Nickcevich: CRC

Question 1

A 57 y/o M comes to your office w/ abdominal pain for 4-6 mos. Intermittent constipation w/ occasional blood in the stool. Labs show a HgB of 10.5 suggesting anemia. What might you suspect?

Answer 1

CRC

Biopsy– Can’t diagnose w/ out tissue

Question 2

What imaging can you do if you suspect CRC?

Answer 2

Colonoscopy
Flexible sigmoidoscopy
Virtual colonoscopy
Barium enema

Question 3

What do you do if you find an adenocarcinoma in the cecum?

Answer 3

CT scan
CEA level
surgery

Question 4

What are the AJCCv6 Staging definitions for a primary tumor (T)?

Answer 4

Tis Carcinoma in situ
T1 Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades through muscularis propria or subserosa
T4 Tumor directly invades other organs or structures

Question 5

What are the AJCCv6 Staging definitions for a Regional LN tumor?

Answer 5

N0 No regional lymph node metastases
N1 Metastases in 1–3 regional lymph nodes
N2 Metastases in 4 or more regional lymph nodes

Question 6

What are the AJCCv6 Staging definitions for a Distant metastases?

Answer 6

M0 No distant metastases

M1 Distant metastases

Question 7

What are the clinical, pathological parameters for treating stage II colon cancer in MOSAIC?

Answer 7

T4 tumors
Obstruction/perforation
Lymphatic or vascular invasion
Undifferentiated histology
Less than 10 (12) LN retrieved

Question 8

How do you decide what pts w/ stage II colon cancer should receive adjuvant chemotherapy?

Answer 8

k

Question 9

What is the recommended follow-up for a pt w/ stage II CRC?

Answer 9

Physical exam every 3 months for 2 years, then every 6 months for 3 years.

CEA every 3 months for 2 years, then every 6 months for 3 years for T2, T3, T4 tumors.

Colonoscopy in 1 year
Repeat in 1 year if abnormal polyps noted
Repeat every 3-5 years if negative
Repeat in 3-6 months after diagnosis if 1st colonoscopy with “unprepped” bowel.

Question 10

What is the standard of care for metastatic CRC?

Answer 10

FOLFOX or FOLFIRI with bevacizumab

Clinical trial option (folfox +/- cetuximab)

Question 11

What are second line options for metastatic CRC?

Answer 11

Cetuximab
Panitumumab

*must be k-ras wild type to use either drug

Question 12

What is regorafenib?

Answer 12

Drug used for metastatic colon cancer

Recent FDA-approved multi-kinase inhibitor

Inhibits both VEGFR2 and TIE2

Question 13

What is used to prevent adenomas in FAP pts?

Answer 13

COX-2 inhibitors

Question 14

What is used to prevent adenomas in pts w/ prior colon cancer or family history of colon cancer?

Answer 14

aspirin

Question 15

Tx for stage I?

Answer 15

surgery only

Question 16

Tx for stage IIA/IIB?

Answer 16

consider chemo, especially for IIB

chemo may be beneficial

Question 17

Chemo is standard of care for what stages of CRC?

Answer 17

Stage III and IV (metastatic disease)