10: Colorectal cancer

Question 1

Colorectal cancer is the 2nd most common cause of cancer ___.

Answer 1

death

Question 2

What is the benign form of colorectal neoplasia?

Answer 2

Adenoma

Question 3

What is the malignant form of colorectal neoplasia?

Answer 3

Adenocarcinoma

Question 4

What are adenomas a subset of?

Answer 4

Polyps

Question 5

Polyps can also be ___.

Answer 5

inflammatory

Question 6

What are two types of genes associated with cancer?

Answer 6

Oncogenes

Tumour suppressor genes

Question 7

Oncogenes promote ___ ___ and ___ when normal.

Answer 7

cell growth

division

Question 8

When mutated, oncogenes cause ___ cell growth and division.

Answer 8

excessive

Question 9

Tumour suppressor genes ___ cell growth and division when normal.

Answer 9

suppress

Question 10

What happens when tumour suppressor genes mutate?

Answer 10

Cell growth and division no longer suppressed

uncontrolled “”

Question 11

Name an example of a tumour suppressor gene associated with colorectal cancer.

Answer 11

APC

Question 12

Name an example of an oncogene involved in colorectal cancer.

Answer 12

K-Ras

Question 13

slide 19

tubular - fissures

villous - seaweed-like fronds

Question 14

Adenocarcinomas can be well, moderately or poorly ___.

Answer 14

differentiated

Question 15

Which two staging systems are used to classify the progression of colorectal cancer?

Answer 15

Dukes

TNM

Question 16

Describe a Dukes A tumour.

Answer 16

Hasn’t invaded the muscle wall

Question 17

Describe a Dukes B tumour.

Answer 17

Tumour has invaded the muscle wall but no lymph nodes are involved

Question 18

Described a Dukes C tumour.

Answer 18

Tumour has invaded muscle wall and lymph nodes are involved

Question 19

Describe a Dukes D tumour.

Answer 19

Distant metastases

Question 20

By what means can colorectal cancer spread?

Answer 20

Local (i.e via adjacent structures)

Lymphatically

Blood (liver and lungs specifically)

Transcoelomic (into the peritoneal cavity)

Question 21

Treatment of colorectal cancer must take into consideration the ___ ___ involved.

Answer 21

lymph nodes

Question 22

What lifestyle factors protect against colorectal cancer?

Answer 22

Diet (high fibre, fruit and veg)

Exercise

Question 23

What lifestyle factors cause colorectal cancer?

Answer 23

Red, processed meat

Smoking

Alcohol

Obesity

Question 24

A large family history of colorectal cancer (increases / decreases) the chances of developing it yourself.

Answer 24

increases

Question 25

What is FAP?

Answer 25

**Familal adenomatous polyposis** an inherited form of colorectal cancer.

Question 26

What is the clinical presentation of FAP?

Answer 26

shitloads of polyps

Question 27

What is **HNPCC**?

Answer 27

**Hereditary nonpolyposis colorectal cancer** i.e FAP without all the polyps

Question 28

Name two **inherited** forms of colorectal cancer. What mode of inheritance do they have?

Answer 28

**FAP , HNPCC** **Autosomal dominant**

Question 29

Which GI conditions **predispose** you to cancer?

Answer 29

**Adenomatous polyps** **Crohn's disease** **Ulcerative colitis**

Question 30

\_\_\_ inflammation is associated with the onset of colorectal cancer.

Answer 30

**Chronic**

Question 31

What general condition is caused by substantial bleeding in the GI tract?

Answer 31

**Anaemia**

Question 32

Why do colorectal cancer patients experience tenesmus?

Answer 32

**Literally a mass in their rectum which can't be evacuated**

Question 33

What are common symptoms of colorectal cancer?

Answer 33

**Bleeding** - rectal, anaemia, with diarrhoea ## Footnote **Abdominal pain** **Altered bowel habits** **Tenesmus** **Weight loss**

Question 34

How is suspected colorectal cancer investigated?

Answer 34

**Barium enema** **CT scan** **Sigmoid/colonoscopy**

Question 35

What can be used to remove polyps during an investigation?

Answer 35

**Endoscope itself**

Question 36

What screening test can be used to detect colorectal cancer early?

Answer 36

**Faecal occult blood test (FOBT)**

Question 37

50-75 year olds should have ___ \_\_\_ every two years.

Answer 37

**bowel screening**

Question 38

Which investigations are used to **stage** the spread of colorectal cancer (e.g to the lungs and liver)?

Answer 38

**CT scan**

Question 39

What is an emergency presentation of colorectal cancer?

Answer 39

**Obstruction** **Bleeding** **Bowel perforation**

Question 40

What treatment is used to treat obstruction in the short term?

Answer 40

**Colostomy / resection / stenting**

Question 41

The higher the Dukes stage, the **(better / worse)** the patient's prognosis.

Answer 41

**worse**

Question 42

Poorly differentiated cancer has a **(good / bad)** prognosis. Well differentiated cancer has a **(good / bad)** prognosis.

Answer 42

poorly differentiated - poor prognosis well differentiated - good prognosis

Question 43

\_\_\_ is often the treatment for colorectal cancer.

Answer 43

**Surgery**

Question 44

What other treatments can be used to treat/palliate colorectal cancer?

Answer 44

**Radiotherapy** **Chemotherapy**

Question 45

The key to ensuring a better prognosis for colorectal cancer is to catch it \_\_\_.

Answer 45

**early**