Therapeutics Iii Exam 3 - Colorectal Cancer Questions

Front 1

What is the most common malignancy worldwide?

Back 1

colorectal cancer

Front 2

What are the main risk factors for developing colorectal cancer?

Back 2

1. dietary
2. environmental factors
3. lifestyle choices
4. comorbid conditions
5. physical and genetic susceptibilities

Front 3

What is the relationship between fiber and colorectal cancer?

Back 3

-fiber may reduce colonic mucosal cell exposure to carcinogens
-it is suggested fiber reduces colorectal cancer risk but this is not conclusive

Front 4

What is the relationship between fat and colorectal cancer?

Back 4

It is unclear, but it likely increases risk. Red meat has the strongest association.

Front 5

What is the relationship between calcium/folic acid and colorectal cancer?

Back 5

Calcium and folic acid both reduce the risk of colorectal cancer.

Front 6

What is the relationship between micronutrient deficiencies and colorectal cancer?

Back 6

Micronutrient deficiencies increase the risk of colorectal cancers. This is especially true for vitamins C and E, selenium, and beta-carotene. Supplements do not reduce the risk.

Front 7

What are the clinical risk factors for colorectal cancer?

Back 7

1. Chronic inflammaotry bowel disease (ulcerative colitis x4-20, Chrohn's disease less than UC)
2. Age over 40
3. History of colorectal polyps
4. Prior colorectal carcinoma
5. Pelvic irradiation

Front 8

What is the relationship between postmenopausal exogenous hormone use and colorectal cancer?

Back 8

Hormone use shows significant reduction in colorectal cancer risk. Decreased risk seems to last 10 years after HRT is discontinued.

Front 9

What is the relationship between obesity and colorectal cancer?

Back 9

Physical inactivity and high BMI increase risk. Physical activity increases bowel peristalsis, decreases bowel transit time, and alters glucose, insulin, and hormones to reduce tumor growth.

Front 10

Alcohol intake and colorectal cancer relationship

Back 10

Colorectal cancer risk is increased by 50% with heavy alcohol use.

Front 11

Aspirin and NSAID use and its relationship to colorectal cancer

Back 11

Regular aspirin use is associated with a 22% reduction in colorectal cancer risk. Regular NSAID use reduces colorectal cancer risk by 30-40%.

Front 12

Type 2 diabetes and its relationship to colorectal cancer

Back 12

Type 2 diabetes is associated with a 30% increase in risk of colorectal cancer.

Front 13

What is the relationship between tobacco use and colorectal cancer?

Back 13

Use of tobacco tobacco products contributes to approximately 12% of colorectal cancer deaths annually.

Front 14

What are familial adenomatous polyposis?

Back 14

They account for 0.2-1% of all colon cancers. They are a rare autosomal dominant trait. Hundreds to thousands of polyps develop in the colon and rectum around age 15. Untreated, it is fatal.

Front 15

What are the 2 major hereditary colorectal cancers?

Back 15

1. familial adenomatous polyposis (FAP)
2. hereditary nonpolyposis colorectal cancer

Front 16

What is hereditary nonpolyposis colorectal cancer (HNPCC)?

Back 16

It is a rare autosomal dominant trait (1-5% of colon cancer). Adenomatous polyps develop in proximal colon. Lynch Syndrome I causes colorectal cancer at an early age and Lynch Syndrome II has an 80-85% chance of developing cancer over any time of their lives.

Front 17

What are the main ways of screening for colorectal cancer?

Back 17

1. Digital rectal exam
2. Fecal occult blood testing
3. Flexible sigmoidoscopy
4. Total colonic exam

Front 18

When and how often is a digital rectal exam used?

Back 18

It used be given annually after age 40. It is used in combination with other screening exams. It can detect about 10% of all colon cancers.

Front 19

When and how often is a fecal occult blood test used?

Back 19

It is given annually or biannually after age 50. It is the only test that has been shown to reduce mortality.

Front 20

What are the 3 methods used for the fecal occult blood test?

Back 20

1. Guaiac dye or derivatives - has decreased sensitivity, false negatives and false positives
2. Heme-porphyrine - measures fecal heme degraded by bacteria
3. Immunochemical assays

Front 21

When and why is flexible sigmoidoscopy used?

Back 21

It is useful in examining the lower 35-60% of the bowel. It has an increased detection rate. It can possibly reduce mortality by 60%. It should be given every 5 years after age 50.

Front 22

What are the stages of colorectal cancer?

Back 22

Stage I - superficial tumor (no muscular involvement)
Stage II - invasion through serosa
Stage III - invasion through regional lymph node involvement
Stage IV - metastasis

Front 23

What does T stand for?

Back 23

Primary tumor

Front 24

What does Tx stand for?

Back 24

primary tumor cannot be assessed

Front 25

What does T0 stand for?

Back 25

no evidence of primary tumor

Front 26

What does Tis stand for?

Back 26

carcinoma in situ: intraepithelial or invasion of the lamina propria

Front 27

What does T1 stand for?

Back 27

tumor invades submucosa

Front 28

What does T2 stand for?

Back 28

tumor invades muscularis propria

Front 29

What does T3 stand for?

Back 29

tumor invades through the muscularis propria into the subserosa, or into the nonperitonealized pericolic or perirectal tissues

Front 30

What does T4 stand for?

Back 30

tumor directly invades other organs or structures and/or perforates the visceral peritoneum

Front 31

What does N stand for?

Back 31

regional lymph node

Front 32

What does Nx stand for?

Back 32

regional nodes cannot be assessed

Front 33

What does N0 stand for?

Back 33

no regional lymph node metastasis

Front 34

What does N1 stand for?

Back 34

metastasis in one to three regional lymph nodes

Front 35

What does N2 stand for?

Back 35

metastasis in four or more regional lymph nodes

Front 36

What does M stand for?

Back 36

distant metastasis

Front 37

What does Mx stand for?

Back 37

distant metastasis cannot be assessed

Front 38

What does M0 stand for?

Back 38

no distant metastasis

Front 39

What does M1 stand for?

Back 39

distant metastasis

Front 40

General treatment information of colorectal cancer

Back 40

Stages I, II, and III are considered potentially curable (20-30%) with a focus on eliminating micrometastases. Stage IV is generally not curable with a focus on palliative treatment of metastatic disease.

Front 41

When is adjuvant chemotherapy used in colorectal cancer?

Back 41

It is recommended in Stage III. Fluorouracil is the mainstay of therapy (leucovorin increases binding affinity of 5FU and enhances it cytotoxic activity).

Front 42

What is the FOLFOX4 regimen?

Back 42

Oxaliplatin on day 1.
Folinic acid on day 1 and 2.
5FU 400 mg/m2 IV bolus, after folinic acid then 600mg/m2 CIV over 22 hours on days 1 and 2.
Repeat every 14 days.

Front 43

What is the FLOX regimen?

Back 43

Oxaliplatin on weeks 1, 3, and 5.
5FU weekly for 6 weeks.
Folinic acid weekly for 6 weeks
-each cycle lasts 8 weeks and is repeated for 3 cycles

Front 44

What is the Mayo Clinic regimen?

Back 44

5FU on days 1-5.
Folinic acid on days 1-5.
-repeat every 4-5 weeks

Front 45

What is the purpose of oxaliplatin?

Back 45

it results in a 23% risk reduction of recurrence and increased 3 year disease free survival

Front 46

What are the adverse effects of 5FU continuous infusion?

Back 46

-Palmar-planter erythrodysesthesia (hand-foot syndrome) which is painful swelling of the hands and feet that is reversible but acutely disabling
-stomatitis

Front 47

What are the adverse effects of oxaliplatin?

Back 47

-anaphylaxis
-neuropathy
-hepatitis
-pulmonary fibrosis