VP - Colorectal cancer Flashcards
Risk Factors for CR Cancer (10)
1) Age
2) Geographical location (higher in westernised)
3) Diet (higher for red meat, saturated fat, low fibre)
4) Alcohol intake
5) Obesity
6) Sedentary lifestyle
7) Other colorectal conditions (ulcerative colitis, Crohns)
8) Smoking
9) Family history (5% FAP gene)
10) Gender (males more likely
Signs and symptoms
- Change in bowel habit (3 weeks)
- Abdo pain
- Rectal bleeding/mucus
- Weight loss - advanced tumours
- Anorexia - advanced tumours
- Abdominal pain
- Anaemia - due to bleed from tumour site
- Its present with acute large bowel obstruction
N.B diff diagnoses include IBS and IBD
Screening for 60-75yrs - faecal occult blood screening every 2 years (kit in post)
Why is adjuvant chemo used? When is it used? What regimen is often used in CR cancer?
Used after surgery to eradicate micro metastases which have been shed from tumour prior to or during resection.
Oxaliplatin de Garment: Oxaliplatin and 5-FU and Folinic acid is used OR capecitabine
5-FU mechanism of action is…
What is given to improve it’s efficacy?
5-FU side effects include (6)
5-FU converted intracellularly to metabolites that bind to enzyme thymidylate synthase so inhibits the synthesis of thymidine needed to make DNA and RNA
Folic acid is given to improve it’s efficacy (prolong inhibition of TS)
Side effects: Diarrhoea Stomatitis Bone marrow suppression Hand food syndrome Excessive tear shedding
Oxaliplatin mechanism of action is... Side effects (5)
A pt based agent which cross links DNA to prevent replication and cell division
Side effects: 95% pts suffer neurological SEs e.g. periph neuropath Sensitive to cold Swollen tongue (can't swallow) Bone marrow suppression Mild alopecia
Oxaliplatin de Gramont (FOLFOX) regime includes:
How is it administered?
What are the issues regarding administration tech?
5-FU
Oxaliplatin
Folinic acid
Administer 5-FU through continuous infusion using Hickmann line (portable)
Need to keep PICC line flushed, clean to reduce infection risk, need to keep on them, need to dispose of cytotoxic waste
Adjuvant chemotherapy can either be FOLFOX regimen or _____ in combination with oxaliplatin
What are the advantages and disadvantages of this therapy being oral?
Capecitabine
Less invasive and distressing for pt, no issues with sterility/short exp dates, reduces pharmacy cost and time, pts can administer themselves in home. Bad as might not be adhering, might not be taking the right dose
Capecitabine is a prodrug of what? Side effects (4)
5-FU Diarrhoea Hand foot syndrome Nausea and vomiting Stomatitis So similar side effects to 5-FU but hand foot syndrome less common
Dukes _ (metastatic) involves surgery to relieve obstruction if needed, _____ ____ and ______ abs to relieve symptoms and prolong survival
Dukes D
Adjuvant chemotherapy
Monoclonal antibodies
New therapies include Lonsurf - what is this?
It’s used in metastatic colorectal cancer usually after other therapies have failed. Taken until disease progression
Trifluridine and Tipiracil (oral agent)
Trifluridine is a thymidine analogue which is phosphorylated by thymidine kinase and metab in cells to DNA substrate and incorporated into DNA but x functional so prevents cell proliferation.
BUT Trifluridine is rapidly degraded by thymidine phosphorylase enzyme TPase SO given with Tipiracil (TPase inhibitor so prolongs action of trifluridine in body)
What are the side effects of Lonsurf? (7)
Lonsurf = Trifluridine and Tipiracil (TPase)
Nausea and vomiting Diarrhoea/constipation Alopecia Tiredness Sore mouth Bone marrow suppression Hand foot syndrome
Bevacizumab is licensed in combination with flurouracil/capecitabine based chemotherapy in pts with metastatic CR cancer
What is its MOA?
What side effects? (4)
It is an Anti-VEGF. It binds VEGF preventing it’s interaction with the VEGF receptor on tumour cell surface. VEGF usually stimulates new blood vessel formation and is essential for tumour development.
GI perforation
Haemorrhage
HTN
Arterial thromboembolism
