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What agents are used in Colon Cancer?
- Bevacizumab
- Capecitabine
- Cetuximab
- Fluorouracil
- Irinotecan
- Oxaliplatin
- Panitumumab
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What are the risk factors associated with colon cancer?
- Increase risk:
- Alcohol > 10-14/wk
- DM
- Obesity + inactivity
- Tobacco use
- Western Diet
- Ulcerative colitis
- Crohn's disease
- Familial Adenomatous Polyposis (FAP)
- Hereditary nonpolyposis colon cancer(HNPCC)
- Decrease risk:
- ASA
- NSAIDs
- Ca + Vit D
- Postmenopausal HRT
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What prognostic factors are used to determine tx in colon cancer?
- Depth of tumor in bowel wall
- Presence in lymph nodes
- Bowel obstruction or perforation, rectal bleeding
- High pre-op CEA (carcinoembryonic antigen)
- Distant metastasis
- K-RAS mutations no MABs
- BRAF mutations no MABs
- DNA mismatch repair (MMR) no 5-FU
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What are the stages of Colon Cancer?
- Stage I: depth has not breached the submucosa
- Stage II: breached the submucosa, lymph nodes negative
- Stage III: Lymph nodes positive, no mets
- Stage IV: Metastatic
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What is the tx strategy for colon cancer?
- Stage I: Surgery
- Stage II: Surgery + Adjuvant tx
- Stage III: Surgery + Adjuvant tx
- Stage IV (isolated): Neoadjuvant tx, then Surgery, then Adjuvant tx
- Stage IV (disseminated): Chemotherapy (if PS < 3)
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What is the adjuvant tx for Stages II and III in colon cancer?
- 5-FU + Leucovorin
- Capecitabine
- FLOX (5-FU bolus + Leucovorin + Oxaliplatin)
- FOLFOX (5-FU infusion + Leucovorin + Oxaliplatin)
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What is the first-line chemotherapy for advanced (disseminated) or recurrent colon cancer?
- FOLFOX +/- Bevacizumab (5-FU + Leucovorin + Oxaliplatin)
- CapeOX +/- Bevacizumab (Capecitabine + Oxaliplatin)
- FOLFOX +/- Cetuximab or Panitumumab
- FOLFIRI + Bevacizumab (5-FU + Leucovorin + Irinotecan)
- FOLFIRI +/- Cetuximab or Panitumumab
- Capecitabine +/- Bevacizumab
- FOLFOXIRI (5-FU + Leucovorin + Oxaliplatin + Irinotecan)
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What is the second-line tx for advanced (disseminated) or recurrent colon cancer?
- FOLFIRI
- Irinotecan
- FOLFIRI + Cetuximab or Panitumumab (5-FU + Leucovorin + Irinotecan)
- Cetuximab + Irinotecan
- FOLFOX (5-FU + Leucovorin + Oxaliplatin)
- CapeOX (Capecitain + Oxaliplatin)
- Cetuximab
- Panitumumab
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What is the salvage tx for advanced (disseminated) or recurrent colon cancer?
- Cetuximab
- Panitumumab
- Cetuximab + Irinotecan
- FOLFOX (5-FU + Leucovorin + Oxaliplatin)
- CapeOX (Capecitabine + Oxaliplatin)
- Irinotecan, then Cetuximab (or Panitumumab or Cetuximab + Irinotecan)
- Clinical trial or best supportive care
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