Colorectal Cancer Flashcards
T/F: Colorectal cancer is the 3rd most common cancer in the United States
True
What are the risk factors for colorectal cancer
Age greater than 50 years old, Ulcerative colitis or Chrohn’s disease, polyps, history of colon cancer in a first or second degree relative
What are polyps and why are they a risk factor, prevention
Extra tissue that grows in the large intestine, increasing in size increases the likelihood of becoming cancerous, removal
What are the inherited syndromes that increase the risk of colorectal cancer
FAP, Lynch Syndrome, MSI
What are protective risk factors against colorectal cancer
High fruits and vegetables, regular exercise, regular use of asprin and NSAIDs
What screenings can be done to see if a patient has colorectal cancer
Digital rectal exam, colonoscopy, endoscopy, CT colonography
What is the normal pathophysiology from normal tissue to cancer/metastases
Normal epithelium -> Early adenoma -> Late adenoma -> carcinoma -> metastatic carcinoma
What is the best way to be diagnose a patient has colorectal cancer
A biopsy
What is a tumor marker for colorectal cancer
CEA
What are the most common ways to treat colorectal cancer
Surgery and Chemotherapy
T/F: Colorectal cancer is one of the few cancer where a patient gets metastes and still be cured
True
What is the basic regimen for colorectal cancer and what are the medicatons involved
FOLFOX6: Leucovorin 400 mg/m2 over 2 hours day 1, Fluorouracil 400 mg/m2 IVP day 1 then 1200 mg/m2/day for 2 days as a continous infusion, oxaliplatin 85 mg/m2 over 2 hours a day 1 (repeat every 2 weeks for 6 months)
What are side effects of the FOLFOX regimen
acute and delyaed neuropathy, moderate emotogenic risk, hypersensitivity (oxaliplatin)/ diarrhea, myelosuppresion (5-FU bolus), Hand-Foot syndrome (infusion)
What are other treatments that can be given
Capecitabine (contraindicated if CrCl less than 30), 5-FU PLUS leucovorin
What are the initial therapy for metastaticCRC involving oxiplatin
FOLFOX or CAPOX with or without Bevacizumab OR FOLFOX with or without Panitumumab OR FOLFOX with or without Cetuximab
What are the initial therapy options for metastaticCRC involving Irinotecan
FOLFIRI with or without Bevacizumab OR FOLFIRI with or without Cetuximab OR FOLFIRI with or without Panitumumab
What is the difference between the FOLFOX and FOLFIRI regimens
Oxaliplatin 85mg/m2 IV is switched for Irinotecan 180 mg/m2 IV
What is in the CapOx regimen and when would it be given
Capecitabine 1000 mg/m2 by mouth every 12 hours for 14 days PLUS Oxaliplatin 130 mg/m2 IV day 1 for intervals of 3 weeks, 2nd line after an Oxaliplatin regimen was used
What are the EGFR inhibitors, toxicities
Cetuximab and Panitumab/ rash (maculopapular), hypomagnesemia, Infusion reactons
What are the VEGF inhibitors, toxicities
Bevacizumab, Ziv-aflibercept, Regorafenib,Ramucrizumab/ Hypertension, Thrombosis, Bleeding, Proteinuria
Which patients should recieve an EGFR inhibitor
Only who KRAS wild type patients (non-mutant)
Which EGFR needs premedication and with what
Cetuximab (chimeric antibody), H1 antagonists (diphenhydramine, loratidine)
Which EGFR is most associated with severe diarrhea and ocular toxicities
Panitumab
T/F: Patient with antibodies to galactose-alpha-1,3 galactose are more likely to have a reaction to Panitumab
False: Patient with antibodies to galactose-alpha-1,3 galactose are more likely to have a reaction to Cetuximab
T/F: Bevacizumab is medication that patients won’t fail and can be continued throughout a course of metastatic treatment
True
What are the boxed warning for bevacizumab, adverse effects
Hemorrhage. GI perforation, Compromised wound healing/ Hypertension, Arterial thromboembolic events, proteinuria
How should Beacizumab be used before and after surgery
Hold 28 days before and after surgery
What are other drugs that can be used in mCRC
Regorafenib (multikinase inhibitor/many adverse effeccts), trifluridine/tipiracil (given monday through friday two weeks in a row every month)
What should be given if a patient has high microsatelite Instability or mismatch repair deficiency, what are the medication
Immunotherapy/ Pembrolizumab, Nivolumab, Nivolumab and Ipilimumab
