The management of colorectal cancer is a complex and rapidly advancing field in oncology, where pharmacists play an integral role in optimizing patient care. Modern treatment extends far beyond traditional chemotherapy, incorporating sophisticated targeted therapies that require an understanding of tumor genetics. As detailed in the Patient Care 4 curriculum, pharmacists must be proficient in everything from colorectal cancer screening and supportive care to the nuances of regimens like FOLFOX and the use of biologic agents. This quiz will test your knowledge on the comprehensive management of this prevalent malignancy.
1. Which of the following is considered the gold standard for colorectal cancer screening due to its ability to both detect and remove precancerous polyps?
- a. Fecal immunochemical test (FIT)
- b. Stool DNA test (Cologuard)
- c. Colonoscopy
- d. Flexible sigmoidoscopy
Answer: c. Colonoscopy
2. The FOLFOX chemotherapy regimen, commonly used in colorectal cancer, includes 5-fluorouracil, leucovorin, and what other agent?
- a. Irinotecan
- b. Oxaliplatin
- c. Cetuximab
- d. Bevacizumab
Answer: b. Oxaliplatin
3. EGFR inhibitors, such as cetuximab and panitumumab, are only effective in patients whose tumors are:
- a. RAS mutant
- b. RAS wild-type
- c. BRAF mutant
- d. Microsatellite instability-high (MSI-H)
Answer: b. RAS wild-type
4. Bevacizumab is a monoclonal antibody that targets which of the following to inhibit angiogenesis?
- a. Epidermal Growth Factor Receptor (EGFR)
- b. Vascular Endothelial Growth Factor (VEGF)
- c. Programmed death-ligand 1 (PD-L1)
- d. Human Epidermal Growth Factor Receptor 2 (HER2)
Answer: b. Vascular Endothelial Growth Factor (VEGF)
5. A common and dose-limiting toxicity associated with oxaliplatin is:
- a. Severe diarrhea
- b. Acneiform rash
- c. Cardiotoxicity
- d. Cumulative, cold-induced peripheral neuropathy
Answer: d. Cumulative, cold-induced peripheral neuropathy
6. The “Management of Colorectal Cancer” is a specific learning module in which course?
- a. PHA5784C Patient Care 4
- b. PHA5104 Sterile Compounding
- c. PHA5703 Pharmacy Law and Ethics
- d. PHA5878C Patient Care 3
Answer: a. PHA5784C Patient Care 4
7. A common dermatologic side effect of EGFR inhibitors like cetuximab is:
- a. Hand-foot syndrome
- b. Alopecia (hair loss)
- c. An acneiform rash
- d. Hyperpigmentation
Answer: c. An acneiform rash
8. The FOLFIRI regimen for colorectal cancer contains 5-fluorouracil, leucovorin, and which other chemotherapeutic agent?
- a. Oxaliplatin
- b. Irinotecan
- c. Capecitabine
- d. Cisplatin
Answer: b. Irinotecan
9. What is the primary purpose of leucovorin when given with 5-fluorouracil (5-FU)?
- a. To reduce the toxicity of 5-FU.
- b. To enhance the binding of 5-FU to its target, thymidylate synthase, increasing its efficacy.
- c. To treat nausea and vomiting.
- d. To prevent neuropathy.
Answer: b. To enhance the binding of 5-FU to its target, thymidylate synthase, increasing its efficacy.
10. A patient with right-sided colon cancer may present with what common sign or symptom?
- a. A change in bowel habits
- b. Rectal bleeding
- c. Iron-deficiency anemia
- d. Left lower quadrant pain
Answer: c. Iron-deficiency anemia
11. The “Transcending Concept” on colorectal screening is a specific topic within the Patient Care 4 curriculum.
- a. True
- b. False
Answer: a. True
12. The dose-limiting toxicity of irinotecan is:
- a. Severe, delayed diarrhea
- b. Nephrotoxicity
- c. Cardiotoxicity
- d. Peripheral neuropathy
Answer: a. Severe, delayed diarrhea
13. Capecitabine is an oral prodrug of which chemotherapy agent?
- a. Oxaliplatin
- b. Irinotecan
- c. 5-fluorouracil
- d. Leucovorin
Answer: c. 5-fluorouracil
14. A patient taking capecitabine should be counseled on monitoring for which common side effect?
- a. Acneiform rash
- b. Cold sensitivity
- c. Hand-foot syndrome
- d. Constipation
Answer: c. Hand-foot syndrome
15. A major counseling point for a patient receiving bevacizumab is to monitor for:
- a. Hypomagnesemia
- b. Anemia
- c. Hypertension and signs of bleeding or poor wound healing.
- d. Diarrhea
Answer: c. Hypertension and signs of bleeding or poor wound healing.
