BCOP Exam Questions with Correct Answers| Latest Update Guaranteed Success
dMMR/MSI-H CRC is responsive to what type of therapy? Immunotherapy check point
inhibitors
Do dMMR/MSI-H CRC have a good prognosis in stage 2? What does it predict? Yes good
prognosis, and does not respond well to 5FU adjuvant therapy
DPD deficiency effects? Increased 5FU toxicity since it's not being metabolized (activity
score 0 or 0.5= poor metabolizer)
What is the antidote for 5FU severe toxicity? Uridine triacetate PO q6h for 20 doses *start
within 96h*
Which drug is affected by UGT1A1*28 polymorphism? Irinotecan—significant toxicity,
reduce the dose
In CRC, how do KRAS and EGFR mutations affect treatment? Needs to be KRAS wild-type (no
mutation) and must be combined with EGFR MAB plus only left sided colon cancer
Is it beneficial to have a BRAF V600E mutation in CRC? No, poor prognosis. Must combined
with anti-EGFR therapy (cannot use solo anti-EGFR or solo BRAF inhibitor)
When do you test for HER2 in CRC? Only if RAS/BRAF wild-type. If there is a RAS/BRAF
mutation= no need to test for HER2
What age group do you screen for CRC? Age 45 to 75 (colonoscopy every 10 years
preferred), do not screen age >85
How often do you do a fecal occult or FIT test? (Average risk) Every 1 year
,How often do you do a FIT-DNA test such as cologuard? (Average risk) Every 1 to 3 years
How often for CT-colonography? (Average risk) Every 5 years
How often for flexible sigmoidoscopy? (Average risk) Every 5 to 10 years
Patients who have IBS should get a colonoscopy how often? Beginning 8 years after onset
and then every 1-3 years thereafter based on findings
>= 1 1st degree relative with CRC or confirmed adenoma— how often to test? CRC:
colonoscopy starting at age 40 or 10 years before earliest dx
Adenoma: age 40 or at age on onset, whichever is first, then every 5-10 years
2nd or 3rd degree relative with CRC, how often to test? Colonoscopy at age 45, then every
10 years
How often to test someone with Lynch syndrome? Age 20-25 or 2-5 years before earliest
colon cancer diagnosis if <25, then every 1 to 2 years
What are the preferred treatment options and duration for high risk stage III CRC? FOLFOX
for 6 months, or CAPEOX for 3-6 months
How many lymph nodes are necessary for adequate sampling to determine node positive or
node negative disease? (CRC) Minimum of 12 lymph nodes
Where is radiation more useful—colon or rectal cancer? XRT is more useful in rectal cancer
and has minimal role in colon cancer (can use for palliative or if unresectable/bleeding tumor)
,What side effects are commonly associated with 5FU infusions? Hand-foot syndrome and GI
toxicity
What side effects are most commonly associated with bolus 5FU/leuco Hematologic toxicity
CAPEOX frequency? Every 21 days (130 mg/m2 oxali, 1000mg/m2/dose BID cape)
Does neoadjuvant therapy play a role in Colon cancer? Not so much but can be considered
for T4b or bulky nodal disease (and if dMMR/MSI-H give neoadjuvant immunotherapy)
What is the role of neoadjuvant tx in rectal cancer? Used in combo with XRT to increase
radiosensitization, 5FU based chemo is recommended
Stage I and II colon cancer treatment? Surgery (adjuvant chemo not really beneficial)—for
stage II see if high risk or not can consider cape or 5FU/leuco 6months
Stage III colon cancer adjuvant therapy? Yes— starting 4-8 weeks after surgery up to 6
months
True or False: Capecitabine is clinically equivalent to bolus 5FU/leucovorin in terms of DFS?
TRUE
Which drug do we add to 5FU backbone to increase benefit for stage 3 colon cancer patients
based on MOSAIC trial? Oxaliplatin, CAPEOX is considered acceptable alternative to FOLFOX
Stage II MSI-H/dMMR colon cancer? Observation
Which checkpoint inhibitors are recommended by NCCN for neoadjuvant use in dMMR/MSI-H
disease? Nivolumab, Pembro or dostarlimab
, What is TNT (total neoadjuvant therapy?) In the TNT approach in rectal cancer, pts receive
both neoadjuvant chemo and chemo radiation or radiation prior to surgery, with no adjuvant
therapy
Which one has more neutropenia and FN— CAPEOX or FOLFOX? FOLFOX
What is recommended for patients with metastatic colon cancer and excellent performance
status? FOLFIRINOX
What is 1st line for metastatic colon cancer? FOLFOX or FOLFIRI (either can be 1st, followed
by the other regimen in the 2nd line)— can add bevacizumab
Which regimen has more neurotoxicity, grade 3/4 neutropenia and thrombocytopenia? FOLFOX
or FOLFIRI FOLFOX
What are the side effects associated with bevacizumab? Bleeding, hypertension,
thromboembolic events
When can we add cetuximab or panitumumab to FOLFOX or FOLFIRI in met CRC? KRAS wild-
type and left sided tumors
What are the common side effects of cetuximab? Cetuximab: infusion reactions, rash,
diarrhea and low Mg
What are the common side effects of panitumumab? Paronychia (nail infection) and
mucositis, rash, diarrhea and low Mg
Can you still use bevacizumab in 2nd line metastatic CRC treatment if it was used in the 1st
line? Yes, continuation of Bev in the 2nd line chemo significantly improved PFS and OS over
