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Cancer CE & VP > VP L2 Colorectal cancer > Flashcards

VP L2 Colorectal cancer Flashcards

(54 cards)

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1
Q

Colorectal caner is the …. most common cancer in the UK

A

3rd

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2
Q

Colorectal cancer affects more men/woman?

What age?

A

Men

Over 60

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3
Q

Risk factors (3)

A

Famillial
dietary/lifestyle
other colorectal conditions

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4
Q

2 Familial risk factors

A

FAP (familial adenomatous polyposis)

and

HNPCC (hereditary non-polyposis colorectal cancer)

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5
Q

Dietary/lifestyle risks (6)

A 
high intake of meat/animal fat
Low fiber intake
Regular consumption of aspirin/NSAIDS (REDUCES RISK)
Inactive lifestyle
Obesity
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6
Q

3 other colorectal conditions that predispose to CC

A

Ulcerative colitis
Previsous colorectual cancer
Crohn’s disease

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7
Q

Pathology of CC

A

polyp to benign adenoma to malignant tumour

vast majority are adenocarcenomas that arise from pre-existing polyps that develop in normal mucosa

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8
Q

How long does it take a polyp to become cancer

A

10 years

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9
Q

symptoms (6)

A 
change in bowel habit
abdo pain
rectal bleeding/mucus
weight loss
anorexia

Anaemia (chronic bleeding from tumour site)

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10
Q

20% of resenting complaints are

A

acute large bowel obstruction (surgical emergency)

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11
Q

Differential diagnosis

A

IBS

and

Inflammatory bowel disease

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12
Q

4 diagnostic investigations

A

colonoscopy
felxible sigmoidoscopy
Ba enema
CT preop to check for metastases

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13
Q

How do we stage CC

A

Duke’s system traditionally

or

TNM more recent

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14
Q

How do we stage CC

A

Duke’s system traditionally

or

TNM more recent

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15
Q

what is first line treat for 80% of patients

A

Surgery

Segment of the large bowel resected

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16
Q

What percentage of patients suffer recurring disease

A

50%

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17
Q

When is radiotherapy indicated

A

rectal cancers only

and

post op to reduce incidence

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18
Q

aim of adjuvant chemo

A

post surgery to eradicate micrometastases

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19
Q

for what dukes score is chemo recommended

A

dukes C

NOT

A

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20
Q

What is the mainstay of chemo treatment for CC

A

5FU

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21
Q

How does 5FU work

A

converted intracellularly to metabolites that bind thymidylate synthase
thus
inhibiting synthesis of thymidine, DNA and RNA

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22
Q

What is given to increase the efficacy of 5FU

How does it work

Study These Flashcards
A

folinic acid

prolongs inhibition of thymidylate synthase

23
Q

side/effects of 5FU (6)

Study These Flashcards
A 
diarrhoea
stomatisis
nausea and vom
bone marrow supression
hand and foot syndrome
excessive tear shedding
24
Q

What adjuvant is given for DUKES C

Study These Flashcards
A

oxaliplatin
5FU
folinic acid

25
How does oxaliplatin work
Cross links DNA, prevents replication and cell devision
26
Oxaliplatin s/e (4)
peripheral neruopathy acute pharyngolaryngeal dysasthesia bone marrow suppression mild alopecia
27
What is a hickman line
central venous catheter coming out of your chest
28
Why Oxaliplatin de Gramont regime?
Infusion is important as tumour cells have low growth fraction Also 5FU has t1/2=10mins and is s phase specific
29
What is the problem with de gramont regime?
increased incidence of hand and foot syndrome from 5FU
30
3 Issues with infusional devices
anxiety for patients disposal of cytotoxic waste in patients homes time consuming to fill for pharma
31
What is capecitabine
oral chemotherapy
32
how is capecitabine used
in combo with oxaliplatin in XELOX regime (instead of the de gramont component)
33
Advantages of oral capecitabine therapy
less invasive no issues with sterility/short exp reduces pharmacy cost and time pt can administer medicines themselves
34
What is Capecitabine?
the prodrug of 5FU - three step acivation process, two steps occur preferentially in tumours
35
What is the capecitabine regieme
bd 14 days out or 21
36
de gramont regieme details
Chemo given every 2 weeks for 12 cycles as outpatient Oxaliplatin 85mg/m2 over 2hrs IV infusion Calcium folinate 350mg over 2hrs IV infusion Fluorouracil 400mg/m2 IV stat Fluorouracil 2400mg/m2 IV infusion over 46hrs in portable infusion device Need Hickman (central) line or PICC line
37
de gramont regieme details
Chemo given every 2 weeks for 12 cycles as outpatient Oxaliplatin 85mg/m2 over 2hrs IV infusion Calcium folinate 350mg over 2hrs IV infusion Fluorouracil 400mg/m2 IV stat Fluorouracil 2400mg/m2 IV infusion over 46hrs in portable infusion device Need Hickman (central) line or PICC line
38
How to treat metastatic disease
Surgery to relieve obstruction/symptoms resection of liver metastases 5FU based regimes plus other drugs (e.g. irinotecan)
39
What is irinotecan?
topoisomerase I inihibtor (enzyme invilved in unwinding of DNA during DNA repair)
40
Treatment summery: Duke's A
Duke’s A: surgery only
41
Treatment summery: Duke's B
Duke’s B: surgery + adjuvant chemotherapy in some cases (patients with risk factors such as vascular invasion of tumour, poorly differentiated tumour)
42
Treatment summery: Duke's C
Duke’s C: surgery + adjuvant chemotherapy
43
Treatment summery: Duke's C
Duke’s D (metastatic): surgery to relieve obstruction if needed, palliative chemotherapy +/- monoclonal antibodies to relieve symptoms & prolong survival
44
e.g. of a new mab therapy
Bevacizumab (avastin)
45
How does avastin work
VEGF inbitor - inhibits VEGF binding to receptor on tumour cell surface VEGF usually stimulates angiogenisis
46
What is avastin licensed for?
Combination therapy with 5FU therapies
47
How is avastin given
IV infusion every 2/3 weeks
48
s/e avastin
GI perforation haemorrhage hypertension arterial thromboembolism
49
What is cetuximab (erbitux)
mab that blocks EGFR
50
Cetuximab is licenced for
treatments of patients with EGFR expressing KRAS wild type - in combo with chemo or -as a single agent in pt who have fails oxaliplatin and irinotecan based therapies
51
Cetuximab is now first line for
metastatic CC in combo with oxaliplatin de gramont
52
Cetuximab is now first line for
metastatic CC in combo with oxaliplatin de gramont
53
cetuximab s/e
rash itching infusion reactios (fever, chills, nausea, vomitting)
54
cetuximab s/e
rash itching infusion reactions (fever, chills, nausea, vomitting)

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