Colorectal Cancer

Front 1

Colonoscopy

Back 1

Facilitates examination of entire bowel to cecum in most patients, simultaneous removal of premalignant lesions, gold standard for colorectal screening

Front 2

Flexible sigmoidoscopy

Back 2

Uses 40-60cm flexible to examine lower of half of the bowel to the splenic flexure for most patients

Front 3

Computed Tomography Colonography (CTC)

Back 3

Virtual colonoscopy: imaging procedure creates 2D or 3D images of colon

Front 4

Double Contrast Barium Enema (DCBE)

Back 4

Coating interior bowel with Barium and distending it with air to produce an image of entire colon

Front 5

Fecal Occult Blood Tests

Back 5

Used to detect occult blood stool that may be associated with bleeding adenomas or cancer

Front 6

STOOL DNA SCREENING TESTS

Back 6

Molecular screening strategies analyze stool samples for presence of potential markers of malignancy in cells

Front 7

EsophagoGastroDuodenoColonoscopy

Back 7

Examination of esophagus, stomach, upper small bowel and large intestine

Front 8

Regional lymphadenectomy

Back 8

Complete surgical resection of primary tumor, curative approach for patients with operable CRC

Front 9

Total Excision of mesorectum

Back 9

Preferred surgical procedure for rectal cancer which includes perirectal fat and draining lymph nodes

Front 10

Adjuvant Therapy for CRC

Back 10

Administered after complete tumor resection to eliminate residual micrometastatic disease, not indicated for stage 1 CRC

Front 11

Adjuvant radiation therapy

Back 11

Limited role in colon cancer, most recurrences are extrapelvic and abdomen

Front 12

Adjuvant Chemotherapy

Back 12

Standard for stage 3 Colon cancer

Front 13

Fluorouracil (fluoropyrimidine)

Back 13

Administered by IV bolus injection (leukopenia) & continuous IV infusion (palmar plantar erythrodysesthesias, hand foot syndrome and stomatitis)

Front 14

Fluorouracil/ leucovorin

Back 14

Acceptable options in patients who cannot receive oxiplatin and unable to tolerate oral capecitabine

Front 15

Oxiplatin based regimens

Back 15

Recommended therapy by national guidelines as 1st line option for stage 3 colon cancer can tolerate combination therapy

Front 16

Adjuvant Radiation plus chemotherapy (rectal cance)

Back 16

Standard for stage 2 and 3 rectal cancer, RT reduces risk of local tumor recurrence , given prior to surgery to decrease tumor size

Front 17

Preoperative (neoadjuvant) chemoradiation

Back 17

Shrinks rectal tumors proor to surgical resection improving sphincter preservation (fluorouracil based regimens or oral capecitabine)

Front 18

Resectable

potentially resectable

unresectable

Back 18

Patients with MRC are considered that are:

Front 19

Multimodality therapy

Back 19

Indicated for resectable or potentially resectable metastasis

Front 20

Chemotherapy

Back 20

For disseminated disease and the primary treatment modality for unresectable MCRC

Front 21

Surgical resection of Metastases

Back 21

Primary goal with curative intent

Front 22

NEOADJUVANT or Conversional chemotherapy

Back 22

Administered to complete resection rates with resectable & potentially resectable liver or lung lesions

Front 23

Hepatic directed therapy

Back 23

In addition or alternative to surgical resection in patients with liver only or predominant MCRC

Front 24

Hepatic Artery Infusion

Back 24

Delivers chemotherapy (floxuridine and fluorouracil) thru hepatic artery directly into the liver

Front 25

Tumor ablation

Back 25

Uses radio-frequency ablation or microwave ablation to generate heat to destroy tumor cells

Front 26

Cryoablation

Back 26

Placement of cryoprobe into tumor, either percutaneously, lowering 20-40 degrees causes tumor destruction

Front 27

Oxiplatin FOLFOX, CapOx

(Fluorouracil, Leucovorin, Oxiplatin)

Back 27

Higher response rates improved PFS and OS

Approved first line and salvage therapy unresectable MCRC

Front 28

Irinotecan (FOLFIRI)

-Topoisomerase I

Back 28

initial therapy improves tumor response rates, time to progression, and OS, dose limiting toxicities late onset diarrhea, neutropenia

Front 29

Infusional Fluorouracil, leucovorin, oxiplatin, irinotecan (FOLFOXIRI)

Back 29

Improved PGS and OS compared to FOLFIRI, causes more neutropenia, neurotoxicity, diarrhea and alopecia

Front 30

Capecitabine monotherapt (Xeloda)

Back 30

Suitable for first line in patients not likely to tolerate IV chemotherapy , available in oral administration, converted to fluorouracil, suitable replacement for infusional fluouracil with oxiplatin

Front 31

Bevacizumab

Back 31

Directed against VEGF, associated with HTN, other safety concerns: bleeding, thrombocytopenia, and proteinuria , should be used as second line if not used as initial tx

Front 32

Cetuximab

Back 32

Patients with wild type KRAS, tumors in combination with FOLFIRI, side effects acne skin like reactions, asthenia, lethargy, malaise, and fatigue

Front 33

Panitumumab (EGFR inhibitor)

Back 33

Can be combined with either FOLFOX or FOLFIRI in patients with wild type KRAS tumors

Front 34

Cetuximab, Panitumumab, Ziv aflebercept, Regorafenib

Back 34

Treatment for metastatic disease, second line therapy

Hint 34

General treatment: administer EFGR inhibitors in combination with irinotecan or as single agents except bevacizumab and ziv aflibercept

Front 35

Cetuximab

Back 35

Alone or combi with irinotecan, patients with disease progression on irinotecan, response rates are greater combination therapy

Front 36

Panitumumab

Back 36

Monotherapy or in combination with chemotherapy regimens, shoule be limited to wild type KRAS tumors

Front 37

Ziv Aflibercept

Back 37

Soluble recombination fusion protein, designed to block angiogenic process

Front 38

Regorafenib (oral angiogenesis inhibitors)

Back 38

Approved for 3rd/4th line treatment of MCRC, no conclusive survival advantage has been demonstrated for palliative HAI

Front 39

•Irinotecan-Induced diarrhea

•Bevacizumab -GI perforation, HTN, proteinuria

•Oxiplatin -induces neuropathy

•cetuximab and panitumumab-skin rash

Back 39

•Irinotecan•Bevacizumab•Oxiplatin •cetuximab and panitumumab

Front 40

•Cure stages 1,2,3 - Eradicate Micromestatic disease

•IV (incurable) -Palliative treatment

-control growth, reduce symptoms, improve QOL, extend survival

Back 40

Goals of treatment for Colorectal Cancer