Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Heme/Onc > Colon Cancer > Flashcards

Colon Cancer Flashcards

(77 cards)

Start Studying
1
Q

What are risk factors for colon cancer?

A 
Age >50
Polyps (adenomatous)
Genetic predisposition
FH of colorectal cancer
T2DM, metabolic syndrome
Personal history
Lifestyle factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the genetic risk factors for colon cancer?

A

Familial adenomatous polyposis (FAP)

Hereditary nonpolyposis colorectal cancer (HNPCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is FAP?

A

Mutations in the adenomatous polyposis coli (APC) gene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does FAP present?

A

Large # of polyps in colon/rectum between ages 5-40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What will happen if FAP is left untreated?

A

100% risk for cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is HNPCC?

A

Mutation in DNA mismatch-repair (MMR) genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most common mutations responsible for HNPCC?

A

MLH1
MSH2
PMS2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What lifestyles are RFs for colorectal cancer?

A 
Obesity
Physical inactivity
Moderate-heavy EtOH
Long-term smoking
High consumption of red/processed meat
Low intake of fiber/fruits and vegetables
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some possible protective factors?

A

Diet (high fiber/fruit and vegetables)
Calcium and Vitamin D
NSAIDs, low dose ASA
Surgical resection in extremely high risk patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is considered Average risk for colorectal cancer?

A

Age > 50

No h/o adenoma, colorectal cancer, or IBD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are methods for colorectal cancer screening?

A

FOBT/FIT
Endoscopy
Radiology-based techniques
Stool DNA test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the types endoscopic imaging?

A

Sigmoidoscopy

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the types of radiology-based techniques?

A

CT

Double contrast basrium enema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the FDA approved stool DNA test?

A

Cologuard

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which methods of colorectal cancer screening find polyps and cancer?

A

Flexible sigmoidoscopy
Colonoscopy
Double contrast barium enema
CT colonography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What methods of colorectal cancer screening find cancer only?

A

FOBT
FIT
Stool DNA test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the tier 1 recommendation for average risk?

A

Colonoscopy every 10 years

Annual fecal immunochemical test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the tier 2 recommendation for average risk?

A

CT colonography every 5 years
FIT-fecal DNA every 3 years
Flexible sigmoidoscopy every 5-10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the tier 3 recommendation for average risk?

A

Capsule colonoscopy every 5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the clinical presentation of colorectal cancer?

A 
Changes in bowel habits
GI (N/V, discomfort, bloating, fullness, cramps, ab pain, ascites)
Rectal bleeding/blood in stool
Fatigue
Wt loss
Leg edema/pain
Back pain w/lymph node involvement
Hepatomegaly, jaundice, possibly LFTs with metastatic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How do we work up a patient with suspected colon cancer?

A 
Hx and PE
Baseline labs
Radiography
PET
Biopsy
Monitoring therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is a PET used for when working up a patient?

A

Can confirm metastatic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

When is a PET scan used?

A

If standard imaging studies are inconclusive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What mutations are we looking for during a biopsy?

