Flashcards in 20 Colorectal Cancer Chan Deck (59)
What is FAP?
Familial Adenomatous Polyposis (FAP). A genetic predisposition. Presence of APC gene mutation, increase polyps, 100% risk for colon cancer by ages 40-50, recommended total colectomy
What is HNPCC?
Hereditary Non-Polyposis Colon Cancer (HNPCC). Presence of mutation in hMLH1 or hMLH2 mismatch repair genes. 70% risk for colon cancer by age 70
Where is most colon cancer found?
Ascending, Sigmoid, Rectum
What is FDA approved to decrease number of polyps in patients with FAP?
What is the preferred screening to be done at age 50?
Annual FOBT (Fecal Occult Blood Test) and FSIG (Flexible Sigmoidoscopy) every 5 years
When is surgery curative for colon cancer?
Stage I, II
When is surgery curative for rectal cancer?
What is the mainstay therapy for Stages I to III Colorectal Cancer?
When is radiation therapy used?
Palliative for unresectable Colon Cancer, pain control. Adjuvant therapy for Stages II, III Rectal Cancer
When is Chemotherapy used?
Standard adjuvant for Stage III Colon Cancer and Stage IV Metastatic Colon Cancer. 5-FU alone based regimens for Stages II, III Rectal Cancer
Which Dukes staging falls under Stage I?
Which Dukes staging falls under Stage II?
Which Dukes staging falls under Stage III?
What is Duke's Stage A?
Indicated penetration into but not through the bowel wall
What is Duke's Stage B?
Indicates penetration through the bowel wall
What is Duke's Stage C?
Indicates lymph node involvement
What is Duke's Stage D?
What does NCCN recommend for Resected Adjuvant Stage II?
5FU/Leucovorin. FOLFOX reasonable for intermediate or high risk Stage II, not for good or average risk
What does NCCN recommend for Resected Stage III?
FOLFOX (repeat every 2 weeks) for 6 months. No indication for targeted therapy
What is in FOLFOX treatment?
Oxaliplatin. Leucovorin. 5FU. Infusional 5FU
What are the general characteristics of Oxaliplatin for Colorectal Cancer?
Increased therapeutic activity and reduced toxicity compared to Cisplatin. Synergistic with 5FU + Leucovorin
What are the side effects of Oxaliplatin?
Acute and chronic neurotoxicity (Acute: peripheral SENSORY neuropathy exacerbated by cold. Chronic: loss of balance, difficulty walking, trouble picking up objects, pain). Nausea and vomiting (Platinum analog; moderate emetogenic risk). Myelosuppression (thrombocytopenia and anemia more common than neutropenia). Nephrotoxicity (less than other 2 platinum)
What is the appropriate antiemetic regimen to use for mFOLFOX?
5HT3 and Steroid. Imend is only for high emetogenic regimens
What are the holding parameters for most cancer treatment?
ANC < 1000 or 1500; Plt < 100k; Hgb < 8.5
What is Oxaliplatin compatible in?
How is Oxaliplatin administered?
Give at same time with IV short infusion as Leucovorin (FOLFOX). Y-site infusion by RNs
What is the difference between the routes of administration for 5FU?
With bolus dosing TS inhibition half life ~10 minutes. Predominant effect of 5FU continuous infusion is binding to TS by FdUMP (i.e. Hand-foot syndrome). Predominant effect of 5FU bolus is incorporation into RNA by FUTP (i.e. Myelosuppression). Infusional 5FU + LV is most efficacious
What is stomatitis management caused by 5FU?
Treat with oral mouthwashes. Good oral hygiene. Avoid alcohol containing mouthwashes
How is hand-food syndrome managed, caused by 5FU?
Avoid wearing tight-fitting shoes and prevent rubbing. Apply emollient cream or ointment. Vitamin B6 may reduce incidence. Grade 4: may require dose interruption, dose reduction, and supportive care measures