August 13, 2015 - Colorectal Cancer (Dr. Tam)

Question 1

Neoadjuvant Treatment

Answer 1

Performing radiation or chemotherapy with the goal of reducing local recurrence and shrinking the tumor prior to surgery.

Surgery is then used to cut out the cancer, followed by further adjuvant chemotherapy.

Question 2

Adjuvant Chemotherapy

Answer 2

Chemotherapy administered after a surgical intervention to try to control cancerous cells. It is similar to spraying weeds.

Question 3

Liver Metastasis for Colon Cancer

Answer 3

Liver is commonly metastasised because of the blood flow. Blood supply goes into the portal flow system which deposits cancerous cells in the liver.

Question 4

Lung Metastasis for Rectal Cancer

Answer 4

Goes into the middle rectal vein and the internal pudendal vein which dump into the right iliac vein which go to the heart and the lungs.

Question 5

Stage III Colorectal Cancer

Answer 5

Cancer has spread to the lymph nodes.

At stage III or higher, you should do chemotherapy as an adjuvant.

Question 6

5-Fluorouracil (5-FU)

Answer 6

A chemotherapeutic agent that is often used as adjuvant therapy.

Question 7

FOLFOX

Answer 7

The standard of care for adjuvant treatment of stage III CRC. It imrpoves 5-year survival from 10-20% compared to no further chemotherapy.

Question 8

Follow-Up with CRC

Answer 8

Intensive follow-up has been shown to increase overall survival.

• Clinical assessment q3-6 months
• CEA blood markers q3 months for 3-5 years

- CT chest/abdomen/pelvis or CXR + abdomenon US q12 months (gold standard)

• Colonoscopy within 3-6 months of surgery

Question 9

Metastatic CRC Prognosis

Answer 9

Often a poor prognosis, but selected patients with metastatic disease may be curable if it is isolated to the liver and the lungs. It is not always palliative.

Question 10

Febrile Neutropenia

Answer 10

A potential toxicity of certain chemotherapies. Neutrophils get so low that infection can occur. This needs IV antibiotics.