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PHCY320 (Oncology) Quiz am ON13 Colorectal cancer, erstellt von Mer Scott am 07/10/2019.

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ON13 Colorectal cancer

Frage 1 von 16

1

Choose the incorrect epidemiology statement about colorectal cancer.

Wähle eine der folgenden:

  • 3rd most common cancer in the world​

  • Highest rates in undeveloped/third world nations​

  • 95% of colorectal cancers are adenocarcinomas​

  • 91% and 88% 5 year survival rate for early stages of colon and rectal cancer, respectively​

  • 70% 5 year survival rate after tumor spreads to adjacent lymph nodes

  • 12% 5 year survival rate after metastasis​

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Frage 2 von 16

1

NZ stats:
- Eight New Zealander’s diagnosed each day​
- New Zealander’s die from bowel cancer each day​
- cause of cancer death in New Zealand​
- One of the highest rates in the
- Rates for are highest in world ​
- Less frequent in vs. non-Maori

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    Three
    2nd highest
    world
    women
    Maori

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Frage 3 von 16

1

Risk factors for colorectal cancer:
sex​
Age​ (older)
History of colorectal cancer,
Inherited factors (e.g. familial adenomatous polyposis, )​
Lifestyle factors​
Diet ( meat, processed food, high fat, low fibre)​
Physical
Long term
Excessive
Obesity

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    Male
    polyps, T2DM, IBD​
    family history
    red
    inactivity
    smoking
    alcohol

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Frage 4 von 16

1

Protective Factors​:
Some evidence use (13-28% RRR)​
hormone use (RRR 35%)​
Healthy BMI, physical , smoking
Fibre, fruits, vegetables, reduced meat consumption​
supplementation​

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    NSAIDs / Aspirin
    Postmenopausal
    activity
    cessation
    Calcium and vitamin D

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Frage 5 von 16

1

Screening usually starts at age 50​. Decreases mortality through early detection​.
Methods:​
(every 10 years post-50)​
Flexible (every 5 years)​
CT scan (every 5 years)​
Double contrast (every 5 years)​
Fecal occult blood tests ()​

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    Colonoscopy
    sigmoidoscopy
    barium enema
    annually

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Frage 6 von 16

1

Which of these is not a symptom of bowel cancer?

Wähle eine der folgenden:

  • Tenesmus​ (continual or recurrent inclination to evacuate the bowels)

  • Advanced: unintentional weight loss, iron-deficiency anemia, weakness​

  • Bloating​

  • Rectal bleeding​

  • Abdominal pain​

  • Changes in bowel habits ​

  • Mucositis

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Frage 7 von 16

1

Diagnosis:
History and physical exam​
Colonoscopy sigmoidoscopy​
(to confirm presence of cancer)​
scanning (search for metastases)​
Baseline (CBC, platelet, liver panel, renal panel, CEA, iron studies)​
Pathological staging after tumor resection ()​
Gene mutation testing (?)​

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    or
    Biopsy
    CT
    labs
    TNM

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Frage 8 von 16

1

Staging:
Stage 1 - tumour size T1 (no deeper than ) and T2 ()
Stage 2 - T3 ( muscularis)
Stage 3 - N1 ( lymph nodes involved), N2 ( lymph nodes involved)
Stage 4 - M - metastases.

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    submucosa
    not all the way through muscularis
    through
    1-3
    >4
    distant

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Frage 9 von 16

1

Clinical factors associated with poor prognosis:​
Bowel
High preoperative
Distant
Location of tumor in area​
Molecular markers (KRAS mutations MSI, BRAF mutations)​

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    obstruction or perforation​
    CEA​ (carcinoembryonic antigen)
    metastases
    rectal or rectosigmoid

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Frage 10 von 16

1

Treatment:
Need to consider stage, performance status, patient preferences, comorbidities, age. Curability depends on tumor stage​.
General approach:​
of primary tumor is 1st line therapy (Stage 1, 2, 3)​
Removal of tumor plus of tumor free bowel and regional for cure​
Adjuvant can be given to eliminate residual micrometastases ​

if it's metastases (Stage 4)​?
Classified as resectable, potentially resectable, or unresectable​
is mainstay, radiation may be used for palliative purposes​

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    Surgical resection
    5cm
    lymph nodes
    chemotherapy and/or radiation
    Systemic chemotherapy

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Frage 11 von 16

1

Adjuvant Systemic Chemotherapy​:
Goal: reduce risk of recurrence and overall mortality in Stage ​. (Little to no benefit from Stage , no benefit in Stage ​.)
Duration: months​
Choice of regimen based on toxicity and convenience​. Typically based on (both with )​.

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    III
    II
    1
    6
    Fluorouracil or Capecitabine
    oxaliplatin

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Frage 12 von 16

1

Leucovorin(Folinic acid), fluorouracil and oxaliplatin aka FOLFOX side effects:
- neutropenia, therefore
- anaemia, therefore breathlessness and
- potentially reversible neuropathy
- nausea
- diarrhoea
- muscositis
- rarely heart problems

CAPOX (capecitabine and oxaliplatin) side effects:
- neutropenia, therefore infections
- anaemia, therefore breathlessness and weakness
- potentially reversible peripheral
- nausea
- diarrhoea OR
- muscositis
- syndrome
- rarely tinnitus, heart problems,

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    infections
    weakness
    peripheral
    neuropathy
    constipation
    palmar-plantar

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Frage 13 von 16

1

Rectal Cancer​
- Poorer outcomes. ​Difficult to , propensity for .
- Most patients with Stage II or III should receive radiation and chemotherapy operatively ​
- chemotherapy and radiation for Stage II or III​
- Adjuvant for 6 months post-surgery​
- Same regimens as indicated or colorectal (e.g. FOLFOX or CapeOx)​

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    resect
    recurrence
    combined
    peri
    Neoadjuvant

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Frage 14 von 16

1

Colorectal – Metastatic Disease​:
- If resectable, surgery is indicated (most commonly )​. Neoadjuvant adjuvant chemotherapy​ for patients with metastatic disease to liver or lung​. FOLFOX, FOLFIRI, FOLFOXIRI, CapOx​.
- Unresectable​ - Chemotherapy (e.g. FOLFOX, CapOx, FOLFIRI)​ only. Goal is to control and prolong survival.​
Role for therapy (bevacizumab) [inhibits VEGF]​ & EGFR inibitors (cetuximab, panitumumab) [for patients with wild-type RAS tumors)​

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    liver and lung
    and
    isolated
    growth
    targeted

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Frage 15 von 16

1

A note about Irinotecan… ​
Evidence exists for metastatic disease​!
Improved overall vs. 5FU/LV alone​ :-)
Combination with 5FU/LV +/- oxaliplatin may improve of metastases and improve patient survival .
Must monitor for ​.

Data in adjuvant setting (non-metastatic disease) lacking​...

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    survival
    resectability
    diarrhea and neutropenia

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Frage 16 von 16

1

Oral Capecitabine:
May be commonly seen in community pharmacy​.
Caution in: electrolyte disturbance, conditions.
Avoid in impairment​.
Dose reductions if CrCl ml/min, avoid ml/min ​.
Contraceptive advice for child-bearing aged females​.
Potential ADRs: ​ hand-foot syndrome, diarrhea, (rare), skin conditions (very rare)​

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    CVD, diabetes,
    skin
    severe hepatic
    < 50
    <30
    required
    arrhythmias
    severe

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