Flashcards in B8. Surgical and pharmacological treatment of small intestinal and colorectal cancer Deck (18):
Surgical procedure in small intestine cancer
-If possible, resection with end to end anastomoses plus lymphadenectomy.
-If resection is not possible, bypass to allow food to go around tumor.
(If positive tumor margins are left, adjuvant radiotherapy is given)
Radiation therapy for small intestinal cancers
External radiation therapy or internal radiation therapy
Chemotherapy for small intestine cancers
For metastatic cases 5-FU/capecitabine, irinotecan, and oxaliplatin are given
(FOLFOX or FOLFORI)
Colorectal cancer Tis or T1a treatment
Endoscopic mucosal dissection or endoscopic submucosal dissection with 1 cm margins. Plus polypectomy for malignant polyps.
Beyond T1b with M0 stage for colorectal carcinoma
Radical surgery and regional lymphadenectomy (test at least 12 nodes).
N1-N3, adjuvant chemotherapy.
M1 stage colorectal carcinoma
Chemobiological treatment. When operable treat primary and metastasis.
-If there is bleeding or passage dysfunction, total resection is preformed as primary therapy.
Unresectable colorectal carcinoma treatment?
Surgical procedures of colorectal carcinoma
Major surgery types include; right hemicolectomy, sigmoid resection, extended left and right hemicolectomy, subtotal colon resection and total proctocolectomy with or without pouch formation.
For a right hemicolectomy could be attached how?
End-to-side or side-to-side anastomoses
For a left hemicolectomy
End-to-end is most common
In case of ileus or more strenuous colorectal carcinoma surgery what is done? What does the more distal the position of tumor indicate?
an end colostomy is performed according to Hartmann’s procedure and a stoma is placed. The more distal the position of the tumour, the higher chance that the patient will have to wear a temporary or even a permanent stoma.
Is radiotherapy treatment given for colorectal carcinoma?
No, maybe palliative treatment.
Adjuvant chemotherapy of colorectal carcinoma
-Locoreginal lymph node metastasis
-6 to 8 weeks after surgery
Adjuvant chemotherapy in stage 2 colorectal carcinoma tumors
5-FU w/ folinic acid
Stage III colorectal carcinoma adjuvant chemotherapy
Chemotherapy of metastatic colorectal carcinoma
Metastasis carries high mortality.
Treat with 5-FU/capecitabine, irinotecan, and oxaliplatin.
Biologics used for metastatic colorectal carcinoma
Targeted biological therapies rely on:
-EGFR-inhibitors (panitumumab, cetuximab) but limited to wild-type RAS tumours.
-VEGFRinhibitors (bevacizumab, ramucirumab)
-Regorafenib, an oral tyrosine kinase inhibitor
-TAS-102, a per os combine thymidylate synthase and thymidine phosphorylase inhibitor. Longest survival is achievable with a combination or sequence of a targeted biological therapy (EGFR and/or VEGF-inhibitor) and all three effective chemotherapy drugs.