QUESTION 1/4

There are several risk factors that could increase a person’s risk of developing colorectal polyps or colorectal cancer. Which of the following claim/s are/is true?1,2

Colorectal cancer is one of the most common cancer types in all Nordic countries. How many new cases of colorectal cancer were reported in Nordic countries in 2020?3

BRAFV600E mutation is one of the most critical mutations associated with metastatic colorectal cancer. Which of the following claim/s regarding BRAFV600E mutations is/are true?4-7

Colorectal cancer exhibits differences in incidence, pathogenesis, molecular pathways and outcome depending on the location of the tumour. It is suggested that there are biological differences between left-sided and right-sided colorectal cancers. Connect the side of the tumour and its typical manifestations.8-11

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  • A Smoking tobacco increases the risk of colorectal cancer.
  • B There is no a correlation between the risk of colorectal cancer and lifestyle.
  • C Inflammatory bowel diseases increase the risk for developing colorectal cancer.

The highest risk of developing colorectal cancer is on people with a family history of colorectal cancer or inflammatory bowel diseases. Moderate risk factors for developing colorectal cancer are smoking tobacco and lifestyle-related factors (low physical activity, low intake of fruit and vegetables, and high intake of red meat). Having a risk factor, or even multiple, does not mean that disease will develop. On the other hand, some people who develop colorectal cancer may not have any known risk factors.

  • A Approximately 2000
  • B Approximately 20 000
  • C Approximately 200 000
  • D Approximately 2 000 000

The estimated number of new cases of colorectal cancer in the Nordic countries in 2020 was 21,498. In the Nordic countries, the estimated cumulative risk of incidence is the highest in Denmark.

  • A BRAFV600E mutation is found in approximately 2–4% of all metastatic colorectal cancers.
  • B Patients with BRAFV600E mutation are more likely to have a weak response to chemotherapy than patients with wild type BRAF.

BRAF mutations (nearly always V600E) are found in the tumours of between 8% and 12% of patients with mCRC included in clinical trials and are almost exclusively non overlapping with RAS mutations. The mutation is often associated with a poor prognosis and does not usually respond well to chemotherapy. BRAF mutations (nearly always V600E) are found population- based in 20-21% of patients with mCRC.

  • Occurs predominantly in males
  • Occurs predominantly in females
  • Associated with better overall survival
  • Associated with worse overall survival
  • Mostly adenocarcinomas
  • Mostly adenomas
  • Chromosomal instability tumours predominate
  • Tumours with CIMP, MSI, or BRAF mutation predominate

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Thank you for testing your knowledge on colorectal cancer!

You can find more information about colorectal cancer on our website. Our colorectal cancer awareness infographics and colorectal cancer patient atlas can be utilised when discussing colorectal cancer with your patient.

Learn the correct answers
ND/ONC/11/22/0001
Referenser
1 Johnson, et al. Meta-analyses of Colorectal Cancer Risk Factors Constance. Cancer Causes Control. 2013;24(6):1207-1222.
2 Jasperson, et al. Hereditary and familial colon cancer. Gastroenterology. 2010;138(6):2044-58. 3. Globocan 2020 / World Health Organization. For data & methods, please read more on: https://gco.iarc.fr/today/data-sources-methods
3 Globocan 2020 / World Health Organization. For data & methods, please read more on: https://gco.iarc.fr/today/data-sources-methods
4 Van Cutsem, et al. ESMO consensus guidelines for the management of patients with metastatic colorectal cancer. Ann Oncol. 2016;27(8):1386-1422
5 Tran, et al. Impact of BRAF mutation and microsatellite instability on the pattern of metastatic spread and prognosis in metastatic colorectal cancer. Cancer. 2011;117:4623–4632.
6 Aasebø, et al. Consequences of a high incidence of microsatellite instability and BRAF-mutated tumors: A population-based cohort of metastatic colorectal cancer patients. Cancer Med. 2019;8:3623–3635.
7 Sorbye, et al. High BRAF Mutation Frequency and Marked Survival Differences in Subgroups According to KRAS/BRAF Mutation Status and Tumor Tissue Availability in a Prospective Population-Based Metastatic Colorectal Cancer Cohort. PLoS One. 2015;29;10(6):e0131046.
8 Lee, et al. Is right-sided colon cancer different to left-sided colorectal cancer? – A systematic review. Eur J Surg Oncol. 2015;41(3):300-8.
9 Shida, et al. Prognostic Value of Primary Tumor Sidedness for Unresectable Stage IV Colorectal Cancer: A Retrospective Study. Ann Surg Oncol. 2019;26(5):1358-1365.
10 Zakavelis, et al. Current and future biomarkers in colorectal cancer. Ann Gastreoentrol. 2017;30: 613-621.
11 Dekker, et al. Colorectal Cancer. The Lancet. 2019;394;1467-1479.
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