16. The pathophysiology and therapeutics of anemia are covered in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
17. What does it mean if a tumor is KRAS mutant?
- a. The EGFR pathway is constitutively activated downstream, making upstream inhibitors like cetuximab ineffective.
- b. The tumor will respond better to EGFR inhibitors.
- c. The tumor is less aggressive.
- d. The patient will not experience side effects from chemotherapy.
Answer: a. The EGFR pathway is constitutively activated downstream, making upstream inhibitors like cetuximab ineffective.
18. Adjuvant chemotherapy is given:
- a. Before surgery to shrink a tumor.
- b. After surgery to eliminate any remaining micrometastatic disease.
- c. For palliative intent in metastatic disease.
- d. In place of surgery.
Answer: b. After surgery to eliminate any remaining micrometastatic disease.
19. Which of the following is a common screening recommendation for an average-risk individual?
- a. Colonoscopy starting at age 65.
- b. Colonoscopy starting at age 45.
- c. Annual FIT testing starting at age 60.
- d. No screening is needed if asymptomatic.
Answer: b. Colonoscopy starting at age 45.
20. A pharmacist’s role in managing colorectal cancer therapy includes:
- a. Managing chemotherapy-induced nausea and vomiting (CINV).
- b. Counseling on side effects like diarrhea and hand-foot syndrome.
- c. Verifying chemotherapy doses and regimens.
- d. All of the above.
Answer: d. All of the above.
21. The basic principles of oncology treatment are covered in the Patient Care 2 curriculum.
- a. True
- b. False
Answer: a. True
22. A patient receiving an EGFR inhibitor like panitumumab should be monitored for which electrolyte abnormality?
- a. Hyperkalemia
- b. Hypomagnesemia
- c. Hypernatremia
- d. Hypocalcemia
Answer: b. Hypomagnesemia
23. What is the acute, dose-limiting toxicity of 5-fluorouracil when given as a bolus?
- a. Diarrhea
- b. Myelosuppression
- c. Neuropathy
- d. Cardiotoxicity
Answer: b. Myelosuppression
24. The management of colorectal cancer is an active learning session in the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
25. A patient receiving oxaliplatin should be counseled to avoid what to reduce the severity of acute neuropathy?
- a. Sunlight
- b. High-fat foods
- c. Exposure to cold, including cold drinks and cold air.
- d. Dairy products
Answer: c. Exposure to cold, including cold drinks and cold air.
26. For a patient with severe, delayed diarrhea from irinotecan, what is the recommended management?
- a. A low dose of a bulk-forming fiber.
- b. A high-dose loperamide regimen.
- c. An oral antibiotic.
- d. No treatment is necessary.
Answer: b. A high-dose loperamide regimen.
27. Before a patient can receive cetuximab, what test must be performed?
- a. A test for tumor RAS mutation status.
- b. A test for TPMT enzyme activity.
- c. A cardiac stress test.
- d. A pulmonary function test.
Answer: a. A test for tumor RAS mutation status.
28. The development of an acneiform rash from an EGFR inhibitor often correlates with:
- a. A poor response to therapy.
- b. An allergic reaction.
- c. A better response to therapy.
- d. The development of skin cancer.
Answer: c. A better response to therapy.
29. UGT1A1 polymorphism testing may be done for patients receiving irinotecan to predict the risk of:
- a. Neuropathy
- b. Severe neutropenia and diarrhea
- c. Hand-foot syndrome
- d. Cardiotoxicity
Answer: b. Severe neutropenia and diarrhea
30. The management of anemia in a patient with colorectal cancer may involve:
- a. A blood transfusion.
- b. IV or oral iron supplementation.
- c. An erythropoiesis-stimulating agent (ESA).
- d. All of the above.
Answer: d. All of the above.
31. What is the primary mechanism of action for 5-fluorouracil?
- a. It is an alkylating agent that cross-links DNA.
- b. It inhibits topoisomerase I.
- c. It inhibits thymidylate synthase, an enzyme critical for DNA synthesis.
- d. It is a platinum-based agent.
Answer: c. It inhibits thymidylate synthase, an enzyme critical for DNA synthesis.
32. The term “neoadjuvant” therapy refers to treatment given:
- a. After surgery.
- b. For metastatic disease.
- c. Before surgery, to shrink a tumor.
- d. For a different type of cancer.
Answer: c. Before surgery, to shrink a tumor.
33. Patients with Lynch syndrome are at a very high genetic risk for which type of cancer?
- a. Lung Cancer
- b. Breast Cancer
- c. Colorectal Cancer
- d. Leukemia
Answer: c. Colorectal Cancer
34. Bevacizumab should be held for at least how long before and after major surgery?
- a. 24 hours
- b. 1 week
- c. 4-6 weeks
- d. It does not need to be held.
