Colon Cancer

Question 1

Risk Factors for Colon Cancer :
1. Modifiable (4)

2. Non-Modifiable (5)

Answer 1

1. Nutrition
   -High red meat consumption can lead to colon cancer
   -Low consumption of fruits and vegs
   -Alcohol consumption

Physical Activity (low levels of physical activity r bad)

Obesity and Cig smoking

2. Age, personal hx of adenomatous polyps , Ulcerative colitis and crohn’s disease
   Family hx of CRC
   Inherited genetic risk (FAP, Lynch syndrome)

Question 2

Prevention :

1. be as ___ as possible within ___
2. be ___ as part of everyday life
3. Eat mostly ___
4. Limit intake of ?
5. Limit ?

Answer 2

1. Lean, normal range of body weight
2. physically active
3. foods of plant origin (especially foods containing dietary fiber)
4. Red meat, avoid processed meat
5. Limit alc drinks

Question 3

Chemoprevention : Aspirin

1. CAn be used for primary prevention for CVD and CRC in which subset of pt’s?
2. What about pt’s who are average risk?

Answer 3

1. Adults age 50-59, 10% or greater 10 yr CVD risk , life expectancy of at least 10 yrs, willing to take low dose aspirin daily for at least 10 yrs
2. NOT RECC

Question 4

TX Options for Stages 1,2,3 :

1. What are the 2 options?

TX options for CRC Stage 4 :

3. What are the 3 options?

Answer 4

1. Surgery (partial colectomy, resection of tumor, removal of 12 lymph nodes)
2. Chemotherapy given post surgery w/goal of elim micrometastatic disease
3. Surgery (removal or primary tumor for sx management of obstruction/bleeding or removal of isolated metastasis)
   -CHemotx sx management/palliation
   -radiation sx management/palliation of pain or bleeding

Question 5

Sequence of TX :

1. Stage 1
2. Stage 2/3
3. Stage 4

Answer 5

1. Surgery –> surveillance
2. Surgery –> adjuvant chemo x 6 months –> surveillance
   -Adjuvant chemo begins 4-8wks after surgery
3. Neoadjuvant chemo –> surg –> adjuvant chemo –> surveillance
   -Neoadjuvant used if needed to convert from unresectable to resectable disease

Question 6

Colon Cancer Chemo by Stages : See Chart

Metastatic/Unresectable Colon Cancer :
1) Whats the standard of care for newly diagnosed pt’s with this condition ?

Answer 6

1. Fluoropyrimidine based chemotx (FOLFOX) plus a biologic agent (Bevacizumab, Panitumumab)

Question 7

For the following regimens, state what drugs are included

1. FOLFOX
2. CapeOx
3. FOLFIRI
4. FOLFOXIRI

Answer 7

1. Folinic acid (leucovorin), 5FU, Oxaliplatin
2. Capecitabine, Oxaliplatin
3. Folinic acid (leucovorin), 5FU, Irinotecan
4. Folinic acid (leucovorin), 5FU, Irinotecan, Oxaliplatin

Question 8

For each drug, state the AE’s and DLT’s

1. 5FU
2. Capecitabine
3. Irinotecan
4. Oxaliplatin
5. Bevacizumab
6. Cetuximab (EGFR) and Panitumumab
7. Regorafenib (VEGFR)

Answer 8

1. Mucositis, N/V,Diarrhea!!, hand foot syndrome, myelosuppression

DLT : Diarrhea and mucositis

2. Diarheea, hand foot syndrome, myelosupp, N/V, Hyperbilirubinemia

DLT : Diarrhea, Hand foot syndrome

3. DIARRHEA, Mucositis, N/V, MyeloSupp, fatigue

DLT : DIARRHEA

4. Myelosupp, N/V, Mucositis, fatiigue, acute and chronic neuropathy

DLT : Acute and chronic neuropathy

5. HTN,poor wound healing, proteinuria, hemorrhage, arterial thrombosis
   DLT : HTN, Poor wound healing
6. Skin rash, paronychia, Hypersensitivity, hypomag

DLT : skin rash and Hypomagnesemia

7. Hepatotoxic, fatigue, hand foot skin rxn, mucositis, Diarrhea, poor wound healing, rash

DLT : HEPATOTOXIC , Hand foot skin rxn

Question 9

Oxaliplatin Induced Neurotoxicity :

1. ACute onset ?
2. How does it present ?
3. How do u prevent this?
4. Non pharm prevention

Answer 9

1. Hours to days post tx
2. Numbness /tingling/reduced sensation /dyesthesias in hands, feet mouth or throat . Dyesthesia may be precipitated by cold!
3. Prolong infusion from 2to6hrs , reduce dose
4. Gloves, hats, scarves (stay warm so cold doesnt trigger this)

Question 10

Irinotecan Induced Diarrhea
1. ACute onset ?
2. Severity of sx’s is ?
3. PRevention ?

4. Delayed onset ?
5. TX ?
6. What enzyme deficiency can play a roll?

Answer 10

1. during irinotecan infusion up to 24hrs after infusion (due to cholinergic sx’s)
2. dose related
3. Atropine 0.25mg IV or SQ given prior to drug infusion
4. > =24hrs after infusion of drug (due to SN38 metabolite)
5. Fluids/electrolytes , brat diet,
6. UGTA1a1 deficiency

Question 11

Patients with DPD Deficiency would have consequences of toxicities with which drugs ?

Answer 11

5FU and CApecitabine (Oral prodrug of 5FU)
–> these pt’s would experience toxicity bc they would have drug overexposure

Question 12

Bevacizumab :
1. MOA
2. ADE’s?
3. Dose limiting ADE’s?

Answer 12

1. VEGF inhibitor
2. HTN, poor wound healing, proteinuria, hemorrhage, arterial thrombosis
3. HTN and poor wound healing

Question 13

Hand foot Syndrome : PREVENTION

1. Happens most with which drugs?
2. Prevention strategies pharm
3. Prevention strategies non pharm

Answer 13

1. Capecitabine and Fluorouracil
2. Ammonium Lactate cream 12% BID , heavy moisturizer BID
3. Thick soft cotton socks w/all shoes. Thick cotton gloves when doing activities outside or in house
   -Keep hands and feet well moisturized, soak in cool water for 20-30 mins, pat dry, fragrance free moisturizer like Eucerin at least once daily
   -Try fragrance free lotion that contains petroleum

Question 14

TX of HFS :

1. Minimal skin changes or dermatitis and no pain
2. SKin changes w/pain and limiting instrumental ADLs
3. SKin changes with pain and limiting self care adl’s

Answer 14

1. Chemo continue, monitor q2wks, Urea 20% BID and clobetasol 0.05% daily
2. Chemo continue, monitor q2wks, Urea 20% BID and clobetasol 0.05% daily , pain control with NSAIDS / GABA agonists/Opioids
3. Chemo hold until skin changes are minimal, Monitor q2weeks, consinder discontinuation if worse.
   Urea 20% BID and clobetasol 0.05% daily , pain control with NSAIDS / GABA agonists/Opioids