Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HPIM Onco > 110 : Lower GI Cancers > Flashcards

110 : Lower GI Cancers Flashcards

1
Q

Polyp is a grossly visible protrusion from the mucosal surface. 3 types of polyps are:

A
  1. Nonneoplastic hamartoma (e.g. juvenile polyp)
  2. Hyperplastic mucosal proliferation (hyperplastic polyp)
  3. Adenomatous polyp
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which type of polyp is premalignant?

A

Adenomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Adenomatous polyps are seen in 30% of middle-aged and 50% of elderly people. What percentage of polyps become malignant?

A

<1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Developmental steps toward carcinogenesis in colorectal cancer

A
  1. Point mutations in K-ras protooncogene
  2. Hypomethylation of DNA –> gene activation
  3. Loss of DNA (allelic loss) at the site of a tumor-suppressor gene (APC geneL on 5q21
  4. Allelic loss at the site of a tumor-suppressor gene on chromosome 18q (the deleted in colorectal cancer [DCC] gene)
  5. Allelic loss at chromosome 17p, associated with mutation in p53 tumor-suppressor gene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Probability of an adenomatous polyp to become a cancer depends on

A
  1. Gross appearance of lesion (pedunculated or sessile)
  2. Histologic features (tubular, villous, tubulovillous)
  3. Size (<1.5cm is negligible, 1.5-2.5cm as intermediate, >2.5cm as substantial)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Characteristics of polyp that can become malignant

A

Sessile polyps
Villous adenomas
>2.5cm in size

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When should colonoscopy be done in patients with adenomatous polyp in the absence of documented malignancy?

A

Colonoscopy should be done periodically at least every 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for the development of colorectal cancer

A
  1. Diet: Animal fat
  2. Hereditary syndromes : Polyposis coli, MYH-associated polyposis, Hereditary nonpolyposis colon cancer [HNPCC] (or Lynch’s syndrome)
  3. Inflammatory bowel disease
  4. Streptococcus bovis bacteremia (endocarditis, septicemia)
  5. ?Tobacco use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

T or F: Colorectal cancer occurs more often among upper socioeconomic population who live in urban areas.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Growth factor implicated to stimulate proliferation of intestinal mucosa, common among obese persons, and associated with colorectal cancers

A

Insulin-like growth factor type I (IGF-I)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

T or F: Accdg to studies and trials, dietary fiber and diets high in fruits and vegetables failed to show that it can prevent colorectal cancer and recurrence of colorectal adenomas

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Rare condition characterized by the appearance of thousands of adenomatous polyps throughout the large bowel transmitted via autosomal dominant trait

A

Polyposis coli (familial polyposis of the colon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Molecular pathology in polyposis coli

A
  1. Deletion in long arm of chromosome 5 (including APC gene) causing allelic loss
  2. Absence of tumor-suppressor genes that would normally inhibit neoplastic growth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Subset of polyposis coli presenting with soft tissue and bony tumors, congenital hypertrophy of retinal pigment epithelium, mesenteric desmoid tumors, and ampullary cancers

A

Gardner’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Polyposis coli with appearance of malignant tumors of the central nervous system

A

Turcot’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prognosis for polyposis coli if not treated surgically

A

Colonic polyps appear by age 25

Colorectal cancer will develop in almost all patients before age 40

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Surgical treatment and prevention for polyposis coli

A

Total colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Medical therapy for polyposis coli that can decrease the number and size of polyps temporarily

A
  1. NSAIDS such as Sulindac

2. Selective COX-2 inhibitors such as Celecoxib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Risk of an offspring to develop polyposis coli

A

50% risk

Screening by annual flexible sigmoidoscopy until age 35 or proctosigmoidoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Location of polyps in polyposis coli

A

Cecum to anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Definitive diagnosis for polyposis coli

A

Detection of APC gene mutation from DNA testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rare autosomal recessive syndrome caused by biallelic mutation in the MUT4H gene

A

MYH-associated polyposis (MAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Recommended surveillance for patients with MYH-Associated Polyposis

A

Annual to biennial colonoscopic surveillance starting at age 25-30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

An autosomal dominant trait, also called the Lynch’s syndrome, associated with high frequency of colorectal cancer arising in proximal large bowel, with median age of <50 years

A

Hereditary nonpolyposis colon cancer (HNPCC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Characteristics of HNPCC

A
  1. Three or more relatives with histologically documented colorectal cancer, one of whom is a first-degree relative of the other two
  2. One or more cases of colorectal cancer diagnosed before age 50 in the family
  3. Colorectal cancer involving at least two generations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HNPCC is associated with multiple primary cancers. Other associated cancers aside from colorectal cancer include

A
  1. Ovarian CA
  2. Endometrial CA
  3. Gastric, small-bowel, genitourinary, pancreaticobiliary and sebacious skin tumors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

In HPNCC, recommended screening for family members would be

A

Annual or biennial colonoscopy beginning at age 25

WITH intermittent pelvic ultrasonography AND endometrial biopsy for afflicted women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Germline mutation of these genes are associated with HNPCC

A

hMSH2 on chromosome 2

hMLH1 on chromosome 3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which inflammatory bowel disease is more associated with colorectal cancer, ulcerative colitis or Crohn’s disease?

A

Ulcerative colitis

30
Q

In a patient with IBD of more than 15 years who continue to experience exacerbations, what can you recommend to reduce the risk of cancer?

A

Surgical removal of colon

31
Q

Most effective class of chemopreventive agents thought to suppress cell proliferation by inhibiting prostaglandin synthesis as primary prevention for colorectal cancer

A

Aspirin

and other NSAIDs

32
Q

Other drugs that appear to reduce the risk of colorectal cancer

A
  1. Oral folic acid supplements
  2. Oral calcium supplements
  3. Estrogen replacement therapy (decreases IGF-I)
33
Q

Suggested screening for colorectal cancer by American Cancer Society and NCCN

A
  1. Fecal occult blood testing ANNUALLY + Flexible sigmoidoscopy EVERY 5 years
    OR
  2. Colonoscopy EVERY 10 years

Starting at age 50 in ASYMPTOMATIC pt with NO personal or family history of polyps or colorectal cancer

34
Q

Presenting symptoms of lesions on the ascending colon

A
  1. Cancers can become quite large without resulting in any obstructive symptoms or alteration in bowel habits since the stool passing here is liquid
  2. Associated symptoms : Fatigue, palpitation, angina pectoris
  3. Hypochromic, microcytic anemia (IDA)
  4. Tumors may bleed intermittently
35
Q

Presenting symptoms of lesions in the transverse and descending colon

A
  1. Abdominal cramping, occasional obstruction, and perforation
  2. Radiographs: Annular constricting lesions (“apple-core” or “napkin-ring”)
36
Q

Presenting symptoms of lesions in the rectosigmoid

A
  1. Hematochezia, tenesmus, narrowing of caliber of stool

2. Anemia is infrequent

37
Q

Basis of prognosis for colorectal cancer

A
  1. DEPTH of tumor penetration into bowel wall
  2. presence of REGIONAL LYMPH NODE involvement
  3. distant METASTASES
38
Q

Stage of colorectal cancer wherein tumors penetrate through the muscularis but have not spread to lymph nodes

A

Stage II (T3-4N0M0)

39
Q

Stage of colorectal cancer showing a regional lymph node involvement

A

Stage III (TXN1-2M0)

40
Q

Minimum number of lymph nodes to be examined to define tumor stage in colorectal cancer

A

at least 12 LN

41
Q

Most frequent visceral site of metastasis

A

Liver

42
Q

T or F: In general, colorectal cancer rarely spreads to the lungs, supraclavicular lymph nodes, bone, or brain without prior spread to the liver

A

True

Except primary tumors in distal rectum which spreads through the paravertebral venous plexus escaping portal venous system and reaching lungs or supraclavicular LN

43
Q

T or F: Plasma CEA level obtained preoperatively, predicts eventual tumor recurrence

A

True

CEA titer >5 ng/mL

44
Q

Optimal treatment in colorectal cancer when malignant lesion is detected in the large bowel

A

Total resection of tumor

45
Q

What evaluation procedures to detect metastatic disease should be done in pt with colorectal cancer prior to surgery?

A
  1. Thorough physical exam
  2. Biochemical assessment of liver function
  3. Measure plasma CEA level
  4. CT scan of chest, abdomen and pelvis

When possible, colonoscopy of entire large bowel to detect synchronous neoplasma and/or polyps

46
Q

Follow-up of patients with colorectal cancer after complete resection and recovery

A
  1. Semiannual physical examinations and blood chemistry measurements for 5 years
  2. Complete colonoscopy post op, if not yet done
  3. CEA levels at 3-month intervals
  4. Endoscopic surveillance at triennial intervals
  5. Some recommended CT scan of abdomen annually for first 3 post-operative years
47
Q

Recommended for patients with rectal cancer to reduce the probablity of regional recurrences following surgical resection of stage II or III tumors, especially if serosa is penetrated

A

Radiation therapy to the pelvis (either pre-op or post-op)

But does not prolong survival

48
Q

In rectal cancer, combining radiotherapy with this chemotherapy using this drug prior to surgery, lowers local recurrence rates and improve survival

A

5-fluorouracil (5-FU)-based chemotherapy

49
Q

Backbone of treatment for colorectal cancer

A

5-FU

50
Q

In patients with advanced colorectal cancer, administration of this medication improves efficacy of 5-FU by enhancing its binding to its target enzyme, thymidylate synthase

A

Folinic acid (Leucovorin)

51
Q

5-FU can be given orally in the form of this drug with seemingly similar efficacy

A

Capecitabine (Xeloda)

52
Q

Adding this topoisomerase 1 inhibitor to 5-FU and Leucovorin improves response rates and survival of patients with metastatic colorectal disease

A

Irinotecan

FOLFIRI regimen

53
Q

FOLFIRI regimen

A
  1. Irinotecan 180mg/m2 as a 90-min infusion on day 1
  2. Leucovorin 400mg/m2 as 2-h infusion during irinotecan administration
  3. Immediately followed by 5-FU bolus, 400mg/m2 and 46-h continuous infusion of 2.4-3g/m2 every 2 weeks
54
Q

Major side effect of Irinotecan

A

Diarrhea

55
Q

A platinum analogue added to 5-FU and Leucovorin that improves response rate as initial treatment of patients with metastatic disease

A

Oxaliplatin

FOLFOX regimen

56
Q

FOLFOX regimen

A
  1. Leucovorin (400mg/m2 per day) as 2-h infusion
  2. Followed by 5-FU bolus (400mg/m2 per day) and 22-h infusion (1200mg/m2) every 2 weeks
  3. Together with Oxaliplatin 85mg/m2 as a 2-h infusion on day 1
57
Q

Dose-dependent adverse reaction of Oxaliplatin that often but not always resolves following cessation of therapy

A

Sensory neuropathy

58
Q

T or F: FOLFIRI is superior to FOLFOX in efficacy

A

False

Equal efficacy

59
Q

Monoclonal antibodies effective in advanced colorectal cancer directed against epidermal growth factor receptor (EGFR)

A
  1. Cetuximab

2. Panitumumab

60
Q

A monoclonal antibody directed against vascular endothelial growth factor (VEGF) that acts as an antiangiogenesis agent used in advanced colorectal cancer in addition to FOLFOX and FOLFIRI

A

Bevacizumab (Avastin)

61
Q

Side effects of Bevacizumab

A
  1. Hypertension
  2. Proteinuria
  3. Increased likelihood of thromboembolic events
62
Q

In patients with solitary hepatic metastases, from colorectal cancer, without clinical or radiographic evidence of additional tumor involvement, what procedure can be considered to increase 5-year survival rate to 25-30%?

A

Partial liver resection

63
Q

In cancer of the ANUS, where do most of the lesions arise?

A

Anal canal

From anorectal ring to a zone approx halfway between the pectinate (or dentate) line and the anal verge

64
Q

Carcinomas of anus arising PROXIMAL to pectinate line

A

Basaloid, cuboidal or cloacogenic tumors

65
Q

Type of anal cancer occurring in 55% of cases, ulcerate more frequently and arises DISTAL to pectinate line

A

Squamous cell carcinoma

66
Q

Development of anal cancer is associated with infection of this virus

A

Human papillomavirus (HPV)

67
Q

Anal warts due to infection with human papillomavirus

A

Condyloma acuminata

68
Q

How do anal warts progress to neoplasia?

A

Anal warts –> Anal intraepithelial neoplasia –> Squamous cell carcinoma

69
Q

T or F: Vaccination against HPV may reduce eventual risk for anal cancer

A

True

70
Q

T or F: Anal cancer occurs most commonly in middle-aged persons and more frequent in men.

A

False

WOMEN

71
Q

Symptoms of patients with anal cancer

A
  1. Bleeding
  2. Pain
  3. Sensation of perianal mass
  4. Pruritus
72
Q

Treatment for anal cancer

A

Preferred: Radiation therapy + Chemotherapy (5-FU and Mitomycin C)

If still with residual tumor: Radical surgery (abdominal-perineal resection with lymph node sampling and permanent colostomy)

HPIM Onco (4 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions