Therapeutics V Exam 2- Colon Cancer

Front 1

rank in cancer deaths for colon cancer

Back 1

#2 cause of cancer deaths in the USA

Front 2

highest incidence of CC is in...(3 countries)

does your risk change if you move there?

Back 2

Highest incidence in North America, Europe, and Australia
Groups moving to high risk areas assume a similar risk

Front 3

CC risk- gender and age relationship

Back 3

Males > females

increase with age

Front 4

4 genetic risk factors for CC

Back 4

1) Familial adenomatous polyposis (APC gene - Adenomatosis polyposis coli)
2) Hereditary nonpolyposis colorectal cancer (no polyps)
3) Family history
4) Inflammatory bowel disease (chrohn's or UC)

Front 5

3 genes associated with CC

Back 5

MLH1 or MSH2 genes (hereditary non polyp cancer)
APC gene (polyp cancer)

Front 6

6 lifestyle risk factors for CC (2 are diet related)

Back 6

Alcohol
Physical inactivity
Obesity
Diets high in fat and red meat
Diets low in fiber, calcium, and folate
Smoking

Front 7

5 preventative factors for CC

Back 7

ASA/NSAIDs due to COX-2 inhibition (COX-2 overexpression found in cancerous and precancerous lesions- angiogenesis and fucks with apoptosis)

Post-menopausal hormone use (19-34% risk reduction)
Physical activity
Statins (?) mevalonic acid decreased-->this is used for cell signalling/synthesis
Diets high in fiber and low in fat (???)

Front 8

NSAID- when do you see benefit for preventing CC (after how long and how many doses per week)

Back 8

there is no significant benefit until after a decade of use, with maximal risk reduction at doses of >14 tabs/week (risk reduction noticed at 2 tablets/week)

Front 9

some may rec what drug and dose for prevention in pt with FAP (familial polyp cc)

Back 9

celecoxib 400 mg PO BID

Front 10

ppl with average risk: what age to screen and frequency

Back 10

routine screen over age of 50 q5 years except colonoscopy which is q10 yr

Front 11

ppl who need to consult with pcp for different screening regimen for cc (2)

Back 11

ppl with fam hx
ppl with genetic mutations (MSH1/2 APC)

Front 12

3 screening options for CC and freq

Back 12

Colonoscopy Q10 years or
Annual FOBT with flexible sigmoidoscopy Q5 years (fecal occult blood test) or
Double-contrast barium enema Q5 years

Front 13

s/sx of early stage CC (7)

Back 13

Change in bowel habits (diarrhea, constipation)
Rectal bleeding
Narrow stools
Feeling of incomplete emptying
N/V
abdominal cramping, distention
Fatigue

Front 14

advanced stage CC sx (7)

Back 14

Hepatomegaly
Jaundice
Leg edema
Weight loss
Thrombophlebitis
Fistula formation
pain of the lower back/leg

Front 15

diagnostic tests for CC (4)

Back 15

CBC, liver chemistries, CEA (carcinoembryonic antigen- will be high)
Colonoscopy or sigmoidoscopy + DCBE (Double contrast barium enema)
Tissue biopsy- most definitive way
CXR- mets?
Chest/abdominal/pelvic CT (check for mets)

Front 16

describe stage 0 through IV of CC

Back 16

Stage 0: carcinoma in situ (not crossed BM)
Stage I: tumor invasion of submucosa or muscularis propria (Muscle layer)
Stage II: serosa involvement or spread to nearby tissues or organs
Stage III: invasion of nearby LN
Stage IV: distant metastases

Front 17

stage 1-4 survival rates

Back 17

Stage 1-3 pretty high survival (up to 83%)

IV is 8%

Front 18

stage 1-3 treatment goals (2)

Back 18

Cure
Avoid recurrence

Front 19

stage IV treatment goals (3)

Back 19

Reduce symptoms
Prolong survival
Improve QOL

Front 20

stage I therapy

Back 20

surgical resection

Front 21

stage II therapy (primary, and additional shit for colon and rectal cancer)

Back 21

surgical resection

Colon cancer: ± chemotherapy (no survival adv so not really standard)
Rectal cancer: 5-FU/leucovorin + RT (remember leucovorin stabilizes 5-FU compound and makes it work better)

RT may benefit stage 2 pts with positive margins

Front 22

stage III therapy (pharm for colon v. rectal and non pharm)

Back 22

surgical section then...

Colon: post-op chemotherapy x 6 months
Rectal carcinoma: pre-op 5-FU/RT + post-op chemotherapy

Front 23

stage IV therapy (2)

Back 23

chemotherapy
Palliative resection and RT

Front 24

adding leucovorin to 5-FU does what?

downside

Back 24

Leucovorin increases the formation of the 5-FU/thymidylate complex, improving efficacy

Toxicities also increased
Diarrhea, mucositis > myelosuppresion

Front 25

Adjuvant Chemotherapy for CC choices

Back 25

5-FU/leucovorin

capecitabine

FOLFOX (infusional 5-FU + leucovorin + oxaliplatin)

Front 26

Capecitabine (PO prodrug of 5-FU)- compare efficacy and safety wise to 5-FU/leucovorin

Back 26

Effective as 5-FU/leucovorin with more tolerable SE

Front 27

FOLFOX- compare to 5-FU/leucovorin (safety (2) and efficacy)

Back 27

Superior to 5-FU/leucovorin
Increased neutropenia, peripheral neuropathy

Front 28

Metastatic Disease:1st line options (3)

Back 28

FOLFOX ± bevacizumab
FOLFIRI ± bevacizumab (Infusional 5-FU/leucovorin/irinotecan)
IFL + bevacizumab (Bolus 5-FU/leucovorin/irinotecan v. the other 2 which were infusions)

Front 29

FOLFIRI: compare to FOLFOX (safety v. efficacy)

Back 29

Similar survival advantage as FOLFOX
Increased diarrhea

Front 30

IFL + bevacizumab v. FOLFIRI/FOLFOX

Back 30

Inferior to FOLFOX or FOLFIRI

Front 31

therapy options for metastatic disease for Patients unable to tolerate intensive therapy (3)

Back 31

Capecitabine
5-FU/leucovorin ± bevacizumab
5-FU

Front 32

2nd line for metastatic disease (4)

Back 32

FOLFOX (like, alone without bevacizumab)
FOLFIRI
Irinotecan and/or cetuximab (can give alone if not tolerating irinotecan)
best supportive care

Front 33

AE of bevacizumab (6)

Back 33

HTN
GI perforation
N/V/Constipation
Impaired wound healing
Proteinuria
Pulmonary hemorrhage

Front 34

bevacizumab indication

Back 34

with 5-FU regimens for initial treatment of metastatic colorectal cancer

Front 35

cetuximab indications (2)

Back 35

2nd line therapy with irinotecan for metastatic colorectal cancer

Monotherapy for patients intolerant to irinotecan

Front 36

cetuximab AE (6)

Back 36

Acne
Nail cracking
Asthenia
Abdominal pain
Nausea, constipation, dyspepsia
Infusion-related reactions