Term
| What are risk factors for colorectal cancer? |
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Definition
- Age - Over 50, especially in men
- Race - Highest in african americans
- Heredity - family history of colorectal. FAP = 100% mortality by age 40, HNPCC/Lynch. Incr risk from UC/Crohns, not IBS
- Environment - western civilization
- Diet - high fat, low fiber
- Alcohol, smoking, obesity, diabetes |
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Term
| How can colorectal cancer be prevented? |
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Definition
- Diet - high fiber, low fat. 39g/day. Incr antioxidants, calcium supplements
- COX inhibitors - Celebrex FDA approved to decr polyps in FAP |
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Term
| How is colorectal cancer screened for? |
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Definition
- Fecal blood test - can have false positives. Annually. Not all cancers bleed, Diet affects
- Flex-sig - looks at lower part of colon. Every 5 years
- Colonoscopy - GOLD STANDARD, every 10 years. Alternative: Barium enema
- Fecal immunochemical test - not affected by vitamins/foods
- Stool DNA - not first line |
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Term
| What are tumor markers for colorectal cancers? |
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Definition
| CEA - not useful for screening, used for response to tx |
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Term
| What are screening guidelines for average risk in colorectal cancer? |
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Definition
At age 50:
- Colonoscopy every 10 years
- Stool based Guaiac or FIT every 5 years |
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Term
| What are screening guidelines for high risk in colorectal cancer? |
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Definition
At age 40:
- 1st degree relative w/ colorectal: colonoscopy every 5 years
- History of FAP - genetic counseling, Colonoscopy or flex-sig every YEAR beginning at age 10-15
- History of HNPCC - Genetic counseling, Colonoscopy every 1-2 years at age 30, every year at age 40 |
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Term
| How does colorectal cancer present? |
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Definition
- Rectal bleeding, blood in stool
- Abdominal pain
- Constipation
- Anorexia/weight loss
- Abdominal distention |
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Term
| What is the staging for colorectal cancer? |
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Definition
- 1 - Local, no muscular mucosa
- 2 - invasion of muscular mucosa
- 3 - nodal involvement
- 4 - metastatic
**Stage is the most important prognostic factor for survival and recurrence |
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Term
| What is the main site of metastasis of colorectal cancer? |
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Definition
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Term
| What indicates a poor prognosis in colorectal cancer? |
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Definition
- Bowel obstruction
- Nodal involvement
- poor differentiation
- Stage 3 or 4
- High CEA level |
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Term
| What is the standard of care for resectable colorectal tumors? |
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Definition
Surgery - 50% cure rate. Harder in rectal cancer
**Radiation - more for rectal cancer. Palliative in colon cancer |
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Term
| When is chemotherapy used for colorectal cancer? |
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Definition
| 1st line for metastatic disease. 6 months is the standard - the least responsive solid tumor to chemo |
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Term
| What is considered the cornerstone of colorectal chemo? |
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Definition
5-FU - indicated in all stages. Bolus (protein) or continuous (DNA) dosing
AE: Hand-Foot syndrome, Diarrhea
**Dose w/ leucovorin - increased response rate |
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Term
| What is given for colorectal cancer following recurrence on 5-FU? |
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Definition
- Irinotecan - Topo I inhibitor. Added to 5-FU/LV 1st line for metastatic. AE: ACUTE and LATE diarrhea. Give SQ atropine and high dose loperamide
- Oxaliplatin - 1st line for metastatic w/ 5-FU/LV or Avastin. Neurotoxic - do not use ICE! PN is cumulative
- Capecitabine - option in place of 5-FU. Increases INR
- Ziv-aflibercept - binds VEGF, when resistant to oxaliplatin. Used w/ 5-FU/LV/Irinotecan. 2nd line. Hemorrage and GI perforation. Wound healing |
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Term
| When should Ziv-aflibercept be suspended in colorectal cancer? |
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Definition
| 4 weeks prior to elective surgery. Recurrent/severe HTN, proteinuria |
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Term
| What monoclonal antibodies can be used for colorectal cancer? |
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Definition
- Cetuximab - EGFR+. Use in K-ras wild type only, in combo w/ FOLFIRI as 1st line. Infusion rxn, diarrhea
- Bevicizumab - targets VEGF receptor. 1st and 2nd line w/ 5-FU. NOT for adjuvant tx of colon cancer. MUST wait 28 days after surgery
- Panitumumab - EGFR+. Can use as single agent, not for use w/ CHEMO |
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Term
| What monoclonal antibody should NOT be used with chemo? |
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Definition
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Term
| What is standard tx for localized disease (stage I-II) in colorectal cancer? |
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Definition
Goal - Cure
Surgery is standard therapy - Primary
**Radiation - adjuvant in stage 2 rectal |
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Term
| What is standard tx for locally advanced (Stage 3) disease in colorectal cancer? |
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Definition
- If tumor is resectable - have surgery
- Radiation + 5-FU (rectal)
- ALWAYS adjuvant chemo - 5-FU based + Leucovorin OR Capec
- FOLFOX - standard of care: 5-FU/LV/Oxaliplatin |
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Term
| What is standard tx for Metastatic(Stage 4) disease in colorectal cancer? |
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Definition
Goal: prolong life. Surgery/radiation are palliative
- Start Chemo w/ a 5-FU/LV regimen -->
- FOLFIRI - 5-FU/LV/Irinotecan
- Can at Avastin or Cetuximab to FOLFIRI
- CapeOX - Capecitabine + oxaliplatin
- CAPIRI - Capecitabine + irinotecan |
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