q

Until what age is screening recommended

A

Up to 10 years prior to a patients life expectancy

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26
Q

Interventions to reduce risk of CRC and protective factors

A 
Increase physical activity
polypectomy
Reduce fat and meat intake
Daily use of ASA + NSAIDs
Metformin possibly
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27
Q

sensitive and specific markers of adenocarcinoma

A

CK20 + CDX2

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28
Q

Signs/symptoms

A

Change in bowel habits (74 percent), rectal bleeding in combination with change in bowel habits, (51 percent of all cancers and 71 percent of those presenting with rectal bleeding), rectal mass (24.5 percent) or abdominal mass (12.5 percent), iron deficiency anemia (9.6 percent)

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29
Q

prognostic significance of MSI

A

positive prognosticator

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30
Q

Management of oligometastatic disease

A

Metastastectomy, particularly if liver mets, (can lead to long term survival)

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31
Q

Name some of the common chemo regimens

A

CapeOX
FOLFOX
FOLFIRI

32
Q

Targeted agents approved for CRC

A 
(VEGF TKI)
Bevacizumab
(EGFR TKI's)
Cetuximab
Regorafenib
Panitumumab
33
Q

Panitumumab mechanism

A

EGFR TKI

34
Q

Prior to use of cetuximab or panitumumab what testing must be performed?

A

Test for mutations in KRAS and NRAS that confer resistance to anti-EGFR therapy

35
Q

Polyp with the greatest malignant potential

A

Serrated

Higher villous histology

36
Q

surgical management of colon cancer

A

Hemicolectomy
IF tumor in distal one third of rectum and invades anal sphincter –> abdominoperineal resection (APR), leading to permanent colostomy.
IF tumor in proximal two thirds of rectum –> low anterior resection

37
Q

Regimen that is standard of care for neoadjuvant and adjuvant treatment of CRC

A

FOLFOX or CapeOX

38
Q

Role for targeted agents for CRC

A

Reserved for advanced-stage metastatic disease

39
Q

General approach to locoregionally advanced CRC

A

IF resectable –> surgery followed by adjuvant chemo

IF nonresectable –> chemo, re-evaluate for surgery

40
Q

Use of cetuximab or panitumumab

A

Addition to FOLFIRI or FOLFOX in metastatic CRC in patients with KRAS and NRAS wild-type tumors

41
Q

Stage I definition

A

tumor restricted to muscularis propria + no nodal or distal mets

42
Q

Stage II definition

A

Muscle invasive + node negative

43
Q

Stage III definition

A

nodal mets

44
Q

Clinical significance of MMR testing

A

IF positive, no benefit from 5-Fu

45
Q

Initial workup

A 
Detailed family history
CMP 
CT chest + abdomen/pelvis
IF suspicious but not well defined lesion on CT → liver MRI (or intraoperative biopsy)
Pretreatment CEA
MMR/MSI testing
46
Q

Initial workup

A 
Detailed family history
CMP 
CT chest + abdomen/pelvis
IF suspicious but not well defined lesion on CT → liver MRI (or intraoperative biopsy)
Pretreatment CEA
MMR/MSI testing
47
Q

Molecular testing needed if metastatic

A

RAS, BRAF, HER2

48
Q

Trends in incidence of CRC

A

Overall incidence and mortality are decreasing but incidence is increasing among younger people

49
Q

Explanation for increasing incidence of CRC in young people

A

Unknown but thought to be genetically dissimilar, so may need different treatment strategies

50
Q

genetic syndromes associated with CRC

A

Lynch syndrome

FAP

51
Q

MMR vs. MSI

A

MMR positive means patient has a germline mutation in mismatch repair protein. Microsatelite instability results from MMR mutation.

52
Q

Classification of mets in CRC (meaning of M1A and M1B)

A 
M1A = Mets limited to one site/solid organ
M1B = Mets to multiple sites
53
Q

What are tumor deposits?

A

Discrete tumor deposits in the pericolic or perirectal fat without lymph node tissue but being within lymphatic drainage system. Associated with reductions in OS and PFS.

54
Q

Management of single malignant polyp

A

IF negative margins + no high risk features (grade 1 or 2 and no angiolymphatic invasion), no further management

55
Q

CT contrast management for CRC evaluation

A

Should always be with PO + IV contrast.

56
Q

Management of patient with contrast contraindication

A

MRI with contrast

57
Q

Stage at which adjuvant chemotherapy is indicated

A

Stage II with high risk features

58
Q

High risk features of stage II CRC warranting chemo

A
  • T4 tumors
  • poorly differentiated histology
  • lymphovascular invasion
  • bowel obstruction
  • lesion with localized perforation
  • close, indeterminate, or positive margins
  • inadequately sampled nodes (less than 12)
59
Q

preferred adjuvant treatment options for Stage III and duration of treatment

A

3 months of CAPEOX
OR
3-6 months of FOLFOX

60
Q

Timing of adjuvant therapy

A

ASAP. There is a survival benefit to starting chemo ASAP

61
Q

Cause of death in most people who die of CRC

A

Metastatic liver disease

62
Q

Term for tumor in the peritoneum

A

Peritoneal carcinomatosis

63
Q

Tumor marker in colorectal cancer

A

CEA

64
Q

term for pain, swelling, erythema associated with 5-Fu

A

palmar/plantar erythrodysesthesia

65
Q

subset of tumors that have shown benefit from CPIs

A

mismatch repair deficient

66
Q

Contraindications to surgical resection of hepatic mets

A

1) Tumor involvement of common artery or portal vein or CBD 2) more than 70% liver involvement 3) more than 6 involved segments 4) involvement of all 3 hepatic veins

67
Q

Difference in SE profile between infusional and bolus 5-FU

A

Cardiotoxicity more commonly found with infusional 5-FU compared to bolus (causes vasospasm)

68
Q

Management of coronary vasospasm from infusional 5-FU

A

Drop infusional, give bolus

69
Q

Significance of MSI-H disease in stage II colon

A

positive prognosticator, don’t need adjuvant treatment

70
Q

alternative term for lynch syndrome

A

Hereditary nonpolyposis colorectal cancer (refers to patients who fulfill amsterdam criteria)

71
Q

N1 disease in colon cancer

A

1-3 nodes involved

72
Q

Adjuvant for elderly for stage III

A

5-FU alone without oxaliplatin

73
Q

Likely SOC for early stage dMMR

A

neoadjuvant IPI/nivo

74
Q

When is 3 month capeox preferred?

A

Low risk Stage III it is preferred
For high risk 3-6 months

75
Q

Systemic therapy for stage II disease

A

5-Fu alone for 6 months

76
Q

First line for HER2+ colon

A

trastuzumab + tucatinib

77
Q

Drugs targeting TRK fusion-positive tumors

A

Entrectinib, larotrectinib

Hematology, oncology (218 decks)

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