Oncology HI Flashcards
What are the histopathologies of lower GI cancers
- adenocarcinoma
Rare: lymphoma, melanoma
How does colorectal cancer present itself
- change in bowel habit , bleeding
- pain, weight loss (for more advanced disease)
- obstruction
How does anal cancer present itself
Pruritus, bleeding
How does anal cancer present itself
Pruritus, nodule, bleeding
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
What is the treatment for early rectal cancer (stage 1)
- surgery (TME , local resection)
What is the treatment regime for rectal cancer for stage II/III (locally advanced) (short course)
short course
- Neoadjuvant radiation
- surgery
- adjuvant chemo
What is the dosage for stage II/III (locally advanced) rectal cancer (short course)
25 Gy / 5
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)
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)
What is the treatment regime for rectal cancer for stage IV
Systemic +/- local therapy
What is the primary treatment for colon cancer
Surgery
What is the role of RT in colon cancer
For metastatic disease
What is the treatment regime for colon cancer for stage I
Surgery only
What is the treatment regime for colon cancer for stage II
- surgery
- adjuvant chemo for high risk
What is considered high risk for colon cancer
High grade, positive margins, microscopic disease remaining, extra nodal deposits
What is considered high risk for colon cancer
High grade, positive margins, microscopic disease remaining, extra nodal deposits
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
5%
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)
