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CDM 4 Exam 3 > Lecture 7 - Colon cancer > Flashcards

Lecture 7 - Colon cancer Flashcards

1
Q

Colon cancer risk factors

A

Age
Diet = fiber, fat, red meat
Polyps
IBS
Genetics
Personal h/x of colorectal cancer
smoking
Diabetes

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2
Q

Stuff that is associated with dec risk colon cancer

A

ASA/NSAID use
Hormones
High Fiber Diet
Calcium rich diet

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3
Q

Stuff that is associated with inc risk colon cancer

A

Obesity
Alcohol n smoking

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4
Q

When to start screening Average risk colon cancer

A

age 45, continue until 75 and after 85 should probs stop screening

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5
Q

When to start screening high risk colon cancer groups

A

40 or earlier
FAP annual screening @ 10-12
HNPCC (Lynch syndrome) annual screening @ 20-25

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6
Q

What makes someone high risk group for colon cancer

A

H/x IBS
H/x adenomas, colon cancer
FH cancer/polyps

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7
Q

Are digital rectal exams used often for colon cancer

A

not really

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8
Q

fecal occult blood test info

A

paper that you poop on

restrict vitamin C
avoid NSAIDs
restrict ASA
avoid red meat

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9
Q

Fecal immunochemical test info

A

no restrictions

more sensitive than guaiac

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10
Q

stool DNA test info

A

repeat every 3 years
if positive, follow up with colonoscopy

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11
Q

Sigmoidoscopy info

A

limited field (distal bowel, left side only)
if positive, follow up with colonoscopy
every 5 years

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12
Q

Colonoscopy info

A

gold standard
requires prep
expensive, burdensome, no one really wants stuff up their butt
every 10 yrs (5yrs for virtual)

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13
Q

most common site for colon cancer to metastasize to is….

A

liver

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14
Q

Tumor marker Colon cancer

A

CEA

Normal < 2.5 non smoker, < 5 smoker

used for detecting recurrences

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15
Q

Colon cancer biomarkers

A

EGFR
KRAS/NRAS/BRAF

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16
Q

KRAS mutation predicts….

A

lack of efficacy with anti-EGFR drugs, won’t respond

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17
Q

KRAS/NRAS mutation pts should not receive…..

A

anti-EGFR agents

18
Q

When is adjuvant therapy used in colon cancer

A

usually start thinking about it stage 2

19
Q

Locally advanced disease (stage 3) therapy

A

do tend to give adjuvant chemo

Stage 3 Low risk = FOLFOX q2w X 3-6M, CapeOX q3w X 3 month
Stage 3 high risk = FOLFOX q2w X 6M, CapeOX q3w X 3-6M

20
Q

1st line colon cancer therapy

A

FOLFOX
CapeOX
FOLFIRI
FOLFOXIRI

21
Q

FOLFOX made up of…

A

5FU + Leucovorin (LV) + Oxaliplatin

22
Q

CapeOX made up of…

A

Capecitabine + Oxaliplatin

23
Q

FOLFIRI made up of…

A

5FU + LV + Irinotecan

24
Q

FOLFOXIRI made up of….

A

5FU + LV + Oxaliplatin + Irinotecan

25
Q

key oxaliplatin toxicity

A

cold-induced neuropathy

dont drink or touch cold stuff

26
Q

most common 5FU toxicity

A

myelosuppresion and diarrhea

27
Q

can you hold Oxaliplatin for few cycles?

A

yea and overall survivability isn’t really effected, helps reduce neuropathy

28
Q

Using FOLFOX or FOLFIRI first?

A

doesnt really matter

FOLFOX = more neuropathy
FOLFIRI = More diarrhea

29
Q

Capecitabine info

A

Toxicity = HandFoot syndorme, diarrhea
Weight based dosing, 14 days on, 7 days off

30
Q

VEGF inhibitors Colon cancer

A

Bevacizumab
Ramucirumab

31
Q

EGFR inhibitors Colon cancer

A

Cetuximab
Panitumumab

32
Q

BRAF inhibitor Colon cancer

A

Encorafenib

33
Q

Immunotherapy Colon cancer

A

Nivolumab
Ipilimumab
pembrolizumab

34
Q

Bevacizumab info

A

Toxicity: bleeding, HTN, bowel perforation, thromboembolic events

VEGF inhibitor

if disease progresses, you can continue if switch backbone therapy

35
Q

Cetuximab (Erbitux) info

A

Used for KRAS wild-type EGFR expressing metastatic colorectal cancer
EGFR inhibitor
Dosed based on surface area, weekly

36
Q

Cetuximab (Erbitux) adverse events

A

Infusion Rxn most common, start slow n pre-medicate with antihistamine
Dont admin w/ bevacizumab

37
Q

Cetuximab (Erbitux) adverse events

A

Infusion Rxn most common, start slow n pre-medicate with antihistamine
Dont admin w/ bevacizumab
skin rash can occur

38
Q

Panitumumab (Vectibix) info

A

Used for KRAS wild-type EGFR expressing metastatic colorectal cancer
usually used based on institutional preference

39
Q

Panitumumab (Vectibix) ADE

A

infusion rxn
Derm toxicity
** dont admin with Bevacizumab**

40
Q

Nivolumab indication

A

pts > 12 yrs old with MSI-H or dMMR metastatic colon cancer that have progressed following txm with other therapies

CDM 4 Exam 3 (11 decks)

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