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47 Cards in this Set
- Front
- Back
What is the most common malignancy worldwide?
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colorectal cancer
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What are the main risk factors for developing colorectal cancer?
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1. dietary
2. environmental factors 3. lifestyle choices 4. comorbid conditions 5. physical and genetic susceptibilities |
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What is the relationship between fiber and colorectal cancer?
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-fiber may reduce colonic mucosal cell exposure to carcinogens
-it is suggested fiber reduces colorectal cancer risk but this is not conclusive |
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What is the relationship between fat and colorectal cancer?
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It is unclear, but it likely increases risk. Red meat has the strongest association.
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What is the relationship between calcium/folic acid and colorectal cancer?
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Calcium and folic acid both reduce the risk of colorectal cancer.
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What is the relationship between micronutrient deficiencies and colorectal cancer?
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Micronutrient deficiencies increase the risk of colorectal cancers. This is especially true for vitamins C and E, selenium, and beta-carotene. Supplements do not reduce the risk.
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What are the clinical risk factors for colorectal cancer?
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1. Chronic inflammaotry bowel disease (ulcerative colitis x4-20, Chrohn's disease less than UC)
2. Age over 40 3. History of colorectal polyps 4. Prior colorectal carcinoma 5. Pelvic irradiation |
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What is the relationship between postmenopausal exogenous hormone use and colorectal cancer?
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Hormone use shows significant reduction in colorectal cancer risk. Decreased risk seems to last 10 years after HRT is discontinued.
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What is the relationship between obesity and colorectal cancer?
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Physical inactivity and high BMI increase risk. Physical activity increases bowel peristalsis, decreases bowel transit time, and alters glucose, insulin, and hormones to reduce tumor growth.
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Alcohol intake and colorectal cancer relationship
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Colorectal cancer risk is increased by 50% with heavy alcohol use.
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Aspirin and NSAID use and its relationship to colorectal cancer
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Regular aspirin use is associated with a 22% reduction in colorectal cancer risk. Regular NSAID use reduces colorectal cancer risk by 30-40%.
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Type 2 diabetes and its relationship to colorectal cancer
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Type 2 diabetes is associated with a 30% increase in risk of colorectal cancer.
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What is the relationship between tobacco use and colorectal cancer?
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Use of tobacco tobacco products contributes to approximately 12% of colorectal cancer deaths annually.
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What are familial adenomatous polyposis?
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They account for 0.2-1% of all colon cancers. They are a rare autosomal dominant trait. Hundreds to thousands of polyps develop in the colon and rectum around age 15. Untreated, it is fatal.
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What are the 2 major hereditary colorectal cancers?
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1. familial adenomatous polyposis (FAP)
2. hereditary nonpolyposis colorectal cancer |
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What is hereditary nonpolyposis colorectal cancer (HNPCC)?
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It is a rare autosomal dominant trait (1-5% of colon cancer). Adenomatous polyps develop in proximal colon. Lynch Syndrome I causes colorectal cancer at an early age and Lynch Syndrome II has an 80-85% chance of developing cancer over any time of their lives.
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What are the main ways of screening for colorectal cancer?
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1. Digital rectal exam
2. Fecal occult blood testing 3. Flexible sigmoidoscopy 4. Total colonic exam |
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When and how often is a digital rectal exam used?
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It used be given annually after age 40. It is used in combination with other screening exams. It can detect about 10% of all colon cancers.
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When and how often is a fecal occult blood test used?
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It is given annually or biannually after age 50. It is the only test that has been shown to reduce mortality.
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What are the 3 methods used for the fecal occult blood test?
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1. Guaiac dye or derivatives - has decreased sensitivity, false negatives and false positives
2. Heme-porphyrine - measures fecal heme degraded by bacteria 3. Immunochemical assays |
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When and why is flexible sigmoidoscopy used?
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It is useful in examining the lower 35-60% of the bowel. It has an increased detection rate. It can possibly reduce mortality by 60%. It should be given every 5 years after age 50.
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What are the stages of colorectal cancer?
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Stage I - superficial tumor (no muscular involvement)
Stage II - invasion through serosa Stage III - invasion through regional lymph node involvement Stage IV - metastasis |
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What does T stand for?
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Primary tumor
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What does Tx stand for?
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primary tumor cannot be assessed
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What does T0 stand for?
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no evidence of primary tumor
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What does Tis stand for?
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carcinoma in situ: intraepithelial or invasion of the lamina propria
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What does T1 stand for?
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tumor invades submucosa
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What does T2 stand for?
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tumor invades muscularis propria
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What does T3 stand for?
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tumor invades through the muscularis propria into the subserosa, or into the nonperitonealized pericolic or perirectal tissues
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What does T4 stand for?
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tumor directly invades other organs or structures and/or perforates the visceral peritoneum
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What does N stand for?
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regional lymph node
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What does Nx stand for?
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regional nodes cannot be assessed
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What does N0 stand for?
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no regional lymph node metastasis
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What does N1 stand for?
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metastasis in one to three regional lymph nodes
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What does N2 stand for?
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metastasis in four or more regional lymph nodes
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What does M stand for?
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distant metastasis
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What does Mx stand for?
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distant metastasis cannot be assessed
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What does M0 stand for?
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no distant metastasis
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What does M1 stand for?
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distant metastasis
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General treatment information of colorectal cancer
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Stages I, II, and III are considered potentially curable (20-30%) with a focus on eliminating micrometastases. Stage IV is generally not curable with a focus on palliative treatment of metastatic disease.
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When is adjuvant chemotherapy used in colorectal cancer?
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It is recommended in Stage III. Fluorouracil is the mainstay of therapy (leucovorin increases binding affinity of 5FU and enhances it cytotoxic activity).
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What is the FOLFOX4 regimen?
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Oxaliplatin on day 1.
Folinic acid on day 1 and 2. 5FU 400 mg/m2 IV bolus, after folinic acid then 600mg/m2 CIV over 22 hours on days 1 and 2. Repeat every 14 days. |
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What is the FLOX regimen?
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Oxaliplatin on weeks 1, 3, and 5.
5FU weekly for 6 weeks. Folinic acid weekly for 6 weeks -each cycle lasts 8 weeks and is repeated for 3 cycles |
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What is the Mayo Clinic regimen?
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5FU on days 1-5.
Folinic acid on days 1-5. -repeat every 4-5 weeks |
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What is the purpose of oxaliplatin?
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it results in a 23% risk reduction of recurrence and increased 3 year disease free survival
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What are the adverse effects of 5FU continuous infusion?
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-Palmar-planter erythrodysesthesia (hand-foot syndrome) which is painful swelling of the hands and feet that is reversible but acutely disabling
-stomatitis |
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What are the adverse effects of oxaliplatin?
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-anaphylaxis
-neuropathy -hepatitis -pulmonary fibrosis |