Oncology HI Flashcards by Jessica Crisolo

What are the histopathologies of lower GI cancers

adenocarcinoma
Rare: lymphoma, melanoma

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How does colorectal cancer present itself

change in bowel habit , bleeding
pain, weight loss (for more advanced disease)
obstruction

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How does anal cancer present itself

Pruritus, bleeding

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How does anal cancer present itself

Pruritus, nodule, bleeding

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How is colorectal cancer staged (TNM)

T: extent / invasion
N: number of lymphnodes
M: presence or absence of distant Mets and number
A: 1 organ or site
B: 2 or more organs/sites
C: Mets to peritoneal surface and/or other organs

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What is the treatment for early rectal cancer (stage 1)

surgery (TME , local resection)

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What is the treatment regime for rectal cancer for stage II/III (locally advanced) (short course)

short course
- Neoadjuvant radiation
- surgery
- adjuvant chemo

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What is the dosage for stage II/III (locally advanced) rectal cancer (short course)

25 Gy / 5

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What is the treatment regime for rectal cancer for stage II/III (locally advanced) (long course)

induction cx + neoCRT/RT (TNT)
Neoadjuvant CRT + consolidation Cx (TNT)
adjuvant chemo (FOLFOX)

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What is the dosage for stage II/III (locally advanced) rectal cancer (long course)

50gy in 25 or 45 in 25 (if small bowels dose contraints are not met)

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What is the treatment regime for rectal cancer for stage IV

Systemic +/- local therapy

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What is the primary treatment for colon cancer

Surgery

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What is the role of RT in colon cancer

For metastatic disease

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What is the treatment regime for colon cancer for stage I

Surgery only

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What is the treatment regime for colon cancer for stage II

surgery
adjuvant chemo for high risk

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What is considered high risk for colon cancer

High grade, positive margins, microscopic disease remaining, extra nodal deposits

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What is considered high risk for colon cancer

High grade, positive margins, microscopic disease remaining, extra nodal deposits

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What is the treatment regime for colon cancer for stage III

Primary: surgery
Adjuvant: chemo
CX
- FOLFOX (oxaplatin, 5FU, leucovorin) OR oxaplatin + capecitabine

What is the treatment regime for colon cancer for stage IV

Primary: surgery
Adjuvant: radiation as needed

How is anal cancer staged?

T: size and invasion / extent
N: location of LNs
M: presence or absence of distant Mets

What is the treatment regime for ANAL for stage I-III

definitive CRT
chemo as a radiosensitizier
Primary: radiation

Describe the chemo options for anal cancer

Preferred: 5FU + mitomycin (5FU + cisplatin if mitomycin is contraindicated) - given in week 1 and 5 of XRT trt

Or oral capecitabine/xeloda during XRT - 5 days a week

What are risk factors of lower GI cancer

Diet
Lifestyle
Smoking
IBS
Family history

Name the genetic factors that are linked to causing CRC. What are each of their percentages of causing CRC

FAP - APC gene, AD
- 100%
HNPCC - AD, MRR (lynch syndrome)
- 80% (right sided)
Gardeners, turcots, cowdens, Li fraumeni
Chromosomal instability pathways (15%)

Name the genetic factors that are linked to causing CRC. What are each of their percentages of causing CRC

FAP - APC gene, AD - 100% HNPCC - AD, MRR (lynch syndrome) - 80% (right sided) Gardeners, turcots, cowdens, Li fraumeni Chromosomal instability pathways (15%)

What is the average lifetime risk of CRC

What is the lifetime risk of having CRC with HNPCC in genders

54-75% men 30-52% women

What is the lifetime risk of having CRC with familial polyposis

100% lifetime risk

How should you get screened for CRC with average risk

- once every 2 years with the fecal immunochemical test (FIT) - or flexible sigmoidoscopy every 10 years

How should you get screened for CRC with increased risk

- colonoscopy at age 50 or 10 years earlier than the age of relative diagnosis whichever is earlier

What are the symptoms of CRC

- changes in bowel habit - bleeding - weight loss - pain - obstruction

What are the advance diseases of CRC

- lymphadenopathy - hepatomegaly - cachexia

What are the staging tools used for CRC

Labs - CBC - CEA (carcinoma embryonic antigen) MRI CT chest/abdo/pelvis Endoscopic ultrasound

What are forms of imaging we can use for diagnosis, screening, and staging

- CT Colonography - barium enema - endoscopic ultrasound - MRI rectum - CT chest abdomen pelvis - ultrasound - liver - MRI liver - CT PET

What are types of surgery involving the mesorectum

Lower anterior resection (LAR) Abdominal perineal resection (APR) Hartmann’s procedure Total mesorectal excision (TME)

What are expected side effects for early radiotherapy

- skin - proctitis - cystitis - diarrhea - fatigue

What are expected side effects of chemotherapy

- diarrhea - nausea/vomiting - hand food syndrome - oral mucositis - reduction in blood count

What are expected side effect of late radiotherapy (lower GI)

- bowel obstruction - change in bowel function - sexual function - ovarian failure

what is TNT

total neoadjuvant therapy (chemo and radiation prior to surgery)

What percentage of people with anal cancer have the HPV virus

90%

What percentage of GI cancers are anal?

2.5%

What percentage of people diagnosed with anal cancer are in stage I-II

> 50%

Dosages for anal cancer

27 in 15 + 18 in 10 (45 in 25) 27 in 15 + 27 in 15 (54 in 30) 36 in 20 + 27 in 15 (63 in 35)