Colorectal Cancer Chemotherapy

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Questions and Answers

Adjuvant chemotherapy is administered at which point in relation to surgery?

  • During surgery to target cancer cells directly.
  • In place of surgery when the tumor is inoperable.
  • Before surgery to prevent metastasis.
  • After surgery to eliminate residual cancer cells. (correct)

What is the primary goal when chemotherapy is used to treat metastatic cancer?

  • To shrink the tumor, prevent obstruction, improve quality of life and prolong survival. (correct)
  • To eliminate the need for further treatments, such as radiation.
  • To completely eradicate the cancer from the body.
  • To prepare the patient for surgery by reducing tumor size.

Why are colorectal cancers (colon and rectal cancers) grouped together?

  • They share similar clinical features, management principles, and prognosis. (correct)
  • They only spread to the same specific distant organs.
  • They always require the same surgical procedures.
  • They respond exclusively to the same chemotherapy regimens.

Which of the following describes systemic chemotherapy?

<p>Involves drugs that reach almost all areas of the body to treat or prevent metastasis. (C)</p> Signup and view all the answers

What is the rationale behind using multiple drugs in combination chemotherapy?

<p>To target cancer cells at different phases of the cell cycle and minimize resistance. (A)</p> Signup and view all the answers

In cancer treatment, what does the term 'targeted therapy' refer to?

<p>Therapies that selectively target specific molecules needed for cancer cell growth. (B)</p> Signup and view all the answers

Why is leucovorin administered along with 5-fluorouracil (5-FU) in chemotherapy regimens?

<p>To enhance the cytotoxic efficacy of 5-FU by stabilizing its binding to thymidylate synthase. (A)</p> Signup and view all the answers

What is the mechanism of action of irinotecan?

<p>It inhibits topoisomerase-I, preventing DNA ligation. (B)</p> Signup and view all the answers

What is a major, dose-limiting side effect associated with Oxaliplatin?

<p>Peripheral neuropathy. (A)</p> Signup and view all the answers

How does Bevacizumab work in cancer treatment?

<p>By blocking vascular endothelial growth factor (VEGF) to inhibit tumor angiogenesis. (D)</p> Signup and view all the answers

Cetuximab targets which of the following?

<p>Epidermal growth factor receptor (EGFR). (D)</p> Signup and view all the answers

Toxicity to which normal cells is a typical side effect of chemotherapy?

<p>Rapidly dividing normal cells. (D)</p> Signup and view all the answers

What is the role of thymidine phosphorylase in the context of capecitabine?

<p>It activates capecitabine into 5-fluorouracil. (B)</p> Signup and view all the answers

Which of these is a common adverse effect associated with 5-Fluorouracil (5-FU)?

<p>Hand-foot syndrome. (A)</p> Signup and view all the answers

Which of these is an example of a cell-cycle specific drug?

<p>5-Fluorouracil (A)</p> Signup and view all the answers

Which of these is an example of a cell cycle non-specific drug?

<p>Oxaliplatin (C)</p> Signup and view all the answers

What is the purpose of a 'rest period' during cycles of chemotherapy?

<p>To give the normal cells time to recover from the effects of chemotherapy. (C)</p> Signup and view all the answers

For which of the following reasons would a patient be advised to take a laxative?

<p>To prepare for a colonoscopy (D)</p> Signup and view all the answers

Which of the following statements regarding chemotherapy is correct?

<p>Anticancer drugs are more selective towards cancer cells because cancer cells divide faster than normal cells. (D)</p> Signup and view all the answers

Which class of drug does Irinotecan belong to?

<p>Campothecin (C)</p> Signup and view all the answers

Which of the following is a potential result of acetylcholinesterase inhibition?

<p>Cholinergic syndrome (B)</p> Signup and view all the answers

Which of the following side effects can result from inflammation at the injection site of Oxaliplatin?

<p>Pain (B)</p> Signup and view all the answers

Which of the following is not a class for laxatives?

<p>Inhibitors (C)</p> Signup and view all the answers

What is the purpose of administering Neoadjuvant Chemotherapy?

<p>To shrink the cancer and make it easier to remove during surgery (D)</p> Signup and view all the answers

What is the main purpose of regional chemotherapy?

<p>Targets the effect of chemo on cancer sites (D)</p> Signup and view all the answers

What is the impact of administering multiple dorugs in combination chemotherapy?

<p>Prevents or delays the emergence of drug-resistant tumor cell lines (C)</p> Signup and view all the answers

Which chemotherapy protocols used for CRC include leucovorin, 5 FU and oxaliplatin?

<p>FOLFOX (D)</p> Signup and view all the answers

Why is the L-asparaginase used in chemotherapy?

<p>Deaminates asparagine (B)</p> Signup and view all the answers

What is the purpose of therapies that Inhibit receptor function & expression?

<p>HORMONE ANTAGONISTS (B)</p> Signup and view all the answers

Which phase does chemotherapy drugs target to undergo apoptosis?

