Colorectal Cancer

Question 1

List the risk factors for colorectal cancer. (7)

Answer 1

age > 40; family history; high fat/low fiber diet; polyps; ulcerative colitis/Crohn’s disease; alcohol/tobacco use; obesity

Question 2

What are the two hereditary syndromes associated with colorectal cancer? (2)

Answer 2

familial adenomatous polyposis (FAP); hereditary nonpolyposis colorectal cancer (HNPCC)

Question 3

What other cancers are those with HNPCC at risk for? (3)

Answer 3

endometrial; stomach; ovarian

Question 4

At what age should you begin screenings for colon cancer?

Answer 4

45

Question 5

At what age should a person with family history of colorectal cancer begin screenings?

Answer 5

40 or 10 years before earliest age of family diagnosis

Question 6

At what age should a person with HPNCC begin screenings?

Answer 6

20-25 or 10 years before earliest age of family diagnosis

Question 7

True or False? The majority of colorectal cancers are adenocarcinomas?

Answer 7

True

Question 8

What is the most common presentation of colorectal cancer? (2)

Answer 8

rectal bleeding and anemia

Question 9

What should be included in the diagnostic workup? (3)

Answer 9

complete blood count; anemia work-up; colonscopy

Question 10

All patients with a colon cancer diagnosis should eb tested for ____.

Answer 10

dMMR

Question 11

In what stages do you use localized therapy?

Answer 11

Stage I and II

Question 12

What are the chemotherapy regimens are available for Stage II colorectal cancer? (2)

Answer 12

FOLFOX; CapeOX

Question 13

When is radiation therapy used in colorectal cancer? (2)

Answer 13

to alleviate pain & decrease bleeding

Question 14

Is Stage IV colorectal cancer curable?

Answer 14

no

Question 15

What is the preferred treatment option for Stage I and II colorectal cancer?

Answer 15

surgery (partial or total colectomy + lymph nodes)

Question 16

What adjuvant chemotherapy do you use in Stage III colorectal cancer?

Answer 16

FOLFOX; CapeOX

Question 17

What are the main toxicities associated with CapeOX? (2)

Answer 17

hand foot syndrome & diarrhea

Question 18

What are two ways you can give local chemotherapy?

Answer 18

hepatic artery infusion; hepatic chemoembolism

Question 19

Which chemotherapy regimen is appropriate for a patient with neuropathy?

Answer 19

irinotecan

Question 20

Which chemotherapy regimen is appropriate for a patient with UGT1A1 deficiency?

Answer 20

oxaloplatin

Question 21

Can dMMR status change after metastasis?

Answer 21

yes

Question 22

What 3 biomarkers should you test colorectal patients for?

Answer 22

BRAF; KRAS; EGFR

Question 23

KRAS mutant patients do not benefit from ____ or ____.

Answer 23

cetuximab; panitumumab

Question 24

What are the first line chemotherapy regimens for metastatic colorectal cancer?

Answer 24

FOLFOX; CapeOX; FOLFIRI

Question 25

What drugs are included in FOLFOX?

Answer 25

5-FU; leucovorin; oxaloplatin

Question 26

What drugs are included in CapeOX?

Answer 26

capcitabine; oxaloplatin

Question 27

What drugs are included in FOLFIRI?

Answer 27

5-FU; leucovorin; irinotecan

Question 28

What regimen would you use in a patient who cannot tolerate intensive chemotherapy? (2)

Answer 28

5-FU + leucovorin; capecitabine

Question 29

What regimen would you switch to if a patient progresses while on FOLFOX?

Answer 29

FOLFIRI

Question 30

What regimen would you switch to if a patient progresses while on FOLFIRI?

Answer 30

FOLFOX

Question 31

What is the common toxicity of 5-FU?

Answer 31

diarrhea

Question 32

What subset of patients will have increased 5-FU toxicities?

Answer 32

patients with DPD deficiency

Question 33

What drug is given with 5-FU to increase efficacy?

Answer 33

leucovorin

Question 34

What are the dose-limiting toxicities of irinotecan? (2)

Answer 34

diarrhea; neutropenia

Question 35

What toxicities are associated with oxaliplatin? (3)

Answer 35

neuropathy; cold intolerance; sensation of not being able to breathe

Question 36

What toxicities are associated with capcitabine?

Answer 36

hand-foot syndrome; diarrhea

Question 37

What does cetuximab target?

Answer 37

EGFR

Question 38

What are the toxicities associated with cetuximab?

Answer 38

infusion reaction; rash; hypomagnesemia

Question 39

What does panitumumab target?

Answer 39

EGFR

Question 40

What does bevacizumab target?

Answer 40

VEGF

Question 41

What toxicities are associated with bevacizumab? (4)

Answer 41

bleeding; hypertension; proteinuria; VTE

Question 42

What does regorafenib target?

Answer 42

multiple kinases