A

RAS

BRAF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do we monitor therapy in colon cancer?
Carcinoembryonic antigen (CEA)
26
What is CEA?
an 'oncofetal' protein
27
When is CEA expressed?
In embryos and in many carcinomas, particularly GI cancers
28
Can CEA be used for diagnosis?
No | Insensitive and nonspecific
29
What does a positive CEA correlate to?
``` Amount of tumor Differentiation of tumor Residual disease Recurrence Poor survival ```
30
What is CEA good for?
Monitoring response to therapy and progression of disease
31
How does the TNM system correlate to Duke's stage A?
T1-2, N0, M0
32
How does the TNM system correlate to Duke's stage B?
T3-4, N0, M0
33
How does the TNM system correlate to Duke's stage C?
T1-4, N1-2, M0
34
How does cancer staging compare to Duke's stage A?
Stage I
35
How does cancer staging compare to Duke's stage B?
Stage II
36
How does cancer staging compare to Duke's stage C?
Stage III
37
What is the approximate 5 year survival for Stage I?
> 90%
38
What is the approximate 5 year survival for Stage II?
63-87%
39
What is the approximate 5 year survival for Stage III?
53-89%
40
What is the approximate 5 year survival for stage IV?
11-13%
41
What is the description of a patient with Stage I colon cancer?
No invasion of muscular mucosa
42
What is the description of a patient with Stage II colon cancer?
Invasion of muscular mucosa, no extracolonic spread
43
What is the description of a patient with Stage III colon cancer?
Lymph node involvement
44
What is the description of a patient with Stage IV colon cancer?
Metastatic
45
What are the prognostic factors for colon cancer?
Stage at diagnosis** Degree of lymphatic invasion Clinical factors High proliferation indices
46
What are clinical factors for prognosis?
Performance status Bowel obstruction or perforation at presentation may worsen risk Location of tumors
47
When is adjuvant chemotherapy recommended in colon cancer?
Stage II if very high risk | Stage III - standard of care
48
What are the regimen options for colon cancer?
FOLFOX/FLOX CapeOx C FL/LV
49
What is FOLFOX/FLOX?
5-FU Leucovorin Oxaliplatin
50
What is CapeOx?
Capecitabine | Oxaliplatin
51
What is FL/LV?
5-FU | Leucovorin
52
What are the options for Stage I colon cancer?
Surgery | Observation
53
What are the options for Stage II colon cancer?
Surgery Consider C or FL/LV Observation
54
What are the options for Stage II high risk colon cancer?
``` Surgery FOLFOX/FLOX CapeOx C FL/LV Observation ```
55
What are the options for Stage III colon cancer?
Surgery FOLFOX/CapeOx preferred Observation
56
How do we confirm diagnosis of stage IV or advanced colon cancer?
Biopsy
57
What is the most common site for metastases to present in colon cancer?
Liver
58
What is a possible option in select circumstances but is not standard of care?
Surgery Neoadjuvant therapy +/- colectomy +/- synchronous or staged liver or lung resection May extend DFS (disease free survival) or produce a cure in some patients
59
What are chemotherapy options for advanced/ metastatic diseases?
``` FOLFOX CapeOx FOLFIRI 5-FU/Leucovorin or Capecitabine FOLFOXIRI ```
60
What is FOLFIRI?
Irinotecan 5-FU Leucovorin
61
What is FOLFOXIRI?
5-FU Leucovorin Oxaliplatin Irinotecan
62
What agents may be added to chemotherapy regimens for advanced/ metastatic disease?
Bevacizumab Cetuximab Paniumumab
63
When V-Ki-Ras2 Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) is turned on what does it do?
Conveys proliferative, growth, and survival signals
64
In a normal setting what happens after KRAS turns on?
Turns off after conveying the activation signal
65
Which type of agents are more likely to respond to wildtype KRAS?
EGFR inhibitors
66
What mutations should also be tested for with KRAS?
NRAS
67
How does KRAS work?
Plays an important role in signal transduction | Signal in the EGFR pathway
68
What is BRAF V600E?
Protein involved with signals that trigger cell growth
69
What is TS/TYMS?
Thymidylate synthase Involved in DNA synthesis Inhibited by 5-FU
70
What may happen if there is an overexpression of TS?
Drug resistance
71
What is DPD/DPYD?
Dihydropyrimidine dehydrogenase | Responsible for degrading pyrimidines
72
What happens when there is a deficiency of DPD?
5-FU/capecitabine toxicity
73
What is UGT1A1?
Codes for UDP-glucuronosyltranserase | Part of a series of drug metabolism enzymes
74
What is UGT1A1 involved in the metabolism of?
Bilirubin Estrogens Thyroid hormone Chemotherapy agents (etoposide, irinotecan)
75
Which UGT1A1 variants result in drug toxicity?
* 28 | * 6
76
What is dMMR/MSI-H?
dMMR - defective mismatch repair | MSI-H - high level microsatellite instability
77
Which drugs is dMMR/MSI-H a predictor of benefit of?
Pembrolizumab Nivolumab (in metastatic disease)

Heme/Onc (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions