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Flashcards in 20 Colorectal Cancer Chan Deck (59)
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1

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

2

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

3

Where is most colon cancer found?

Ascending, Sigmoid, Rectum

4

What is FDA approved to decrease number of polyps in patients with FAP?

COX-2 (Celecoxib)

5

What is the preferred screening to be done at age 50?

Annual FOBT (Fecal Occult Blood Test) and FSIG (Flexible Sigmoidoscopy) every 5 years

6

When is surgery curative for colon cancer?

Stage I, II

7

When is surgery curative for rectal cancer?

Stage I

8

What is the mainstay therapy for Stages I to III Colorectal Cancer?

Surgery

9

When is radiation therapy used?

Palliative for unresectable Colon Cancer, pain control. Adjuvant therapy for Stages II, III Rectal Cancer

10

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

11

Which Dukes staging falls under Stage I?

A, B1

12

Which Dukes staging falls under Stage II?

B2

13

Which Dukes staging falls under Stage III?

C1, C2

14

What is Duke's Stage A?

Indicated penetration into but not through the bowel wall

15

What is Duke's Stage B?

Indicates penetration through the bowel wall

16

What is Duke's Stage C?

Indicates lymph node involvement

17

What is Duke's Stage D?

Distant metastases

18

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

19

What does NCCN recommend for Resected Stage III?

FOLFOX (repeat every 2 weeks) for 6 months. No indication for targeted therapy

20

What is in FOLFOX treatment?

Oxaliplatin. Leucovorin. 5FU. Infusional 5FU

21

What are the general characteristics of Oxaliplatin for Colorectal Cancer?

Increased therapeutic activity and reduced toxicity compared to Cisplatin. Synergistic with 5FU + Leucovorin

22

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)

23

What is the appropriate antiemetic regimen to use for mFOLFOX?

5HT3 and Steroid. Imend is only for high emetogenic regimens

24

What are the holding parameters for most cancer treatment?

ANC < 1000 or 1500; Plt < 100k; Hgb < 8.5

25

What is Oxaliplatin compatible in?

Dextrose only

26

How is Oxaliplatin administered?

Give at same time with IV short infusion as Leucovorin (FOLFOX). Y-site infusion by RNs

27

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

28

What is stomatitis management caused by 5FU?

Treat with oral mouthwashes. Good oral hygiene. Avoid alcohol containing mouthwashes

29

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

30

What are the most common metastatic sites?

Liver, Lung, Bone, Brain