Colon Cancer

Question 1

What are the 6 risk factors for colon cancer?

Answer 1

1. Age
2. African American race
3. Genetic predisposition
4. Other GI conditions
5. Diet
6. Physical inactivity

Question 2

What is the best type of prevention for colon cancer?

Answer 2

Lifestyle modifications

Question 3

What are the 3 lifestyle modifications that can be used in colon cancer?

Answer 3

1. Diet
2. Physical activity
3. Limit alcohol consumption

Question 4

What drug is FDA approved to decrease the number of polyps in patients with familial adenomatosis polyposis?

Answer 4

Celecoxib

Question 5

What patient population is aspirin reserved in?

Answer 5

Cardiovascular disease prevention

Question 6

What are 4 screening tests used for colon cancer?

Answer 6

1. Endoscopy (colonoscopy)
2. Stool DNA test
3. Fecal occupant blood test
4. Digital rectal exam

Question 7

What age should patients with average risk get screened?

Answer 7

After age 45

Question 8

When should a patient get a colonoscopy if they are average risk?

Answer 8

Every 10 years

Question 9

When should a patient get a flexible sigmoidoscopy if they are average risk?

Answer 9

Every 5 years

Question 10

When should a patient get a stool DNA test if they are average risk?

Answer 10

Every 1-3 years

Question 11

What are 5 signs and symptoms of colon cancer?

Answer 11

1. Change in bowel habits
2. Diarrhea or constipation
3. Blood in the stool
4. Anorexia
5. Abdominal pain/ fullness
6. Weight loss

Question 12

What are the 3 main sites of metastases?

Answer 12

1. Brain
2. Liver
3. Lungs

Question 13

For diagnosis what is required?

Answer 13

A biopsy

Question 14

After colon cancer is confirmed, what do patients have to do?

Answer 14

Go through staging scans to determine if disease is already metastatic

Question 15

For stage I treatment, surgery is followed by what?

Answer 15

Surveillance

Question 16

True or false: adjuvant therapy can be given to stage I colon cancer patients

Answer 16

False

Question 17

When can adjuvant chemotherapy be used in stage II?

Answer 17

If patient has poor prognostic factors

Question 18

What are 2 poor prognostic factors that can be used to determine therapy?

Answer 18

1. Larger tumor
2. Lymphovascular invasion

Question 19

Chemotherapy for colon cancer is _____ based

Answer 19

5-FU

Question 20

How long is a patient on adjuvant therapy for in stage III?

Answer 20

6 months

Question 21

What is the 1st line chemotherapy regimen for stage III colon cancer?

Answer 21

FOLFOX

Question 22

What is the oral equivalent to FOLFOX?

Answer 22

CapeOx

Question 23

What does 5-FU inhibit?

Answer 23

Thymidylate synthase

Question 24

What drug helps to increase 5-FU activity?

Answer 24

Leucovorin

Question 25

What are the 5 toxicities that can be caused by 5-FU?

Answer 25

1. Myelosuppression 2. Hand-foot syndrome 3. Diarrhea 4. Mucositis 5. N/V

Question 26

How is 5-FU administered?

Answer 26

IV

Question 27

What drug is the prodrug of 5-FU?

Answer 27

Capecitabine

Question 28

How is capecitabine administered?

Answer 28

PO

Question 29

What is the MOA of oxaliplatin?

Answer 29

Cross linking of DNA to cause double-stranded breaks

Question 30

What is the main toxicity of oxaliplatin?

Answer 30

Neuropathy

Question 31

What is neuropathy exacerbated by?

Answer 31

Cold temperatures

Question 32

What is the goal of therapy for stage IV colon cancer?

Answer 32

Palliative care

Question 33

When can surgery be considered for stage IV colon cancer?

Answer 33

If there is bowel obstruction

Question 34

What is the best treatment option for stage IV colon cancer?

Answer 34

Chemotherapy

Question 35

What does FOLFIRI consist of? 3

Answer 35

1. 5-FU 2. Leucovorin 3. Irinotecan

Question 36

What does irinotecan inhibit?

Answer 36

Topoisomerase I

Question 37

What is the main toxicity for irinotecan?

Answer 37

Diarrhea

Question 38

What should you base the choosing of a regimen on for stage IV colon cancer?

Answer 38

Expected tolerability

Question 39

What are the 3 drugs that are in the FOLFOX regimen?

Answer 39

1. 5-FU 2. Leucovorin 3. Oxaliplatin

Question 40

What two monoclonal antibody inhibitors can be used in stage IV?

Answer 40

1. VEGF inhibitors 2. EGFR inhibitors

Question 41

What does VEGF promote?

Answer 41

Angiogenesis

Question 42

What 3 things does blocking VEGF cause?

Answer 42

1. Inhibition of tumor angiogenesis 2. Normalization of tumor vasculature 3. Facilitation of chemotherapy delivery to tumor site

Question 43

Bevacizumab

Answer 43

AVASTIN

Question 44

What are 5 ADEs of avastin?

Answer 44

1. Hypertension 2. Proteinuria 3. Would healing complications 4. Thromboembolic events 5. GI perforation

Question 45

What is avastin only indicated for?

Answer 45

Metastatic colon cancer

Question 46

What can bevacizumab be used in combination with?

Answer 46

5-FU based chemotherapy

Question 47

What type of KRAS gene would have a good response to anti-EGFR therapies?

Answer 47

KRAS wild type

Question 48

What does using an EGFR inhibitor cause? 3

Answer 48

1. Inhibits cell growth 2. Promotes apoptosis 3. Decreases production of growth factors

Question 49

Cetuximab

Answer 49

ERBITUX

Question 50

What are 4 ADEs of cetuximab?

Answer 50

1. Infusion related reactions 2. Acne form rash 3. Hypomagnesemia 4. Diarrhea

Question 51

Panitumumab

Answer 51

VECTIBIX

Question 52

_______ has no role in colon cancer

Answer 52

Radiation

Question 53

What is the treatment for stage I?

Answer 53

Surgery alone

Question 54

What is the preferred regimen for stage III?

Answer 54

FOLFOX

Question 55

What are the 2 EGFR inhibitors?

Answer 55

1. Cetuximab 2. Panitumumab

Question 56

Switching for what inhibitors are not recommended?

Answer 56

EGFR