dMMR/MSI-H CRC is responsive to what type of therapy? Immunotherapy check point
inhibitors
Do dMMR/MSI-H CRC have a good prognosis in stage 2? What does it predict? Yes good
prognosis, and does not respond well to 5FU adjuvant therapy
DPD deficiency effects? Increased 5FU toxicity since it's not being metabolized (activity
score 0 or 0.5= poor metabolizer)
What is the antidote for 5FU severe toxicity? Uridine triacetate PO q6h for 20 doses *start
within 96h*
Which drug is affected by UGT1A1*28 polymorphism? Irinotecan—significant toxicity,
reduce the dose
In CRC, how do KRAS and EGFR mutations affect treatment? Needs to be KRAS wild-type (no
mutation) and must be combined with EGFR MAB plus only left sided colon cancer
Is it beneficial to have a BRAF V600E mutation in CRC? No, poor prognosis. Must combined
with anti-EGFR therapy (cannot use solo anti-EGFR or solo BRAF inhibitor)
When do you test for HER2 in CRC? Only if RAS/BRAF wild-type. If there is a RAS/BRAF
mutation= no need to test for HER2
What age group do you screen for CRC? Age 45 to 75 (colonoscopy every 10 years
preferred), do not screen age >85
How often do you do a fecal occult or FIT test? (Average risk) Every 1 year
,How often do you do a FIT-DNA test such as cologuard? (Average risk) Every 1 to 3 years
How often for CT-colonography? (Average risk) Every 5 years
How often for flexible sigmoidoscopy? (Average risk) Every 5 to 10 years
Patients who have IBS should get a colonoscopy how often? Beginning 8 years after onset
and then every 1-3 years thereafter based on findings
>= 1 1st degree relative with CRC or confirmed adenoma— how often to test? CRC:
colonoscopy starting at age 40 or 10 years before earliest dx
Adenoma: age 40 or at age on onset, whichever is first, then every 5-10 years
2nd or 3rd degree relative with CRC, how often to test? Colonoscopy at age 45, then every
10 years
How often to test someone with Lynch syndrome? Age 20-25 or 2-5 years before earliest
colon cancer diagnosis if <25, then every 1 to 2 years
What are the preferred treatment options and duration for high risk stage III CRC? FOLFOX
for 6 months, or CAPEOX for 3-6 months
How many lymph nodes are necessary for adequate sampling to determine node positive or
node negative disease? (CRC) Minimum of 12 lymph nodes
Where is radiation more useful—colon or rectal cancer? XRT is more useful in rectal cancer
and has minimal role in colon cancer (can use for palliative or if unresectable/bleeding tumor)
,What side effects are commonly associated with 5FU infusions? Hand-foot syndrome and GI
toxicity
What side effects are most commonly associated with bolus 5FU/leuco Hematologic toxicity
CAPEOX frequency? Every 21 days (130 mg/m2 oxali, 1000mg/m2/dose BID cape)
Does neoadjuvant therapy play a role in Colon cancer? Not so much but can be considered
for T4b or bulky nodal disease (and if dMMR/MSI-H give neoadjuvant immunotherapy)
What is the role of neoadjuvant tx in rectal cancer? Used in combo with XRT to increase
radiosensitization, 5FU based chemo is recommended
Stage I and II colon cancer treatment? Surgery (adjuvant chemo not really beneficial)—for
stage II see if high risk or not can consider cape or 5FU/leuco 6months
Stage III colon cancer adjuvant therapy? Yes— starting 4-8 weeks after surgery up to 6
months
True or False: Capecitabine is clinically equivalent to bolus 5FU/leucovorin in terms of DFS?
TRUE
Which drug do we add to 5FU backbone to increase benefit for stage 3 colon cancer patients
based on MOSAIC trial? Oxaliplatin, CAPEOX is considered acceptable alternative to FOLFOX
Stage II MSI-H/dMMR colon cancer? Observation
Which checkpoint inhibitors are recommended by NCCN for neoadjuvant use in dMMR/MSI-H
disease? Nivolumab, Pembro or dostarlimab
, What is TNT (total neoadjuvant therapy?) In the TNT approach in rectal cancer, pts receive
both neoadjuvant chemo and chemo radiation or radiation prior to surgery, with no adjuvant
therapy
Which one has more neutropenia and FN— CAPEOX or FOLFOX? FOLFOX
What is recommended for patients with metastatic colon cancer and excellent performance
status? FOLFIRINOX
What is 1st line for metastatic colon cancer? FOLFOX or FOLFIRI (either can be 1st, followed
by the other regimen in the 2nd line)— can add bevacizumab
Which regimen has more neurotoxicity, grade 3/4 neutropenia and thrombocytopenia? FOLFOX
or FOLFIRI FOLFOX
What are the side effects associated with bevacizumab? Bleeding, hypertension,
thromboembolic events
When can we add cetuximab or panitumumab to FOLFOX or FOLFIRI in met CRC? KRAS wild-
type and left sided tumors
What are the common side effects of cetuximab? Cetuximab: infusion reactions, rash,
diarrhea and low Mg
What are the common side effects of panitumumab? Paronychia (nail infection) and
mucositis, rash, diarrhea and low Mg
Can you still use bevacizumab in 2nd line metastatic CRC treatment if it was used in the 1st
line? Yes, continuation of Bev in the 2nd line chemo significantly improved PFS and OS over
