colon and lung Flashcards Preview

PT3 Oncology > colon and lung > Flashcards

Flashcards in colon and lung Deck (55):
1

colon cancer risk

1 in 25

2

colon cancer growth rate

slow

3

risk factors of colon cancer

-Family history 20%
-IBD
-lifestyle factors

4

life style risk factors for colon cancer

-smoking
-red/processed meats
-alcohol
-low physical activity
-high BMI

5

age to start colon cancer screening if no risk factors

50

6

age to start colon cancer screening if FHx positive

40 or 10 years prior to relatives diagnosis

7

age to start colon cancer screening if HNPCC

20-25

8

age to start colon cancer screening if FAP

puberty, 10-12

9

age to start colon cancer screening if UC or CD

8 years after onset

10

two types of screening tools for colon cancer

-flexible sigmoidoscopy
-total colonoscopy

11

flexible sigmoidoscopy features

-removes polyps
-20 mins
-no sedation
-only examines 60% of colon
-no biopsy
-less bowel prep

12

total colonoscopy features

-examines whole bowel
-removes polyps
-can biopsy
-not as cost effective
invasive
-intense bowel prep

13

factors that lead to mutation in colon cancer development

-activation of Wnt
-activation of EGFR and oncogenes
-inactivation of tumor suppressors

14

most common sites of metastasis for colon cancer

in order:
-liver
-lung
-bone

15

staging work up needed for colon cancer

-CT or MRI
-diagnostic colonoscopy
-CBC and CMP
-genetic testing

16

important genetic tests for colon cancer

-Ras
-micro-satellite instability
-mismatch repair

-UGT1A1

17

curable stages of colon cancer

stage 1 - 3B

18

general treatment for stage 0 and 1 colon cancer

surgery
surveillance

19

general treatment for stage 2 colon cancer

surgery
adjuvant chemo?

20

general treatment for stage 3 colon cancer

surgery?
adjuvant chemo

21

general treatment for stage liver only metastasis in colon cancer

-chemoembolization
-hepatic arterial infusion chemo
-surgery?

22

general treatment for stage 4 colon cancer

-palliative chemo
-surgery/radiation?

23

treatment of choice for stages 1-3 of colon cancer

surgery

24

what drug do we need to check UGT1A1 for

irinotecan

25

adjuvant chemo for stage 3 colon cancer

5-FU/leucovorin

26

adjuvant chemo options for high risk stage 3 or palliative colon cancer

-FOLFOX +/- bevacizumab
-FOLFOX +/- cetuximab/panitumumab
-CAPEOX +/- bevacizumab
-FOLFIRI + cetuximab/panitumumab

27

duration of therapy for high risk stage 3 colon cancer

6 months

28

duration of therapy for metastatic colon cancer

until progression or intolerance to therapy

29

if patient progressed through FOLFOX and FOLFIRI OR can't tolerate intense therapy, what can we use

-MIS, MMR therapy
-PD-1 therapy (nivolumab/ pembrolizumab)

30

drugs in mFOLFOX 6 + beva regimen and cycle length

-leucovorin
-oxaliplatin
-5-FU push and cont.
-Beva
14 day cycle, 12 cycles

31

unique toxicity from oxaliplatin

laryngeal spasms when drinking something cold

32

how leucovorin works in colon cancer

helps 5-FU bind and stay bound to thymidylate synthase

33

monitoring for FOLFOX + Bev

-bone marrow, especially platelets
-renal/hepatic function
-neurologic effects
-vascular - VTE
-wound healing

34

minimum time between bevacizumab treatment and surgical procedures

28 days due to reduced healing

35

side effects for FOLFOX + bevacizumab

-fatigue
-N/V/D
-infection
-laryngeal spasm/neuropathy
-bruising, bleeding, clotting

36

lifetime risk of lung cancer

1 in 15

37

workup and staging of lung cancer

-Hx and physical
-symptoms (coughing blood)
-cbc/cmp
-PET-Ct or MRI
-biopsy
-ECOG

38

ECOG scale for lung cancer

0 = fully active
1 = restricted from strenuous activity, can do light work
2 = up and about >50%
3 = in bed or chair > 50%
4 = completely disabled
5 = dead

39

ECOG scores we're willing to treat aggressively

0-2

40

general types of lung cancer

-non-small cell lung cancer
-small cell lung cancer

41

characteristics of small cell lung cancer

-fast doubling time
-high growth fraction
-early development of metastasis
-highly correlated with smoking
-no effective means to screen

42

most pts diagnosed with SCLC are in which stage

stage 4

43

upside of treating SCLC

-responsive to chemo
-responsive to radiation
-substantial improvement in QoL

44

downside of treating SCLC

-metastasis has usually already occurred
-after initial treatment its usually resistant
-abnormal secretions (ACh, prothrombotics)

45

treatment plan for limited stage SCLC

chemo and radiotherapy to chest

46

treatment plan for extensive stage SCLC

chemo alone

47

chemo treatment for SCLC including cycle

etoposide and cisplatin/carboplatin
21 day cycle, 6 cycles

48

characteristics of non-small cell lung cancer

-moderate doubling time
-low growth fraction
-early development of metastasis
-highly correlated with smoking
-no effective means to screen

49

staging of SCLC

1-3 confined to ipsilateral hemithorax
4 beyond ipsilateral hemithorax

50

staging of NSCLC

1 - localized
2 - localized w/lymph
3 - invasion through lung
4 - distant spread

51

chemotherapy strategy for early stage lung cancer

doublet therapy

52

chemotherapy strategy for metastatic NSCLC

if we have agents that can be used for targeted therapy use the
otherwise doublet therapy if they can tolerate

53

doublet therapy regimens for NSCLC

-cisplatin + paclitaxel or gemcitabine or docetaxel
-carboplatin + paclitaxel

54

mutations important in treatment of NSCLC

ALK
ROS1
KRAS
BRAF

55

oncogene addiction

mutations that drive the neoplastic phenotype