Answer: c. 4-6 weeks
35. A pharmacist’s role in supportive care for a patient on chemotherapy for colorectal cancer includes managing:
- a. Nausea and vomiting
- b. Diarrhea
- c. Mucositis
- d. All of the above
Answer: d. All of the above
36. Most colorectal cancers arise from:
- a. Inflammatory bowel disease
- b. Adenomatous polyps
- c. Genetic syndromes
- d. A high-fiber diet
Answer: b. Adenomatous polyps
37. When counseling a patient on the FOLFIRI regimen, the pharmacist should emphasize management strategies for:
- a. Neuropathy and cold sensitivity.
- b. Diarrhea and myelosuppression.
- c. Acneiform rash.
- d. Hand-foot syndrome.
Answer: b. Diarrhea and myelosuppression.
38. The addition of bevacizumab to a chemotherapy regimen for metastatic colorectal cancer aims to:
- a. Cure the cancer.
- b. Improve progression-free and overall survival by inhibiting tumor blood vessel growth.
- c. Reduce the side effects of chemotherapy.
- d. Make the chemotherapy easier to administer.
Answer: b. Improve progression-free and overall survival by inhibiting tumor blood vessel growth.
39. Iron-deficiency anemia is a common finding in colorectal cancer due to:
- a. Poor dietary intake.
- b. Chronic, slow blood loss from the tumor.
- c. Bone marrow suppression.
- d. Increased iron absorption.
Answer: b. Chronic, slow blood loss from the tumor.
40. An active learning session on colorectal cancer and anemia is part of the Patient Care 4 course.
- a. True
- b. False
Answer: a. True
41. Which targeted therapy is associated with a risk of severe, sometimes fatal, infusion reactions?
- a. Bevacizumab
- b. Cetuximab
- c. Panitumumab
- d. Regorafenib
Answer: b. Cetuximab
42. For patients with microsatellite instability-high (MSI-H) metastatic colorectal cancer, which class of drugs has shown significant efficacy?
- a. EGFR inhibitors
- b. VEGF inhibitors
- c. Immune checkpoint inhibitors (e.g., pembrolizumab)
- d. Traditional chemotherapy
Answer: c. Immune checkpoint inhibitors (e.g., pembrolizumab)
43. A pharmacist reviewing a chemotherapy order for colorectal cancer must verify:
- a. The patient’s diagnosis and stage.
- b. The dose calculation, often based on Body Surface Area (BSA).
- c. The appropriateness of the regimen based on guidelines and biomarker status.
- d. All of the above.
Answer: d. All of the above.
44. The primary goal of therapy for metastatic colorectal cancer is:
- a. Curative
- b. Palliative (to prolong life and improve quality of life)
- c. To prevent the cancer from occurring.
- d. To manage anemia only.
Answer: b. Palliative (to prolong life and improve quality of life)
45. What is a key counseling point for a patient receiving an oxaliplatin infusion?
- a. They will definitely lose all their hair.
- b. They may experience an acute reaction during the infusion, such as jaw tightness or voice changes.
- c. They should drink a very cold beverage during the infusion to prevent neuropathy.
- d. The infusion only lasts 15 minutes.
Answer: b. They may experience an acute reaction during the infusion, such as jaw tightness or voice changes.
46. The management of anemia includes treatment with:
- a. Vitamin B12
- b. Folic Acid
- c. Iron
- d. The specific agent depends on the cause of the anemia.
Answer: d. The specific agent depends on the cause of the anemia.
47. The role of the pharmacist in colorectal cancer screening is to:
- a. Perform colonoscopies.
- b. Encourage patients to adhere to recommended screening schedules and explain the different options.
- c. Diagnose colorectal cancer.
- d. Prescribe chemotherapy.
Answer: b. Encourage patients to adhere to recommended screening schedules and explain the different options.
48. An active learning session on colorectal cancer is part of which course?
- a. PHA5784C Patient Care 4
- b. PHA5163L Professional Skills Lab 3
- c. PHA5781 Patient Care I
- d. PHA5782C Patient Care 2
Answer: a. PHA5784C Patient Care 4
49. Which of the following is NOT a component of the FOLFOX regimen?
- a. 5-Fluorouracil
- b. Leucovorin
- c. Oxaliplatin
- d. Irinotecan
Answer: d. Irinotecan
50. The ultimate goal of a pharmacist’s involvement in the management of colorectal cancer is to:
- a. Ensure the most expensive drugs are used.
- b. Optimize the safety and efficacy of complex medication regimens through evidence-based care.
- c. Complete the paperwork for chemotherapy.
- d. Mix all the chemotherapy drugs personally.
Answer: b. Optimize the safety and efficacy of complex medication regimens through evidence-based care.