Oncology HI

Question 1

What are the histopathologies of lower GI cancers

Answer 1

• adenocarcinoma
  Rare: lymphoma, melanoma

Question 2

How does colorectal cancer present itself

Answer 2

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

Question 3

How does anal cancer present itself

Answer 3

Pruritus, bleeding

Question 4

How does anal cancer present itself

Answer 4

Pruritus, nodule, bleeding

Question 5

How is colorectal cancer staged (TNM)

Answer 5

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

Question 6

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

Answer 6

• surgery (TME , local resection)

Question 7

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

Answer 7

short course
- Neoadjuvant radiation
- surgery
- adjuvant chemo

Question 8

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

Answer 8

25 Gy / 5

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

What is the treatment regime for rectal cancer for stage IV

Answer 11

Systemic +/- local therapy

Question 12

What is the primary treatment for colon cancer

Answer 12

Surgery

Question 13

What is the role of RT in colon cancer

Answer 13

For metastatic disease

Question 14

What is the treatment regime for colon cancer for stage I

Answer 14

Surgery only

Question 15

What is the treatment regime for colon cancer for stage II

Answer 15

• surgery
• adjuvant chemo for high risk

Question 16

What is considered high risk for colon cancer

Answer 16

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

Question 17

What is considered high risk for colon cancer

Answer 17

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

Question 18

What is the treatment regime for colon cancer for stage III

Answer 18

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

Question 19

What is the treatment regime for colon cancer for stage IV

Answer 19

Primary: surgery
Adjuvant: radiation as needed

Question 20

How is anal cancer staged?

Answer 20

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

Question 21

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

Answer 21

• definitive CRT
• chemo as a radiosensitizier
  Primary: radiation

Question 22

Describe the chemo options for anal cancer

Answer 22

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

Question 23

What are risk factors of lower GI cancer

Answer 23

Diet
Lifestyle
Smoking
IBS
Family history

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

What is the average lifetime risk of CRC

Answer 26

5%

Question 27

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

Answer 27

54-75% men 30-52% women

Question 28

What is the lifetime risk of having CRC with familial polyposis

Answer 28

100% lifetime risk

Question 29

How should you get screened for CRC with average risk

Answer 29

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

Question 30

How should you get screened for CRC with increased risk

Answer 30

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

Question 31

What are the symptoms of CRC

Answer 31

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

Question 32

What are the advance diseases of CRC

Answer 32

- lymphadenopathy - hepatomegaly - cachexia

Question 33

What are the staging tools used for CRC

Answer 33

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

Question 34

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

Answer 34

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

Question 35

What are types of surgery involving the mesorectum

Answer 35

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

Question 36

What are expected side effects for early radiotherapy

Answer 36

- skin - proctitis - cystitis - diarrhea - fatigue

Question 37

What are expected side effects of chemotherapy

Answer 37

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

Question 38

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

Answer 38

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

Question 39

what is TNT

Answer 39

total neoadjuvant therapy (chemo and radiation prior to surgery)

Question 40

What percentage of people with anal cancer have the HPV virus

Answer 40

90%

Question 41

What percentage of GI cancers are anal?

Answer 41

2.5%

Question 42

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

Answer 42

> 50%

Question 43

Dosages for anal cancer

Answer 43

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)