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Cancer CE & VP > VP L2 Colorectal cancer > Flashcards

VP L2 Colorectal cancer Flashcards

1
Q

Colorectal caner is the …. most common cancer in the UK

A

3rd

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2
Q

Colorectal cancer affects more men/woman?

What age?

A

Men

Over 60

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3
Q

Risk factors (3)

A

Famillial
dietary/lifestyle
other colorectal conditions

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4
Q

2 Familial risk factors

A

FAP (familial adenomatous polyposis)

and

HNPCC (hereditary non-polyposis colorectal cancer)

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5
Q

Dietary/lifestyle risks (6)

A 
high intake of meat/animal fat
Low fiber intake
Regular consumption of aspirin/NSAIDS (REDUCES RISK)
Inactive lifestyle
Obesity
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6
Q

3 other colorectal conditions that predispose to CC

A

Ulcerative colitis
Previsous colorectual cancer
Crohn’s disease

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7
Q

Pathology of CC

A

polyp to benign adenoma to malignant tumour

vast majority are adenocarcenomas that arise from pre-existing polyps that develop in normal mucosa

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8
Q

How long does it take a polyp to become cancer

A

10 years

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9
Q

symptoms (6)

A 
change in bowel habit
abdo pain
rectal bleeding/mucus
weight loss
anorexia

Anaemia (chronic bleeding from tumour site)

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10
Q

20% of resenting complaints are

A

acute large bowel obstruction (surgical emergency)

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11
Q

Differential diagnosis

A

IBS

and

Inflammatory bowel disease

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12
Q

4 diagnostic investigations

A

colonoscopy
felxible sigmoidoscopy
Ba enema
CT preop to check for metastases

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13
Q

How do we stage CC

A

Duke’s system traditionally

or

TNM more recent

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14
Q

How do we stage CC

A

Duke’s system traditionally

or

TNM more recent

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15
Q

what is first line treat for 80% of patients

A

Surgery

Segment of the large bowel resected

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16
Q

What percentage of patients suffer recurring disease

A

50%

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17
Q

When is radiotherapy indicated

A

rectal cancers only

and

post op to reduce incidence

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18
Q

aim of adjuvant chemo

A

post surgery to eradicate micrometastases

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19
Q

for what dukes score is chemo recommended

A

dukes C

NOT

A

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20
Q

What is the mainstay of chemo treatment for CC

A

5FU

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21
Q

How does 5FU work

A

converted intracellularly to metabolites that bind thymidylate synthase
thus
inhibiting synthesis of thymidine, DNA and RNA

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22
Q

What is given to increase the efficacy of 5FU

How does it work

A

folinic acid

prolongs inhibition of thymidylate synthase

23
Q

side/effects of 5FU (6)

A 
diarrhoea
stomatisis
nausea and vom
bone marrow supression
hand and foot syndrome
excessive tear shedding
24
Q

What adjuvant is given for DUKES C

A

oxaliplatin
5FU
folinic acid

25
Q

How does oxaliplatin work

A

Cross links DNA, prevents replication and cell devision

26
Q

Oxaliplatin s/e (4)

A

peripheral neruopathy
acute pharyngolaryngeal dysasthesia
bone marrow suppression
mild alopecia

27
Q

What is a hickman line

A

central venous catheter coming out of your chest

28
Q

Why Oxaliplatin de Gramont regime?

A

Infusion is important as tumour cells have low growth fraction

Also 5FU has t1/2=10mins and is s phase specific

29
Q

What is the problem with de gramont regime?

A

increased incidence of hand and foot syndrome from 5FU

30
Q

3 Issues with infusional devices

A

anxiety for patients
disposal of cytotoxic waste in patients homes
time consuming to fill for pharma

31
Q

What is capecitabine

A

oral chemotherapy

32
Q

how is capecitabine used

A

in combo with oxaliplatin in XELOX regime (instead of the de gramont component)

33
Q

Advantages of oral capecitabine therapy

A

less invasive
no issues with sterility/short exp
reduces pharmacy cost and time
pt can administer medicines themselves

34
Q

What is Capecitabine?

A

the prodrug of 5FU - three step acivation process, two steps occur preferentially in tumours

35
Q

What is the capecitabine regieme

A

bd 14 days out or 21

36
Q

de gramont regieme details

A

Chemo given every 2 weeks for 12 cycles as outpatient

Oxaliplatin 85mg/m2 over 2hrs IV infusion
Calcium folinate 350mg over 2hrs IV infusion
Fluorouracil 400mg/m2 IV stat
Fluorouracil 2400mg/m2 IV infusion over 46hrs in portable infusion device

Need Hickman (central) line or PICC line

37
Q

de gramont regieme details

A

Chemo given every 2 weeks for 12 cycles as outpatient

Oxaliplatin 85mg/m2 over 2hrs IV infusion
Calcium folinate 350mg over 2hrs IV infusion
Fluorouracil 400mg/m2 IV stat
Fluorouracil 2400mg/m2 IV infusion over 46hrs in portable infusion device

Need Hickman (central) line or PICC line

38
Q

How to treat metastatic disease

A

Surgery to relieve obstruction/symptoms

resection of liver metastases

5FU based regimes

plus other drugs (e.g. irinotecan)

39
Q

What is irinotecan?

A

topoisomerase I inihibtor (enzyme invilved in unwinding of DNA during DNA repair)

40
Q

Treatment summery: Duke’s A

A

Duke’s A: surgery only

41
Q

Treatment summery: Duke’s B

A

Duke’s B: surgery + adjuvant chemotherapy in some cases (patients with risk factors such as vascular invasion of tumour, poorly differentiated tumour)

42
Q

Treatment summery: Duke’s C

A

Duke’s C: surgery + adjuvant chemotherapy

43
Q

Treatment summery: Duke’s C

A

Duke’s D (metastatic): surgery to relieve obstruction if needed, palliative chemotherapy +/- monoclonal antibodies to relieve symptoms & prolong survival

44
Q

e.g. of a new mab therapy

A

Bevacizumab (avastin)

45
Q

How does avastin work

A

VEGF inbitor - inhibits VEGF binding to receptor on tumour cell surface

VEGF usually stimulates angiogenisis

46
Q

What is avastin licensed for?

A

Combination therapy with 5FU therapies

47
Q

How is avastin given

A

IV infusion every 2/3 weeks

48
Q

s/e avastin

A

GI perforation
haemorrhage
hypertension
arterial thromboembolism

49
Q

What is cetuximab (erbitux)

A

mab that blocks EGFR

50
Q

Cetuximab is licenced for

A

treatments of patients with EGFR expressing KRAS wild type

  • in combo with chemo
    or
    -as a single agent in pt who have fails oxaliplatin and irinotecan based therapies
51
Q

Cetuximab is now first line for

A

metastatic CC

in combo with oxaliplatin de gramont

52
Q

Cetuximab is now first line for

A

metastatic CC

in combo with oxaliplatin de gramont

53
Q

cetuximab s/e

A

rash
itching
infusion reactios (fever, chills, nausea, vomitting)

54
Q

cetuximab s/e

A

rash
itching
infusion reactions (fever, chills, nausea, vomitting)

Cancer CE & VP (15 decks)

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