Day 6- GI Cancer Flashcards
Is Colorectal the 3rd most common malignancy in both men and women?
What are some colorectal risk factors?
How does colon cancer develop?
Yes. 2nd/3rd leading cause of deaths.
Smoking, Diets high in processed foods, obesity, physical inactivity, race, type 2 diabetes, IBD, colorectal polyps, Age, Family history(Lynch syndrome, familial adenmatous polyposis).
Non cancerous polyp grows(around 10 years) to cancer.
What is the gold standard for colon cancer?
What other options do we have for colon cancer screening?
When do we start screening for colon cancer?
Colonscopy, allows for removal of polyps, very invasive(requires prep and sedation during procedure), shown to reduce colon cancer mortality by 50%, recommended every 10 years.
Flexible Sigmoidoscopy(5 years, lower half only), CTC, Double Contrast Barium Enema, Fecal Occult Blood Test.
Average risk age 50, Higher risk either start at 40 or prior to the age of the youngest case in the immediate family(whichever comes 1st), Subsequent screening(if polyps found may need more frequent screenings).
What are signs and symptoms of colon cancer?
How do you treat stage 1 colon cancer?
How do you treat stage 2 colon cancer?
asymptomatic early, abdominal pain, change in bowel habits(diarrhea, constipation, shape or size of stool), blood in the stool, fatigue accompanied by anemia.
Surgical removal and observation.
No high risk features(surgery followed by observation), high risk(Lymphatic or vascular invasion, positive margin at resection, bowel obstruction or perforation) and choose 1 of (5-FU/LV, Capecitabine, FOLFOX(not the best option)).
What is FOLFOX?
What is FOLFIRI?
What is XELOX or CAPEOX?
5-FU,LV, Oxaliplatin.
5-FU, LV, Irinotecan.
Capectiabine, Oxaliplatin.
How do you treat stage 3 colon cancer?
How do you treat someone with stage 3 colon cancer with comorbidities OR poor performance OR Age>70?
How do you treat stage 4 colon cancer?
Surgery followed by adjuvant therapy, Preferred Regimen is FOLFOX or CAPEOX. Other option is FLOX.
5-FU/LV or Capecitabine. AVOID FOLFIRI in the adjuvant setting.
Prolong life and palliate symptoms OR if there is a resectable site in liver or lungs can do surgery, cure is uncommon at this stage.
What are tumor markers/mutations to look for in colon cancer?
How do you treat resectable metastatic cancer?
How do you treat unresectable metastatic disease?
EGFR, RAS-KRAS, VEGF, dMMR/ MSI-H.
Surgery followed by FOLFOX, FOLFOX or FOLFIRI +/- Bevacizumab, Cetuximab, or Panitumumab(last 2 RAS wild type only).
FOLFOX or FOLFIRI +/- Bevacizumab or Cetuximab and Pantiumumab. Surgery only if patient has obstruction of bowel or will improve quality of life.
If a patient is not appropriate for extensive therapy how do you treat them?
How do you treat recurrent disease?
How do you treat recurrent further progression disease?
Capecitabine +/- bevacizumab or 5-FU/LV +/-
bevacizumab or Single agent cetuximab or panitumumab (RAS wild type only) or Pembrolizumab
dMMR/MSI-H only.
FOLFOX in previous 12 months?–> FOLFIRI +/- bevacizumab or FOLFIRI +/- cetuximab or panitumumab
RAS wild type only or Irinotecan +/- bevacizumab. If greater than 12 months any active regimen.
Regorafenib, Ziv-Aflibercept, Ramucirumab. Or Pembrolizumab for dMMR/MSI-H only.
What are FOLFOX/CAPOX’s major toxicities?
What are Bevacizumab’s major toxicities?
What are Cetuximab/ Pantitumumab’s major toxicites?
N/V, Diarrhea, Myelosuppresion, Hand foot syndrome, Neuropathy. Irinotecan is diarrhea and myelosuppresion.
Hypertension, Proteinuria, GI perforation, Hemmorhage, Imparied wound healing.
Acneiform rash, Premedicate with Diphenhydramine.
How do you treat Rectal Cancer?
Are there any screenings for pancreatic cancer patients?
What are symptoms of pancreatic cancer?
FOLFOX or CAPEOX.
NO.
Ab or back pain, weight loss and poor appetite, weakness, jaundice, new onset diabetes.
What are the stages of pancreatic cancer?
How do you treat stage 1 or 2 pancreatic cancer?
What drugs can you give resectable surgery?
Resectable, Non-resectable, Borderline resectable.
Whipple Surgery
Gemcitabine, 5-FU/Leucovorin.
What drugs can you give borderline resectable surgery?
What about unresectable, locally advance, metastatic?
Gemcitabine + Abraxane and FOLFIRINOX(5-FU/LV, Irinotecan, Oxiplatin).
Choose either clinical trial, FOLFIRINOX,
