Colorectal cancer

Question 1

how common is colorectal cancer

Answer 1

3rd most common in men and women

Question 2

what disease states increasee risk of colorectal cancer

Answer 2

Crohns and ulcerative collitis

Question 3

risk factors for colorectal cancer

Answer 3

family hx
fatty diet , low fiber
increases risk after 40
alcohol, obesity, smoking

Question 4

hereditary predisposal with 100% chance of getting

Answer 4

Familial Adenomatous Polyposis (FAP)

Question 5

what does Hereditatry Nonpolyposis Colorectal Cancer put pts at rrisk of

Answer 5

other cancers like endometrial, stomach, and ovarian

Question 6

most colorectal cancers are what type

Answer 6

95% adenocarcinoma

Question 7

symptoms and presentation

Answer 7

can be asymptomatic
rectal bleeding
change in bowel habits
N/V
20-25% will have metastatic disease

Question 8

what is dMMR

Answer 8

defective DNA mismatch repair

Question 9

which mutations are defective

Answer 9

dMMR
MSI-H

Question 10

what is MSI-H

Answer 10

high level of microsatelite instability

Question 11

patients with MSI-H or dMMR can benefit in what stage with 5-FU

Answer 11

Stage III, not stage II

Question 12

what stages are curable in colorectal cancer

Answer 12

I-III potentially

Question 13

stage I and II treatment

Answer 13

surgery is definitive
(can do chemo in 2)

Question 14

who should get chemo in stage II

Answer 14

not reccomended unless high risk of recurrence

Question 15

what is FOLFOX

Answer 15

5-FU (2 day infusion)
leucovorin
oxaliplatin

Question 16

what is CapeOX

Answer 16

capecitabine (orally)
oxaliplatin

Question 17

which treatment has chemo pod

Answer 17

FOLFOX every 2 days
FOLFIRI

Question 18

how often to repeat folfox

Answer 18

every 14 days

Question 19

how often to repeat capeox

Answer 19

every 21 days

Question 20

low risk pts get which regimen for how long

Answer 20

capeox 3 months
folfox 3-6 months

Question 21

high risk pts get what drugs for how long

Answer 21

capeox 3-6 months
folfox 6 months

Question 22

oxaliplatin big side effect

Answer 22

neuropathy

Question 23

capeox side effects

Answer 23

increased hand foot syndrome
diarrhea

Question 24

which regimen do we think about adherence with

Answer 24

capeox
(oral agent) - make sure they are taking

Question 25

if pt has a KRAS mutation what not to use

Answer 25

cetuximab panitumumab

Question 26

KRAS mutations predict poor response to what kind of drugs

Answer 26

anti-EGFR

Question 28

1st line metastatic disease options chemo

Answer 28

FOLFOX CapeOx FOLFIRI FOLFIRINOX + bevacizumab if no KRAS (cetux /panit)

Question 29

which drug has big neuropathy

Answer 29

oxaliplatin

Question 30

which regimen if they have neuropathy

Answer 30

folfiri

Question 31

if pt cant tolerate intense chemo what can we give

Answer 31

5-FU leucovorin

Question 32

second line therapies: if disease progression with oxaliplatin first

Answer 32

use folfiri

Question 33

second line therapies: if disease progression with ironotecan first

Answer 33

use FOLOFX/CapeOx

Question 34

screenings that primarily detect cancer

Answer 34

fecal blood test (FOBT) fecal immunohistochemical test (FIT)

Question 35

screenings that detect cancer and lesions

Answer 35

endoscopic and radiologic exams Ex. scopes and colonoscopys

Question 36

FOBT effectiveness

Answer 36

high false pos - avoid red meat / veggies high false neg - avoid vit c

Question 37

fecal immunochemical test (FIT) advantages

Answer 37

not as many restrictions and false negatives

Question 38

FIT DNA test is what

Answer 38

takes DNA from stool (cologuard)

Question 39

gold standard for screening

Answer 39

colonoscopy

Question 40

when should you be screened in colon cancer

Answer 40

>45

Question 41

options for screening timelines how frequently do they reccomend

Answer 41

1 year annual FOBT/FIT 10 year colonoscopy

Question 42

family history what age to screen

Answer 42

40 or 10 years younger than the age of diagnosis

Question 43

what age to screen if HNPCC

Answer 43

20-25 or 10 year younger

Question 44

what age to screen FAP

Answer 44

10-12

Question 45

dietary prevention with what foods

Answer 45

high fiber low fat high calcium

Question 46

which agents can be prevenative in colorectal cancer

Answer 46

NSAIDs aspirin

Question 47

5-FU and fDUMP binds what

Answer 47

thymidylate synthase

Question 48

patients with a deficiency in what might have 5-FU toxicities

Answer 48

DPD

Question 49

what is a synergist with 5-FU

Answer 49

leucovorin

Question 50

side effects with 5-FU

Answer 50

diarrhea mucositis

Question 51

ironotecan side effect

Answer 51

diarrhea (i run to the can)

Question 52

what class is ironotecan

Answer 52

topoisomerase I inhibitor

Question 53

what is late onset diarhhea and what can increase the toxicity for it

Answer 53

UGT1-A1 deficiency 3-5 days and can be fata;

Question 54

UGT1A1 deficiency can have toxicity in what drug

Answer 54

ironotecan

Question 55

oxaliplatin side effects

Answer 55

cold intolerance neuropathy

Question 56

capcitabine side effect

Answer 56

hand-foot syndrome diarrhea

Question 57

cetuximab is what class

Answer 57

EGFR inhibitor

Question 58

cetuximab and panitumumab cannot be used with what mutation

Answer 58

KRAS

Question 59

cetuximab and panitumumab side effects

Answer 59

acne rash hypomagnesia (premedicate with H1)

Question 60

bevacizumab is what class

Answer 60

VEGF inhibitor

Question 61

bevacizumab toxicities - significant

Answer 61

hypertension!!! bleeding caution with surgery

Question 62

which drug will we check pts HTN for before

Answer 62

bevacizumab

Question 63

what drug do we check protein in urine and BP

Answer 63

bevacizumab