Colorectal Cancer

Front 1

right colon sx

Back 1

anemia

Front 2

transverse colon sx

Back 2

obstruction

Front 3

sigmoid colon & rectum sx

Back 3

bleeding, change in bowel habits

Front 4

stage 1

Back 4

no LN, small tumor

Front 5

stage 2

Back 5

no LN, invades subserosa

Front 6

stage 3

Back 6

LN w/ cancer

Front 7

stage 4

Back 7

distant metastasis

Front 8

colon and rectal cancers are both...

Back 8

adenocarcinoma!

Front 9

rectal cancer dx

Back 9

endorectal US, MRI

Front 10

rectal cancer surgery - w/ colostomy

Back 10

abdominal perineal (AP) resection

Front 11

rectal cancer surgery - no colostomy

Back 11

colo-anal anastomosis, low anterior resection

Front 12

Mesorectal excision

Back 12

extremely important in rectal cancer

Front 13

Rectal cancer therapy

Back 13

Neoadjuvant chemo & radiation for stage 2 and 3

Front 14

Colon cancer therapy

Back 14

no neoadjuvant therapy; adjuvant chemo for stage 3 (and 2?)

Front 15

treating stage 4 colon and rectal cancer - old drugs

Back 15

standard chemo = 5-FU, Leucovorin, Irinotecan, Oxaliplatin

Front 16

treating stage 4 colon and rectal cancer - biological agents

Back 16

Bevacizumab, Cetuximab & Panitumumab, Aflibercept, Regorafenib, Trifluridine & Tipiracil

Front 17

EGFR1 antibody drugs

Back 17

Cetuximab, Panitumumab - only in KRAS, NRAS wild type

Front 18

multi-kinase inhibitor

Back 18

Regorafenib (oral)

Front 19

anti-angiogenesis

Back 19

Bevacizumab, Aflibercept

Front 20

survival for stage 4 colon cancer

Back 20

no chemo = 5mo; old chemo = 11mo; new chemo/biological agents = 24-30mo

Front 21

treat hepatic mets of colon cancer

Back 21

resection, radio frequency ablation (RFA), cryoablation, stereotactic radiation

Front 22

anal cancer RF

Back 22

HIV, HPV, smoking

Front 23

anal cancer Rx

Back 23

radiation with chemotherapy (5FU/Mitomycin C); biopsy 6-8 weeks after completing chemo - failure do surgery (AP resection)

Front 24

anal cancer histology

Back 24

squamous, cloacogenic

Front 25

boundary for anus/rectum

Back 25

dentate line

Front 26

boundary for rectum/colon

Back 26

peritoneal reflection

Front 27

esophageal cancer

Back 27

upper 1/3 = squamous; a/w smoking & alcohol

lower = adenoCA; a/w BE

Front 28

esophageal cancer rx

Back 28

overall 5ys is 15%; surgery + neoadjuvant chemoradiation (Cisplatinum/5FU, carboplatin/paclitaxel)

Front 29

Metastatic esophageal cancer Rx

Back 29

Cisplatinum, 5FU, Irinotecan, Taxanes, Trastuzumab; median survival 6-12mo

Front 30

gastric cancer rx

Back 30

combined neoadjuvant/adjuvant therapy - epirubicin, cisplatin, 5-FU + surgery + 5FU after surgery

Front 31

Metastatic gastric cancer

Back 31

survival ~8mo; use multiple agents, more aggressive regimens

Front 32

MALT lymphoma

Back 32

in stomach; cure w/ H. pylori antibiotics

Front 33

Hepatocellular carcinoma

Back 33

6-20 mo survival; causes = hepB carrier, HCV infection, aflatoxin, hereditary hemochromatosis, cirrhosis

Front 34

when do screening for hepatocellular CA?

Back 34

Hep B carriers, cirrhosis from HepC, hemochromatosis, alcohol, primary biliary cirrhosis

Front 35

hepatocellular CA screening

Back 35

alpha feto protein (AFP), liver US

Front 36

hepatocellular CA Rx - curative

Back 36

liver transplant is best option, surgical resection

Front 37

hepatocellular CA Rx - noncurative

Back 37

radiofrequency ablation, perQ ethanol/acetic acid ablation, Transarterial chemoembolization (TACE), cryoablation, radiation, systemic chemo

Front 38

Pancreatic cancer survival & causes

Back 38

5ys <5%; causes = chronic pancreatitis, smoking, DM, genetics

Front 39

Pancreatic cancer sx

Back 39

pain, weight loss, jaundice, steatorrhea, left supraclavicular lymphadenopathy (Virchow's node)

Front 40

Courvoisier's sign

Back 40

nontender but palpable distended GB at right costal margin

Front 41

Trousseau's syndrome

Back 41

migratory superficial thrombophlebitis + DVT

Front 42

pancreatic cancer dx

Back 42

US, CT scan, ERCP, endoscopic US, MRI, MRCP, laparoscope

Front 43

Whipple surgery

Back 43

pancreaticoduodenectomy - remove pancreatic head, duodenum, prox. jejunum, common bile duct, GB, part of stomach

Front 44

Pancreatic cancer rx

Back 44

adjuvant chemo/radiation: 5FU, gemcitabine

Front 45

metastatic pancreatic cancer rx

Back 45

Gemcitabine + nab-paclitaxel, Folfirinox, Erlotinib (oral EGFR inhibitor)

Front 46

gallbladder cancer

Back 46

uncommon, poor prognosis, a/w gallstones

Front 47

Cholangiocarcinoma

Back 47

cancer of bile duct - intra/extra hepatic ducts; RF = primary sclerosing cholangitis; give Gemcitabine, Cisplatinum

Front 48

GIST (gastrointestinal stromal tumor)

Back 48

stomach and prox. small intestine; KIT or PDGFRA mutation; resection or chemo if unresectable - Imatinib, Sunitinib, Regorafenib

Front 49

Carcinoid syndrome

Back 49

flushing, diarrhea; rx = somatostatin analog octreotide

Front 50

carcinoid - sign of metastasis

Back 50

elevated 24h urine 5-HIAA (liver mets)

Front 51

primary carcinoid

Back 51

appendix, small bowel, lung; 5ys = 82%

Front 52

overall prognosis for upper GI cancer?

Back 52

poor prognosis, relatively insensitive to chemo