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Solid Tumor Oncology > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

(51 cards)

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1
Q

Mutation and inheritance in familial adenomatous polyposis

A

AD mutation in APC gene

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2
Q

Who should be tested for HNPCC/Lynch syndrome?

A

All CRC patients, regardless of stage or age

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3
Q

How do you screen for HNPCC?

A

Mismatch repair protein ICH or MSI testing (PCR)

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4
Q

What genes are implicated in HNPCC? (4)

A

MSH2
MSH6
MLH1
PMS2

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5
Q

What is difference about MLH1 mutations compared to other mutations seen in MMR-deficient CRC?

A

MLH1 mutation can be sporadic. If it is seen in MLH1 hypermethylation or BRAF mutation, then it is sporadic, not germline

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6
Q

At what age should CRC screening begin?

A

45

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7
Q

T stage in colorectal cancer

A

T1: submucosal invasion
T2: Invasion muscularis propria
T3: Invades through muscularis propria or subseroa
T4: Directly invades other structures

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8
Q

N stage in CRC

A

N1: 1-3 LNs
N2: 4+ LNs

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9
Q

Adjuvant treatment for intermediate risk stage III CRC

A

3 months CAPEOX
6 months FOLFOX

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10
Q

Adjuvant treatment for high risk stage II CRC?

A

3 months CAPEOX
6 months FOLFOX
6 months 5-FU or Cape

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11
Q

What designates someone as high risk Stage III?

A

T4 and/or N2

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12
Q

Adjuvant treatment for high-risk stage III CRC? (2)

A

6 months CAPEOX
6 months FOLFOX

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13
Q

Adjuvant Treatment for low-risk stage III CRC

A

3 months CAPEOX
3-6 months FOLFOX
if can’t tolerate doublet, 6 months 5-FU or Cape

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14
Q

What classifies someone as high risk stage II CRC (6)

A

T4
Less than 12 LNs
Obstruction/perforation
LVI
PNI
Poor differentiation

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15
Q

Adjuvant treatment for a patient with stage II MSI-H/MMR-D CRC?

A

No adjuvant chemotherapy, unless high risk features

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16
Q

For stage T3Nx rectal cancer, what is the preferred treatment paradigm?

A

Preoperative chemoradiation with 5-FU, then surgery, then adjuvant chemotherapy with CAPEOX or FOLFOX maybe

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17
Q

What is the benefit of preoperative chemoRT compared to postoperative RT in rectal cancer?

A

Less toxic, less local recurrence, more sphincter sparing surgeries, no change in distant mets

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18
Q

For rectal cancer, what is the difference in short course preoperative radiation compared to chemoRT?

A

short course radiation had more locoregional recurrence

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19
Q

In patients with upper rectal cancer who wish to avoid radiation, what is their option?

A

Preoperative FOLFOX can allow people to avoid chemoRT 90% of the time

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20
Q

Management of T1N0 rectal cancer

A

Local transanal excision

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21
Q

Management of T2N0 rectal cancer

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A

upfront resection

22
Q

High T2N0 rectal cancer management

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A

Upfront surgery

23
Q

What does a KRAS mutation mean for treatment of metastatic CRC?

Study These Flashcards
A

They will not respond to EGFR inhibitors

24
Q

What is the definition of left sided colon cancer?

Study These Flashcards
A

Splenic flexure to rectum

25
What sided colon cancers respond well to EGFR inhibitors?
Left
26
Treatment for left sided KRASwt metastatic colon cancer? (2)
FOLFOX + Cetuximab/Panitumumab FOLFIRI + Cetuximab/Panitumumab Could do Bev instead of EGFR mAb
27
Treatment for right sided KRASwt metastatic colon cancer?
FOLFOX + Bev FOLFIRI + Bev
28
Right sided colon cancer should NOT receive what type of systemic therapy?
EGFR inhibitors
29
Who should not receive EGFR inhibitors? (2)
Right sided cancer RAS/BRAF mutated -Also those who have resectable liver mets
30
BRAF V600E mutations have what prognosis in metastatic colon cancer?
Poor
31
What is the indication for encorafenib and cetuximab in colon cancer?
2nd line metastatic BRAF V600E mutated
32
What is the indication for Trastuzumab + Tucatinib?
2nd line or later mCRC with HER2 amplification
33
What is the specific metastatic pattern for BRAF mutated CRC?
RP LNs and peritoneum
34
3rd line treatment options for mCRC without driver mutations (3)
Regorafenib Tirpacil fluoracil (Lonsurf) +/- Bevacizumab Fruquitinib
35
Treatment for 1L MSI-H/dMMR mCRC?
Pembrolizumab
36
Treatment for 2L MSI-H/dMMR mCRC? (2)
Pembrolizumab Nivolumab Ipi/Nivo Dostarlimab
37
Treatment paradigm for liver-only mCRC?
Perioperative FOLFOX (3 months prior), surgery, then 3 months adjuvant FOLFOX
38
What are poor prognostic signs in anal cancer (4)
Tumor >5 cm LN mets Male HPV ctDNA + after chemoRT
39
Standard of care for locally advanced anal cancer?
Concurrent 5-FU/Mitomycin + RT
40
Treatment of 1L metastatic anal cancer?
Carboplatin + Paclitaxel
41
Treatment of 2L metastatic anal cancer?
Nivolumab Pembrolizumab
42
Treatment for perianal cancer T1 or T2 that doesn't involve the anal sphincter?
Surgical excision
43
Treatment of perianal cancer that is T1N0 and poorly differentiated
5-FU/Mitomycin + Rt
44
Treatment of perianal cancer that is T2-T4 or N+
5-FU/MItomycin + RT
45
Preferred treatment for locoregional recurrence of anal cancer after chemoRT?
Surgical resection (APR), though could consider IO prior to surgery
46
Patient with T2N0 rectal cancer undergoes up front resection and surgery upstages them to T3. What now?
Adjuvant CAPEOX or FOLFOX then chemoRT or vice versa
47
Preferred treatment paradigm for locally advanced rectal cancer
Total neoadjuvant therapy ChemoRT, then FOLFOX or CAPEOX x3-4 months, then restage. If a great response, can observe and avoid surgery.
48
Indications for ICI in rectal cancer?
In dMMR/MSI-H rectal cancer: T3Nany T1-2, N1-2 T4Nx Locally unresectable Medically inoperable
49
In what patient population can you safely omit oxaliplatin from adjuvant therapy?
Stage II, Older than 70 Low risk stage III older than 70
50
T2N0 is what stage colon cancer?
Stage I
51
Treatment for BRAF mutated metastatic colon cancer that has progressed on FOLFOX + Bev?
Encorafenib + Cetuximab (or Panitumumab)

Solid Tumor Oncology (20 decks)

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