<p>S-phase (C)</p> Signup and view all the answers

Which drug inhibits vascular growth of tumor blood vessels (angiogenesis), thus limits blood flow to tumor?

<p>Bevacizumab (B)</p> Signup and view all the answers

What do Cetuximab receptors bind to?

<p>EGF (B)</p> Signup and view all the answers

Which of the following is a symptom of toxicity?

<p>All of the above (D)</p> Signup and view all the answers

What causes Cholinergic syndrome treated with atropine?

<p>Acetylcholinesterase inhibition (B)</p> Signup and view all the answers

Which treatment is often the main one for early-stages of colon cancers ?

<p>Surgery (A)</p> Signup and view all the answers

What is used to treat patients that have low ECOG performance?

<p>Capecitabine PO (B)</p> Signup and view all the answers

Which route of administration is not used with 5-Fluorouracil (5 FU)?

<p>Oral (C)</p> Signup and view all the answers

Flashcards

Colorectal Cancer

Cancer of the colon or rectum.

Curative Chemotherapy

Treatment that aims to eliminate all cancer cells and prevent recurrence.

Palliative Chemotherapy

Treatment that relieves symptoms and improves quality of life when a cure is not possible.

Adjuvant Chemotherapy

Treatment administered after surgery to eliminate remaining cancer cells.

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Neoadjuvant Chemotherapy

Treatment given before surgery to shrink the tumor.

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Chemotherapy

Drugs that kill cancer cells but also harm rapidly dividing normal cells.

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Targeted therapy

Drugs that target molecules needed for cancer cell growth, minimizing harm to normal cells.

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Immunotherapy

Therapy that stimulates the immune system to kill cancer cells.

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Cell cycle

Cell division leading to mature cells.

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Cell Cycle Specific Chemotherapy

Chemotherapy that targets specific phases of the cell cycle.

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Cell Cycle Non-Specific Chemotherapy

Chemotherapy that is effective in all phases of the cell cycle.

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Prodrug

A medication that is converted into an active drug by the body.

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Chemotherapy for Metastatic Cancer

Used to shrink tumors, prevent obstruction, improve quality of life, and prolong survival in metastatic cancer.

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Combination Chemotherapy

The use of multiple chemotherapy drugs together to maximize cell kill.

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Alopecia

A common side effect of chemotherapy which causes hair loss.

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Mucositis

A common side effect of chemotherapy which causes inflammation of the mucous membranes.

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Adverse Effects of Chemotherapy

Side effects that result from toxicity of chemo drugs.

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Laxatives

Drugs that loosen stools and increase bowel movements.

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FdUMP

5-Fluorouracil is metabolized to this active metabolite.

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Bevacizumab

Blocks vascular endothelial growth factor (VEGF).

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Cetuximab

Binds to epidermal growth factor receptor (EGFR).

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Irinotecan

A chemotherapy drug used in colorectal cancer that inhibits topoisomerase I, leading to DNA breaks.

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Oxaliplatin

Cell cycle non-specific platinum compound used to treat CRC.

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Capecitabine

An antimetabolite prodrug that is converted to 5-fluorouracil in the body.

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5-Fluorouracil (5-FU)

An antimetabolite chemotherapy drug that inhibits thymidylate synthase.

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FOLFOX

Contains leucovorin, 5-FU, and oxaliplatin; a chemotherapy regimen for colorectal cancer.

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FOLFIRI

Contains leucovorin, 5-FU, and irinotecan; a chemotherapy regimen for colorectal cancer.

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FOLFIXIRI

Contains leucovorin, 5-FU, oxaliplatin, and irinotecan; a chemotherapy regimen for colorectal cancer.

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5-FU side effects

Hand-foot syndrome and bone marrow suppression.

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Study Notes

Trigger Cases

  • A patient is advised to take a laxative the night before a colonoscopy or barium enema to clear the bowel
  • A multidisciplinary team determined a patient was unfit for FOLFOX chemotherapy, so adjuvant chemotherapy with the oral prodrug capecitabine was administered instead of radiation therapy

Learning Needs

  • General principles of anticancer chemotherapy, its adverse effects, cytotoxic drugs for colorectal cancer, principles of colorectal cancer chemotherapy, and laxative classification based on mechanism and onset need to be understood

About Colorectal Cancer

  • It refers to both colon and rectal cancer
  • They are grouped together due to having similar clinical features, management principles, and prognosis

Goals of Therapy

  • Cure is the target with localized cancer
  • Palliation is the target with metastatic cancer

Multidisciplinary Approach

  • The treatment used depends on the cancer stage

Local Treatments

  • Surgery is a common treatment, especially in the early stages
  • Radiation involves using high-energy rays or particles to destroy cancer cells, more often used for rectal cancer instead of colon cancer
  • Ablation destroys small metastatic tumors without surgically removing them, done using radiofrequency, microwave, ethanol, or cryo-ablation
  • Embolization is used for tumors too big for ablation, substances are injected into blood vessels to block or reduce blood flow of metastatic cancer

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