colon cancer

Question 1

Tx: Stage I - IIC (without high risk features), LN negative

Answer 1

Resection

Question 2

Tx: Stage III - LN positive

Answer 2

Resection + FOLFOX (5FU, Leucovorin, Oxiplatin)

Question 3

Tx: Stage IV

Answer 3

Palliative resection,
5FU + leucovorin + Irinotecan
Bevacizumab (FOLFIRI) + Ziv-Aflibercept

Question 4

Layers and stages
I
IIA
IIB
IIC
III
IV

Answer 4

I - Mucosa
IIA - Submucosa
IIB - Muscularis
IIC -Serosa
III - visceral perotineum (past the serosa)
IV - distant mets

*I, IIA, IIB, IIC - all node negative
III, IV - node positive

Question 5

What treatment shows benefit in patients with metastatic mismatch repair−deficient colorectal cancer?

Answer 5

An immune checkpoint inhibitor, such as pembrolizumab

Question 6

Screening colonoscopy for:

average risk

Answer 6

50 YO - every 10 years to age 75

Question 7

Screening colonoscopy for:

first-degree relative with colon cancer at age greater than or equal to 60 YO

Answer 7

50 YO - every 10 years to age 75

Question 8

Screening colonoscopy for:
First-degree relative diagnosed with an adenomatous polyp or colon cancer at age less than or equal to 60 YO
OR
Two second-degree relatives with adenomatous polyp or colon cancer at any age

Answer 8

40 YO or 10 years younger than the earliest diagnosis in the family - every 5 years

Question 9

Screening colonoscopy for:

two first-degree relatives with colon cancer

Answer 9

40 YO or 10 years younger than the earliest diagnosis in the family - every 3-5 years

Question 10

Screening colonoscopy for:
HNPCC risk (Lynch syndrome)

Answer 10

20-25 YO or 10 years younger than the age of youngest person in family diagnosed with colon cancer - every 1-2 years

Question 11

Screening colonoscopy for:

Familial adenomatous polyposis risk

Answer 11

10-12 YO - every 1-2 years with colonoscopy or sigmoidoscopy

Question 12

Screening colonoscopy for:

Pancolitis (ulcerative colitis or Crohn disease)

Answer 12

8 years after initial diagnosis - every 1-2 years

Question 13

Screening colonoscopy for:

Primary sclerosing cholangitis

Answer 13

at time of diagnosis - 1-2 years

Question 14

Postpolypectomy surveillance:
1-2 tubular adenomas < 10 mm
OR
few small (< 10 mm), distal hyperplastic polyps

Answer 14

5-10 years

Question 15

Postpolypectomy surveillance:

3-10 adenomas, greater or equal to 10 mm, villous histology, or high grade dysplasia

Answer 15

3 years

Question 16

Postpolypectomy surveillance:

greater than or equal to 10 adenomas on single examination

Answer 16

< 3 years; a genetic cause of disease should be investigated