Colorectal

Question 1

FOLFOX regime

Answer 1

1, 2nd line treatment of advanced/metastatic CRC with stage iii, WHO PS0/1

FOLinic acid (Leucovorin)
Fluorouracil
OXaliplatin

Question 2

FOxTROT trial

Answer 2

For T3+ disease with WT RAS

DoesNeoadjuvant 6 weeks CTx to the advanced tumour?
Also adding Panitumumab (anti-EGFR) to the neoadjuvant to tumours with KRAS/NRAS-WT would benefit?

Question 3

KRAS mutation in CRC

Answer 3

Protooncogene
Tumours with KRAS mutation = poor response to anti-EGFR E.g. panitumumab, cetuximab

Question 4

Definition of IF

Answer 4

encompasses a spectrum of conditions that manifest as an inability to maintain adequate nutritional, fluid and electrolyte homeostasis without supportive therapy

Question 5

Criteria of referral for IF

Answer 5

1. Persistence of IF >6 weeks without any evidence of resolution and/or venous access problems
2. Multiple intestinal fistulation in a totally dehisced abdominal wound
3. An intestinal fistula outside the expertise of the referring unit or 2nd/3rd recurrence in colorectal unit
4. Total/near-total small bowel enterectomy, resulting in <30cm small bowel left
5. Recurrence venous access problems in patient requiring PN.
6. Persistent intra-abdominal sepsis, complicated by severe metabolic derangement with hypoalbuminaemia that isn’t responding to surgical/IR drainge
7. Metabolic complications relating to high-output fistulas and stomas and to prolonged IV feeding, not responsive to medication and adjustment of the feeding regimen. Disorders of hepatic and renal function associated with IV nutrition that are resistant to metabolic and nutritional supplementation
8. Chronic IF in a hospital without adequate experience/expertise

Question 6

4 areas of causes of IF

Answer 6

1. Loss of intestinal length
2. Loss of functional intestinal length
3. Loss of intestinal absorptive capacity
4. Loss of intestinal function

Question 7

NICE stratification of rectal cancer according to risk of local pelvic recurrence

Answer 7

Low : No RTx and proceed with surgery
Medium : Short-course preoperative RTx or pre-op CRTx
High : Pre-op CRTx

Question 8

Sensitivity and Specificity of
1) Colonoscopy
2) FIT
3) CT Colonoscopy

Answer 8

1) 90% for large polyps
2) 79% sensitivity, 94% specificity
3) 93% sensitivity, 97% specificity

Question 9

Oncogenes

Answer 9

Oncogenes are genes which have the potential to induce cellular proliferation and avoid apoptosis. Oncogene mutations are general gain of function and are therefore dominant.

Question 10

Tumour suppressor gene

Answer 10

inhibit cellular proliferation or induce apoptosis. Mutations in tumour suppressor genes are generally loss of function mutations, and are therefore recessive.

Question 11

Mechanism of Botox

Answer 11

Inhibit release of acetylcholine to the neuronal space