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Pathoma > 10.8 Colon and Colorectal Carcinoma > Flashcards

10.8 Colon and Colorectal Carcinoma Flashcards

1
Q

Hirschsprung Disease

A

Defective relaxation and peristalsis of the rectum and distal sigmoid colon

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2
Q

What is Hirschspring Disease associated with?

A

Down Syndrome

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3
Q

What is the cause of Hirschsprung?

A

Failure of the ganglion cells to descend - lacking in the rectum and the sigmoid

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4
Q

What are the clinical features of Hirschsprung?

A

Failure to pass meconium with massive dilation of the the bowel proximal to obstruction with risk for rupture

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5
Q

Colonic Diverticula

A

Outpouchings of mucosa and submucosa through the muscularis propria - pseudo-diverticula - often on the left colon

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6
Q

What is the cause of the colonic diverticula?

A

Increased wall stress from straining and constipation

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7
Q

What is the most common location of the colonic diverticula?

A

Sigmoid Colon

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8
Q

Angiodysplasia

A

Acquired malformation of mucosal and submucosal capillary beds - usually in the right colon and cecum from high wall tension

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9
Q

Hereditary Hemorrhagic Telangiectasia

A

Autosomal dominant disorder that results in thin walled vessel in the nasopharynx and the GI tract - bleeding can occur

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10
Q

Ischemic Colitis

A

Ischemic damage to the colon - usually at the splenic flexure

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11
Q

What is the most common cause of ischemic colitis?

A

Atherosclerosis of the SMA

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12
Q

Irritable Bowel Syndrome

A

Relapsing abdominal pain with bloating flatulence and change in bowel habits that improves with defecation

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13
Q

Who is the typical patient of irritable bowel syndrome?

A

Middle aged females

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14
Q

Colonic Polyps

A

Raised protrusions of the colonic mucosa

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15
Q

What are the 2 most common types of colonic polyps?

A
  • Hyperplastic

- Adenomatous

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16
Q

Hyperplastic Polyp

A

“Serrated” and due to hyperplasia of the glands - benign with NO malignant potential

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17
Q

Where do hyper plastic polyps tend to arise?

A

Left Colon - they are the most common polyps

18
Q

Adenomatous Polyp

A

Neoplasm of glands and is benign but premalignant and can progress to adenocarcinoma

19
Q

Adenoma - Carcinoma Sequence

A

APC mutation leads to increased risk with KRAS mutation leading to polyp formation and p53 mutation leading to carcinoma

20
Q

What chromosome is APC found on?

A

Chromosome 5

21
Q

How does aspirin protect against adenocarcinoma sequence?

A

It decreases the COX levels which are needed for adenocarcinoma formation

22
Q

What are the risks for a polyp to progress to carcinoma?

A
  • Size greater than 2 cm
  • Sessile growth
  • Villous histology
23
Q

Familial Adenomatous Polyposis

A

Autsomal dominant disorder with many polyps and is due to an inherited APC gene

24
Q

Gardner Syndrome

A

FAP disorder with fibrzomatosis and osteomas

25
Q

Turcot Syndrome

A

FAP with CNS tumors (medullooblastoma and glial tumors)

26
Q

Juvenile Polyp

A

Hamartomatous polyps that are benign and arise in children - usually solitary rectal polyp

27
Q

Juvenile Polyposis

A

Multiple juvenile polyps in the stomach and in the colon

28
Q

Peutz-Jeghers Syndrome

A

Hamartomatous polyps throughout the GI tract - autosomal dominant and increases the risk for colorectal, breast and GYN cancer

29
Q

What is the most common pathway from which colorectal cancer arises?

A

Adenoma-Carcinoma Sequence

30
Q

What is the second most common pathway by which colon cancer arises?

A

Microsatellite Instability

31
Q

Microsatellite Instability Pathway

A

Mutation in DNA repair enzymes that leads to them being unstable and accumulating mutations

32
Q

Hereditary Nonpolyposis Colorectal Carcinoma

A

Due to the MSI pathway with an inherited mutation in the DNA mismatch repair enzymes that will have increased risk for colorectal, ovarian and endometrial carcinoma - cancer arises at an early age and is usually right sided

33
Q

What are some of the other risks for colorectal carcinoma?

A
  • Ulcerative Colitis

- Peutz-Jehger Syndrome

34
Q

How is CRC screened for?

A

Colonoscopy and fecal occult blood testing

35
Q

Describe left sided CRC.

A

Napkin ring lesion with LLQ pain, decreased stool caliber and blood streaked stool

36
Q

Describe right sided CRC.

A

Raised lesion with iron deficiency anemia and vague pain

37
Q

What side CRC is associated with the adenoma-carcinoma sequence?

A

Left Sided

38
Q

What side CRC is associated with MSI?

A

Right Sided

39
Q

What are patients with Streptococcus bovis endocarditis at increased risk of?

A

CRC - do a colonoscopy

40
Q

What is the most common site of metastasis of CRC?

A

Liver

41
Q

What is the tumor marker of CRC?

A

CEA - used for assessing treatment response

Pathoma (119 decks)

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