Therapeutics of Colorectal Cancer (Weddle) Flashcards

1
Q

Patients of what disease state(s) are at 5-10x higher risk of developing colorectal cancer?

A

UC and Crohn’s

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2
Q

People with which syndrome have nearly a 100% lifetime risk of developing colon cancer?

A

familial adenomatous polyposis (FAP)

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3
Q

What tests can be used for the primary detection of colorectal cancer?

A

FOBT and FIT

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4
Q

What tests can be used for the detection of colorectal cancer and advanced lesions (NOT primary detection)?

A

endoscopic and radiologic exams

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5
Q

What’s the definite drawback of using FOBT to detect colorectal cancer?

A

high false negative rate

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6
Q

How can you avoid a false negative with FOBT?

A
  • < 250 mg in vitamin C supplements, citrus juices and fruits for 3 days prior
  • avoid aspirin/NSAIDs for up to 7 days prior
  • delay test until 3 days after end of period
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7
Q

How can you avoid a false positive FOBT?

A
  • avoid red meat/vegetables with peroxidase for 3 days prior
  • avoid enemas, rectal medications, and digital rectal exams for 3 days prior
  • avoid testing if blood from hemorrhoids is present
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8
Q

The fecal immunochemical test (FIT) detects __________.

A

hemoglobin

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9
Q

Which primary detection test would be preferred for colorectal cancer screening: FOBT or FIT?

A

FIT

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10
Q

What is the difference between a flexible sigmoidoscopy and a colonoscopy?

A

flexible sigmoidoscopy only examines the lower 60% of the bowel, colonoscopy examines the entire bowel

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11
Q

Which organization recommends screening for colorectal cancer starting at age 45?

A

American Cancer Society

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12
Q

What screening practices are recommended if you have HPNCC?

A

colonoscopy at 20-25 or 10 years younger than the youngest age at first familial diagnosis (whichever comes first)

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13
Q

What diet considerations can be made to prevent colorectal cancer?

A
  • high fiber
  • low fat
  • high calcium
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14
Q

What medications have been shown to help with colorectal cancer prevention?

A
  • COX inhibitors
  • NSAIDs/aspirin
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15
Q

>95% of colorectal cancers are ______________.

A

adenocarcinomas

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16
Q

What are the eight warning signs of colon cancer?

A
  1. constipation
  2. diarrhea
  3. blood in stools
  4. narrow stools
  5. unexplained anemia
  6. tender abdomen/abdominal pain
  7. unexplained weight loss
  8. weakness/fatigue
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17
Q

Where may a colorectal tumor be located if they find occult blood in the stool?

A

transverse colon

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18
Q

Where may a colorectal tumor be located if a patient is complaining of dull abdominal pain?

A

ascending colon

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19
Q

Where may a colorectal tumor be located if a patient states they have noticed increased cramps and flatulence?

A

descending colon

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20
Q

Where may a colorectal tumor be located if a patient is producing low-caliber stools?

A

descending colon

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21
Q

Where may a colorectal tumor be located if a patient is experiencing weight loss?

A

ascending colon

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22
Q

Where may a colorectal tumor be located if the patient complains of tenesmus (feeling of rectal fullness)?

A

sigmoid colon/rectum

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23
Q

How is colorectal cancer staged?

A

TNM

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24
Q

In most cancers’ staging, the “T” in TNM is for tumor size. What does the “T” stand for in colorectal cancer?

A

the level of invasion into the colon

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25
dMMR or MSI-H tumors predict a ________ benefit from adjuvant 5-FU for stage ___ disease.
decreased; II
26
Stage ____ patients with dMMR or MSI-H ________ from adjuvant 5-FU.
III; benefit
27
Is stage IV colorectal cancer curable?
no
28
What is the definitive therapy for stage I and II colorectal cancer?
surgery
29
Should you consider initiating chemotherapy in stage II colon cancer?
current guidelines recommend against it…*might* be acceptable in \*high-risk\* stage II patients
30
True or false: MSI-H colon cancer patients will not benefit from chemotherapy.
true
31
What characteristics would make a colorectal cancer patient high-risk?
* poorly-differentiated tumors * lymphatic/vascular invasion * bowel obstruction * \<12 lymph nodes removed * perineural invasion * localized perforation * close/indeterminate/positive margins
32
What are the two chemotherapy options for high-risk stage II colon cancer?
FOLFOX and CapeOx
33
What is the general treatment guidance for stage III colon cancer?
surgery (+ regional lymph removal) and chemotherapy
34
What chemotherapy regimen would you recommend for stage III low-risk colon cancer?
3 months CapeOx or 3-6 months FOLFOX
35
What chemotherapy regimen would you recommend for stage III high-risk colon cancer?
6 months FOLFOX or 3-6 months CapeOx
36
What drugs make up FOLFOX?
leucovorin + 5-FU + oxaliplatin
37
What drugs make up CapeOx?
capecitabine + oxaliplatin
38
What did the MOSAIC Trial assess?
FOLFOX vs 5-FU/leucovorin
39
What was the purpose of the IDEA Trial?
to evaluate if 3 months of oxaliplatin was non-interior to 6 months
40
What did the IDEA Trial conclude?
3 months CapeOx = 6 months CapeOx 6 months FOLFOX \> 3 months FOLFOX
41
Which regimen requires a port: FOLFOX or CapeOx?
FOLFOX
42
Which regimen has fewer overall infusions: FOLFOX or CapeOx?
CapeOx
43
Which regimen has increased incidence of hand foot syndrome: FOLFOX or CapeOx?
CapeOx
44
Which regimen has more myelosuppression and mouth sores: FOLFOX or CapeOx?
FOLFOX
45
Which regimen is more prone to drug-drug interactions: FOLFOX or CapeOx?
CapeOx (capecitabine)
46
What is the mainstay therapy of metastatic colon cancer?
chemotherapy
47
What is the benefit of radiation therapy in metastatic colon cancer?
only for palliation of symptoms
48
What is hepatic artery infusion (HAI)?
targeted chemotherapy to the liver
49
What are the 1st line chemotherapy regimens for metastatic colon cancer with no targetable mutations?
FOLFOX/CapeOx/FOLFIRI +/- bevacizumab
50
What would be an acceptable chemotherapy regimen for a metastatic colon cancer patient with no targetable mutations, who is NOT tolerative to intensive chemotherapy?
5-FU + leucovorin OR capecitabine +/- bevacizumab
51
What is the general dogma about 2nd line/salvage therapy for colon cancer?
If you've progressed on FOLFOX first, try FOLFIRI next (and vice versa)
52
What treatment options are available for colon cancer patients with known BRAF V600E mutation?
encorafenib + cetuximab OR panitumumab
53
What treatment options are available for colon cancer patients with known HER2 amplification?
trastuzumab + pertuzumab OR lapatinib OR fam-trastuzumab
54
FdUMP binds ___________ and reduces rate of DNA synthesis, replication, and repair.
thymidylate synthase (TS)
55
5-FU is extensively metabolized where?
in the liver
56
What is a common 5-FU toxicity?
diarrhea
57
What agent is a pro-drug of SN-38?
irinotecan
58
What are the two dose-limiting toxicities of irinotecan?
diarrhea and neutropenia
59
What agent could be used to help with early-onset diarrhea caused by irinotecan?
atropine
60
\_\_\_\_\_\_\_\_\_ deficiency prevents SN-38 conversion of irinotecan and leads to increased toxicity.
UGT1A1
61
Describe some of the unique toxicities associated with oxaliplatin.
* neuropathy * cold intolerance * sensation of breathlessness
62
What agent is the oral pro-drug of 5-FU?
capecitabine
63
What are the two dose-limiting toxicities of capecitabine?
hand foot syndrome and diarrhea
64
What adverse events are associated with cetuximab?
* acneiform rash * asthenia/malaise * fever * nausea * hypomagnesemia
65
What can be used to help prevent infusion reactions with cetuximab?
premedicating with an H1 antagonist
66
Bevacizumab is a _____ inhibitor.
VEGF
67
Why should you wait a period of time before surgery if taking bevacizumab?
the drug has a long half-life and can lead to decreased wound healing (significant toxicities of bleeding, GI perforations, decreased wound healing)
68
True or false: regorafenib is pretty well-tolerated.
false; lots of toxicities (HTN, mucositis, fatigue, hand foot, hemorrhage, rash, metabolic disorders, diarrhea, myelosuppression, increased LFTs, proteinuria)