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40 Cards in this Set

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Facilitates examination of entire bowel to cecum in most patients, simultaneous removal of premalignant lesions, gold standard for colorectal screening

Flexible sigmoidoscopy

Uses 40-60cm flexible to examine lower of half of the bowel to the splenic flexure for most patients

Computed Tomography Colonography (CTC)

Virtual colonoscopy: imaging procedure creates 2D or 3D images of colon

Double Contrast Barium Enema (DCBE)

Coating interior bowel with Barium and distending it with air to produce an image of entire colon

Fecal Occult Blood Tests

Used to detect occult blood stool that may be associated with bleeding adenomas or cancer


Molecular screening strategies analyze stool samples for presence of potential markers of malignancy in cells


Examination of esophagus, stomach, upper small bowel and large intestine

Regional lymphadenectomy

Complete surgical resection of primary tumor, curative approach for patients with operable CRC

Total Excision of mesorectum

Preferred surgical procedure for rectal cancer which includes perirectal fat and draining lymph nodes

Adjuvant Therapy for CRC

Administered after complete tumor resection to eliminate residual micrometastatic disease, not indicated for stage 1 CRC

Adjuvant radiation therapy

Limited role in colon cancer, most recurrences are extrapelvic and abdomen

Adjuvant Chemotherapy

Standard for stage 3 Colon cancer

Fluorouracil (fluoropyrimidine)

Administered by IV bolus injection (leukopenia) & continuous IV infusion (palmar plantar erythrodysesthesias, hand foot syndrome and stomatitis)

Fluorouracil/ leucovorin

Acceptable options in patients who cannot receive oxiplatin and unable to tolerate oral capecitabine

Oxiplatin based regimens

Recommended therapy by national guidelines as 1st line option for stage 3 colon cancer can tolerate combination therapy

Adjuvant Radiation plus chemotherapy (rectal cance)

Standard for stage 2 and 3 rectal cancer, RT reduces risk of local tumor recurrence , given prior to surgery to decrease tumor size

Preoperative (neoadjuvant) chemoradiation

Shrinks rectal tumors proor to surgical resection improving sphincter preservation (fluorouracil based regimens or oral capecitabine)


potentially resectable


Patients with MRC are considered that are:

Multimodality therapy

Indicated for resectable or potentially resectable metastasis


For disseminated disease and the primary treatment modality for unresectable MCRC

Surgical resection of Metastases

Primary goal with curative intent

NEOADJUVANT or Conversional chemotherapy

Administered to complete resection rates with resectable & potentially resectable liver or lung lesions

Hepatic directed therapy

In addition or alternative to surgical resection in patients with liver only or predominant MCRC

Hepatic Artery Infusion

Delivers chemotherapy (floxuridine and fluorouracil) thru hepatic artery directly into the liver

Tumor ablation

Uses radio-frequency ablation or microwave ablation to generate heat to destroy tumor cells


Placement of cryoprobe into tumor, either percutaneously, lowering 20-40 degrees causes tumor destruction

Oxiplatin FOLFOX, CapOx

(Fluorouracil, Leucovorin, Oxiplatin)

Higher response rates improved PFS and OS

Approved first line and salvage therapy unresectable MCRC

Irinotecan (FOLFIRI)

-Topoisomerase I

initial therapy improves tumor response rates, time to progression, and OS, dose limiting toxicities late onset diarrhea, neutropenia

Infusional Fluorouracil, leucovorin, oxiplatin, irinotecan (FOLFOXIRI)

Improved PGS and OS compared to FOLFIRI, causes more neutropenia, neurotoxicity, diarrhea and alopecia

Capecitabine monotherapt (Xeloda)

Suitable for first line in patients not likely to tolerate IV chemotherapy , available in oral administration, converted to fluorouracil, suitable replacement for infusional fluouracil with oxiplatin


Directed against VEGF, associated with HTN, other safety concerns: bleeding, thrombocytopenia, and proteinuria , should be used as second line if not used as initial tx


Patients with wild type KRAS, tumors in combination with FOLFIRI, side effects acne skin like reactions, asthenia, lethargy, malaise, and fatigue

Panitumumab (EGFR inhibitor)

Can be combined with either FOLFOX or FOLFIRI in patients with wild type KRAS tumors

Cetuximab, Panitumumab, Ziv aflebercept, Regorafenib

Treatment for metastatic disease, second line therapy

General treatment: administer EFGR inhibitors in combination with irinotecan or as single agents except bevacizumab and ziv aflibercept


Alone or combi with irinotecan, patients with disease progression on irinotecan, response rates are greater combination therapy


Monotherapy or in combination with chemotherapy regimens, shoule be limited to wild type KRAS tumors

Ziv Aflibercept

Soluble recombination fusion protein, designed to block angiogenic process

Regorafenib (oral angiogenesis inhibitors)

Approved for 3rd/4th line treatment of MCRC, no conclusive survival advantage has been demonstrated for palliative HAI

Irinotecan-Induced diarrhea

•Bevacizumab -GI perforation, HTN, proteinuria

•Oxiplatin -induces neuropathy

•cetuximab and panitumumab-skin rash

Irinotecan•Bevacizumab•Oxiplatin •cetuximab and panitumumab

•Cure stages 1,2,3 - Eradicate Micromestatic disease

•IV (incurable) -Palliative treatment

-control growth, reduce symptoms, improve QOL, extend survival

Goals of treatment for Colorectal Cancer