Colon and Rectal Cancer
 • Adenoca (98%), Neuroendocrine, ...
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Description

Colon and Rectal Cancer

 • Adenoca (98%), Neuroendocrine, Lymphoma

Risk factors:

 • Obesity, physical inactivity, smoking, red/processed meat, ETOH, adenomatous polyps, IBD, hereditary syndrome (FAP, HNPCC), age, AA race

 • Risk of increased death w/ R-sided compared w/ L-sided due to BRAF/KRAS mutation

Protective factors: ASA intake for pts 50-60 years

Screening: Colo, flex sig, CT colo, FIT, FOBT for ≥50yo

Staging: Staged I-IV using TNM system

Diagnostics:

 • Colonoscopy, CT C/A/P, CEA

 • Pelvic MRI or endorectal US for rectal CA

 • Genetic testing (RAS, BRAF, MSI status)

Treatment - Colon:

 • Stage I: surgery + observation

 • Stage II: surgery + neo- vs. adjuvant chemo (5-FU/leucovorin or capecitabine, add oxali if highrisk features)

 • Stage III: surgery + adjuvant FOLFOX/CAPEOX

 • Stage IV: resection of limited liver or lung mets + FOLFOX/CAPEOX/FOLFIRI/FOLFOXIRI +/- bevacizumab

 • KRAS/NRAS wt and left-sided tumors: FOLFOX/FOLFIRI + EGFR inhibitor

 • MSI-H/dMMR: immunotherapy (pembrolizumab, nivolumab or nivolumab + ipilimumab)

Treatment - Rectal:

 • Stage I: low anterior resection (LAR) or abdominoperineal resection (APR) +/- neo- vs. adjuvant chemoRT

 • Stage II-III: resection with neoadjuvant chemoRT



#Colon #Rectal #Cancer #Diagnosis #Management #oncology #treatment
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