Quiz
ON13 Colorectal cancer
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Fragen in diesem Quiz (16)
1Choose the incorrect epidemiology statement about colorectal cancer.
- A3rd most common cancer in the world
- BHighest rates in undeveloped/third world nations
- C95% of colorectal cancers are adenocarcinomas
- D91% and 88% 5 year survival rate for early stages of colon and rectal cancer, respectively
- E70% 5 year survival rate after tumor spreads to adjacent lymph nodes
- F12% 5 year survival rate after metastasis
2NZ stats:
- Eight New Zealander’s diagnosed each day
- [blank_start]Three[blank_end] New Zealander’s die from bowel cancer each day
- [blank_start]2nd highest[blank_end] cause of cancer death in New Zealand
- One of the highest rates in the [blank_start]world[blank_end]
- Rates for [blank_start]women[blank_end] are highest in world
- Less frequent in [blank_start]Maori[blank_end] vs. non-Maori- AThree
- B2nd highest
- Cworld
- Dwomen
- EMaori
3Risk factors for colorectal cancer:
[blank_start]Male[blank_end] sex
Age (older)
History of colorectal cancer, [blank_start]polyps, T2DM, IBD[blank_end]
Inherited factors (e.g. familial adenomatous polyposis, [blank_start]family history[blank_end])
Lifestyle factors
Diet ([blank_start]red[blank_end] meat, processed food, high fat, low fibre)
Physical [blank_start]inactivity[blank_end]
Long term [blank_start]smoking[blank_end]
Excessive [blank_start]alcohol[blank_end]
Obesity- AMale
- Bpolyps, T2DM, IBD
- Cfamily history
- Dred
- Einactivity
- Fsmoking
- Galcohol
4Protective Factors:
Some evidence [blank_start]NSAIDs / Aspirin[blank_end] use (13-28% RRR)
[blank_start]Postmenopausal[blank_end] hormone use (RRR 35%)
Healthy BMI, physical [blank_start]activity[blank_end], smoking [blank_start]cessation[blank_end]
Fibre, fruits, vegetables, reduced meat consumption
[blank_start]Calcium and vitamin D[blank_end] supplementation- ANSAIDs / Aspirin
- BPostmenopausal
- Cactivity
- Dcessation
- ECalcium and vitamin D
5Screening usually starts at age 50. Decreases mortality through early detection.
Methods:
[blank_start]Colonoscopy[blank_end] (every 10 years post-50)
Flexible [blank_start]sigmoidoscopy[blank_end] (every 5 years)
CT scan (every 5 years)
Double contrast [blank_start]barium enema[blank_end] (every 5 years)
Fecal occult blood tests ([blank_start]annually[blank_end])- AColonoscopy
- Bsigmoidoscopy
- Cbarium enema
- Dannually
6Which of these is not a symptom of bowel cancer?
- ATenesmus (continual or recurrent inclination to evacuate the bowels)
- BAdvanced: unintentional weight loss, iron-deficiency anemia, weakness
- CBloating
- DRectal bleeding
- EAbdominal pain
- FChanges in bowel habits
- GMucositis
7Diagnosis:
History and physical exam
Colonoscopy [blank_start]or[blank_end] sigmoidoscopy
[blank_start]Biopsy[blank_end] (to confirm presence of cancer)
[blank_start]CT[blank_end] scanning (search for metastases)
Baseline [blank_start]labs[blank_end] (CBC, platelet, liver panel, renal panel, CEA, iron studies)
Pathological staging after tumor resection ([blank_start]TNM[blank_end])
Gene mutation testing (?)- Aor
- BBiopsy
- CCT
- Dlabs
- ETNM
8Staging:
Stage 1 - tumour size T1 (no deeper than [blank_start]submucosa[blank_end]) and T2 ([blank_start]not all the way through muscularis[blank_end])
Stage 2 - T3 ([blank_start]through[blank_end] muscularis)
Stage 3 - N1 ([blank_start]1-3[blank_end] lymph nodes involved), N2 ([blank_start]>4[blank_end] lymph nodes involved)
Stage 4 - M - [blank_start]distant[blank_end] metastases.- Asubmucosa
- Bnot all the way through muscularis
- Cthrough
- D1-3
- E>4
- Fdistant
9Clinical factors associated with poor prognosis:
Bowel [blank_start]obstruction or perforation[blank_end]
High preoperative [blank_start]CEA[blank_end]
Distant [blank_start]metastases[blank_end]
Location of tumor in [blank_start]rectal or rectosigmoid[blank_end] area
Molecular markers (KRAS mutations MSI, BRAF mutations)- Aobstruction or perforation
- BCEA (carcinoembryonic antigen)
- Cmetastases
- Drectal or rectosigmoid
10Treatment:
Need to consider stage, performance status, patient preferences, comorbidities, age. Curability depends on tumor stage.
General approach:
[blank_start]Surgical resection[blank_end] of primary tumor is 1st line therapy (Stage 1, 2, 3)
Removal of tumor plus [blank_start]5cm[blank_end] of tumor free bowel and regional [blank_start]lymph nodes[blank_end] for cure
Adjuvant [blank_start]chemotherapy and/or radiation[blank_end] can be given to eliminate residual micrometastases
if it's metastases (Stage 4)?
