Lecture 17 colorectal cancer Flashcards
Describe the risk factors associated with colorectal cancer.
Colorectal cancer risk factors include previous history of carcinoma or adenoma, inflammatory bowel disease, family history of colorectal cancer, genetic syndromes like Lynch syndrome andial adenomatous polyposis, lifestyle factors like smoking and alcohol consumption, obesity, lack of exercise, diet, age, and previous pelvic radiotherapy.
What are the common clinical presentations of colorectal cancer?
Common clinical presentations of colorectal cancer include change in bowel habit, rectal bleeding, increase in passing of flatus, tenesmus, abdominal and pelvic pain, effects of anaemia, colicky pain from bowel obstruction, weight loss, and anorexia.
Explain the symptoms associated with colorectal cancer.
Symptoms of colorectal cancer depend on the stage and site of the cancer. They can range from being asymptomatic in early stages to local symptoms like bleeding, cramps, pain, and tenesmus, systemic symptoms like fatigue, malaise, weight loss, anorexia, and advanced symptoms like jaundice, palpable masses, and ascites.
What are the common investigations used for diagnosing colorectal cancer?
Common investigations for diagnosing colorectal cancer include abdominal examination, digital rectal examination, full blood count, sigmoidoscopy, barium enema, flexible sigmoidoscopy, flexible colonoscopy, and CT colonography.
How do genetic factors contribute to the risk of colorectal cancer?
Genetic factors like Lynch syndrome, Familial adenomatous polyposis, Gardner’s syndrome, Peutz-Jegher’s syndrome, Juvenile polyposis, and Turcot’s syndrome can significantly increase the risk of developing colorectal cancer. These syndromes are inherited and predispose individuals to the disease.
Describe the treatment options available for patients with advanced or metastatic cancer.
Treatment options for advanced or metastatic cancer include surgery, systemic anti-cancer therapy, radiotherapy, and various chemotherapy regimens like FOLFOX, CAPOX, fluorouracil, capecitabine, oxaliplatin, irinotecan, raltitrexed, mitomycin, and Lonsurf®.
How can chemotherapy benefit patients with advanced or metastatic cancer?
Chemotherapy can improve survival, alleviate symptoms, enhance quality of life, and potentially shrink liver or lung metastases in patients with resectable disease.
Define the management approach for patients presenting with stage IV cancer.
For patients with stage IV cancer, management involves assessing if there are obstructive symptoms, determining if the primary tumor and metastases are surgically resectable with curative intent, and categorizing patients based on the resectability of metastases after chemotherapy.
What are the chemotherapy options available for patients with advanced cancer?
Chemotherapy options for advanced cancer include fluorouracil, capecitabine, oxaliplatin, irinotecan, raltitrexed, mitomycin, and Lonsurf® (trifluridine/tipiracil).
Describe the adjuvant treatment options for cancer patients.
Adjuvant treatment options for cancer patients include fluorouracil and folinic acid, capecitabine as monotherapy, and oxaliplatin in combination with either fluorouracil or capecitabine (FOLFOX or CAPOX).
Describe some targeted therapy options for cancer treatment and list some regimens commonly used in combination with targeted therapy.
Targeted therapy options for cancer include Cetuximab, Panitumumab, Encorafenib, Regorafenib, and Lonsurf®. Common regimens used with targeted therapy are CAPOX, FOLFOX, FOLFIRI, IROX, XELIRI, TOMIRI, and TOMOX.
What are some side effects associated with Oxaliplatin treatment?
Side effects of Oxaliplatin treatment include moderate nausea and vomiting, diarrhea, peripheral neuropathy, myelosuppression, and ototoxicity.
How can nausea and vomiting be managed in cancer patients undergoing chemotherapy?
Nausea and vomiting in cancer patients undergoing chemotherapy can be managed with medications like Ondansetron, Dexamethasone, and Domperidone administered orally before and after chemotherapy.
What lifestyle adjustments can be made to manage acute peripheral neuropathy in cancer patients?
Acute peripheral neuropathy in cancer patients can be managed through lifestyle adjustments, such as modifying physical activities and avoiding exposure to extreme temperatures.
How should chronic peripheral neuropathy be addressed in cancer patients receiving treatment?
Chronic peripheral neuropathy in cancer patients receiving treatment may require dose reduction of the medication causing the neuropathy to alleviate symptoms and prevent further nerve damage.
Describe the side effects associated with Irinotecan. What is the management strategy for delayed diarrhoea caused by Irinotecan? How is acute cholinergic syndrome characterized and treated?
Irinotecan side effects include delayed diarrhoea, myelosuppression, alopecia, moderate nausea & vomiting, and acute cholinergic syndrome. Delayed diarrhoea is managed with loperamide, while acute cholinergic syndrome is characterized by early diarrhoea, sweating, abdominal cramping, and treated with atropine sulfate.
What are the side effects of Raltitrexed? How are Cetuximab and Panitumumab used in targeted therapy for colorectal cancer?
Raltitrexed side effects include low nausea, vomiting, and diarrhoea. Cetuximab and Panitumumab are indicated for metastatic colorectal cancer with specific RAS status. They are given in combination with FOLFIRI or FOLFOX, require verification of wild-type RAS status, and may cause infusion-related reactions.
How is Cetuximab different from Panitumumab in targeted therapy for colorectal cancer? What is the common requirement for using these drugs?
Cetuximab and Panitumumab are both used in metastatic colorectal cancer but differ in their specific indications. Cetuximab is for EGFR-expressing, RAS wild-type cancer, while Panitumumab is for wild-type RAS cancer. Both require verification of wild-type RAS status and are given with FOLFIRI or FOLFOX.
Describe the management strategy for delayed diarrhoea caused by Irinotecan. What are the symptoms and treatment for acute cholinergic syndrome?
Delayed diarrhoea from Irinotecan is managed with loperamide, starting at 4mg after the first loose motion and continuing for 12 hours after the last liquid stool. Acute cholinergic syndrome presents with early diarrhoea, sweating, abdominal cramping, and is treated with atropine sulfate.
What is the primary side effect of Irinotecan? How is delayed diarrhoea managed? What are the indications for Cetuximab and Panitumumab in colorectal cancer treatment?
The primary side effect of Irinotecan is delayed diarrhoea, managed with loperamide. Cetuximab and Panitumumab are indicated for metastatic colorectal cancer with specific RAS status, given with FOLFIRI or FOLFOX, and may cause infusion-related reactions.
Describe the infusion-related side effects associated with cetuximab treatment.
Infusion-related side effects of cetuximab can range from mild to severe and include flushing, rash, chest tightness, swelling of lips, tongue or throat, dyspnea, drug fever, skin changes, nausea, vomiting, diarrhea, fatigue, hair changes, low magnesium, eye disorders, and breathlessness.
What are some of the common later side effects that may occur after cetuximab treatment?
Common later side effects of cetuximab treatment may include various symptoms such as skin changes, fatigue, hair changes, low magnesium levels, eye disorders, and breathlessness.