Classified as resectable, potentially resectable, or unresectable
[blank_start]Systemic chemotherapy[blank_end] is mainstay, radiation may be used for palliative purposes- ASurgical resection
- B5cm
- Clymph nodes
- Dchemotherapy and/or radiation
- ESystemic chemotherapy
11Adjuvant Systemic Chemotherapy:
Goal: reduce risk of recurrence and overall mortality in Stage [blank_start]III[blank_end]. (Little to no benefit from Stage [blank_start]II[blank_end], no benefit in Stage [blank_start]1[blank_end].)
Duration: [blank_start]6[blank_end] months
Choice of regimen based on toxicity and convenience. Typically based on [blank_start]Fluorouracil or Capecitabine[blank_end] (both with [blank_start]oxaliplatin[blank_end]).- AIII
- BII
- C1
- D6
- EFluorouracil or Capecitabine
- Foxaliplatin
12Leucovorin(Folinic acid), fluorouracil and oxaliplatin aka FOLFOX side effects:
- neutropenia, therefore [blank_start]infections[blank_end]
- anaemia, therefore breathlessness and [blank_start]weakness[blank_end]
- potentially reversible [blank_start]peripheral[blank_end] neuropathy
- nausea
- diarrhoea
- muscositis
- rarely heart problems
CAPOX (capecitabine and oxaliplatin) side effects:
- neutropenia, therefore infections
- anaemia, therefore breathlessness and weakness
- potentially reversible peripheral [blank_start]neuropathy[blank_end]
- nausea
- diarrhoea OR [blank_start]constipation[blank_end]
- muscositis
- [blank_start]palmar-plantar[blank_end] syndrome
- rarely tinnitus, heart problems,- Ainfections
- Bweakness
- Cperipheral
- Dneuropathy
- Econstipation
- Fpalmar-plantar
13Rectal Cancer
- Poorer outcomes. Difficult to [blank_start]resect[blank_end], propensity for [blank_start]recurrence[blank_end].
- Most patients with Stage II or III should receive [blank_start]combined[blank_end] radiation and chemotherapy [blank_start]peri[blank_end]operatively
- [blank_start]Neoadjuvant[blank_end] chemotherapy and radiation for Stage II or III
- Adjuvant for 6 months post-surgery
- Same regimens as indicated or colorectal (e.g. FOLFOX or CapeOx)- Aresect
- Brecurrence
- Ccombined
- Dperi
- ENeoadjuvant
14Colorectal – Metastatic Disease:
- If resectable, surgery is indicated (most commonly [blank_start]liver and lung[blank_end]). Neoadjuvant [blank_start]and[blank_end] adjuvant chemotherapy for patients with metastatic disease [blank_start]isolated[blank_end] to liver or lung. FOLFOX, FOLFIRI, FOLFOXIRI, CapOx.
- Unresectable - Chemotherapy (e.g. FOLFOX, CapOx, FOLFIRI) only. Goal is to control [blank_start]growth[blank_end] and prolong survival.
Role for [blank_start]targeted[blank_end] therapy (bevacizumab) [inhibits VEGF] & EGFR inibitors (cetuximab, panitumumab) [for patients with wild-type RAS tumors)- Aliver and lung
- Band
- Cisolated
- Dgrowth
- Etargeted
15A note about Irinotecan…
Evidence exists for metastatic disease!
Improved overall [blank_start]survival[blank_end] vs. 5FU/LV alone :-)
Combination with 5FU/LV +/- oxaliplatin may improve [blank_start]resectability[blank_end] of metastases and improve patient survival .
Must monitor for [blank_start]diarrhea and neutropenia[blank_end].
Data in adjuvant setting (non-metastatic disease) lacking...- Asurvival
- Bresectability
- Cdiarrhea and neutropenia
16Oral Capecitabine:
May be commonly seen in community pharmacy.
Caution in: [blank_start]CVD, diabetes,[blank_end] electrolyte disturbance, [blank_start]skin[blank_end] conditions.
Avoid in [blank_start]severe hepatic[blank_end] impairment.
Dose reductions if CrCl [blank_start]< 50[blank_end]ml/min, avoid [blank_start]<30[blank_end]ml/min .
Contraceptive advice [blank_start]required[blank_end] for child-bearing aged females.
Potential ADRs: hand-foot syndrome, diarrhea, [blank_start]arrhythmias[blank_end] (rare), [blank_start]severe[blank_end] skin conditions (very rare)- ACVD, diabetes,
- Bskin
- Csevere hepatic
- D< 50
- E<30
- Frequired
- Garrhythmias
- Hsevere
Informationen
- Beschreibung
- Der Nutzer hat seine Fachbereichs-Information gelöscht. Quiz am ON13 Colorectal cancer, erstellt von Gelöschter Nutzer am 09/10/2019.
- Autor
- Gelöschter Nutzer
- Sprache
- English
- Aufrufe
- 67
- Verlauf
- Erstellt am 9 Okt 2019 · aktualisiert am 9 Okt 2019
- Schlagwörter