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1. Clin Med III > 2- Colon CA > Flashcards

2- Colon CA Flashcards

1
Q

What is a growth on the inner surface of the colon?

A

Polyp

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2
Q

What type of polyp is attached by a stem/stalk?

A

Pendunculated

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3
Q

What type of polyp is flat?

A

Sessile

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4
Q

What types of polyps are benign?

A 
Hyperplastic
Pseudopolyps (inflammatory)
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5
Q

What types of polyps are malignant?

A

Adenomas

Sessile serrated polyps (pre-cancerous)

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6
Q

70% of all CRC arise from what type of polyp?

A

Adenomas

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7
Q

An adenoma will slowly transition to a carcinoma over 10 years. What is the best early treatment?

A

Early detection and removal

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8
Q

How is an “advanced” carcinoma defined?

A

≥ 1 cm
Villous component
High grade dysplasia

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9
Q

What are the 3 types of adenoma polyps? What is the most common?

A

Tubular adenoma = most common
Tubulovillous adenoma
Villous adenoma

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10
Q

Risk of CRC increases by what (3)?

A

of adenomas, size and histology

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11
Q

What is defined as a malignant growth on the inner wall of the colon or rectum?

A

Colorectal CA

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12
Q

What is the most common presentation of CRC?

A

Left sided colon cancer

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13
Q

Are rates of right sided colon CA rising or falling?

A

Rising

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14
Q

Early screening for CRC is recommended in what population?

A

African American

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15
Q

Clinically how will a pt w/ CRC present?

A

Often ASX

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16
Q

Change in bowel habits, blood in stool, IDA, weight loss, and abd pain are all what related to CRC?

A

Red flags

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17
Q

On exam of pt that presents w/ abd pain, you find the pt is cachectic, pale, + lymphdenopathy, abd distention & mass, and + hemoccult on DRE. What is the suspected dx and what is your next step?

A

CRC

Refer to GI for colonoscopy

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18
Q

Carcinoembryonic antigen (CEA) is a marker for what?

A

Tumor marker

Not used for screening, helpful as prognostic indicator and to monitor for recurrence

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19
Q

What study will permit biopsy for pathologic confirmation of CRC (dx and therapeutic)?

A

Colonoscopy

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20
Q

An apple core lesion on barium enema is concerning for what?

A

CRC

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21
Q

What staging sx is used for CRC?

A

Tumor: depth of tumor
Node: regional lymph node involvement
M: +/- mets

Staging 0-4

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22
Q

When is chemotherapy used in the TX of CRC?

A

Usually if mets are presents

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23
Q

When is radiation therapy used in the TX of CRC?

A

For rectal adenocarcinoma

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24
Q

What surveillance studies are used to tack CRC?

A

Serial CEA level, annual CT chest/adb/pelvis, periodic colonoscopy

25
Q 
The following are RF for what? 
Hereditary syndromes (FAP, HNPCC), PMHx or FHx of adenomas or CRC, PMHx IBD, and age > 50
A

CRC

FAP = Familial adenomatous polyposis
HNPCC = Hereditary nonpolyposis colorectal cancer
26
Q

What is the difference b/w screening vs surveillance?

A

Screening: process of detecting early stage CRC/preCA lesion in asx pts w/ no prior hx

Surveillance: follow up testing in pts w/ hx of polyps, CA, IBD

27
Q

What screening tests will visualize the colon? (3)

A

Colonoscopy
Flex sigmoidoscopy
CT colonography

28
Q

What screening tests are stool based?

A

gFOBT (hemocucult SENSA)
FIT
FIT-DNA

29
Q

T or F: Barium enema, office-based stool guaiac, serology- Septin 9, and colon capsule endoscopy are recommended screenings tests for CRC?

A

FALSE

They are NOT recommended for screening

30
Q

What screening test is gold standard (both diagnostic and therapeutic)?

A

Colonoscopy

31
Q

What are the advantages of a colonoscopy? (5)

A
  1. Visualize entire colon
  2. Detect and remove polyps to PREVENT turning into CA
  3. High CRC sensitivity
  4. Single session
  5. Long screening intervals
32
Q

What are the disadvantages of a colonoscopy? (6)

A
  1. Cost/time
  2. Bowel prep
  3. Invasive/complications
  4. Sedation
  5. Bowel prep influences adenoma detection ability
  6. Operator dependent
33
Q

What will influence postpolypectomy surveillance?

A

of polyps, size, histologic features

*endoscopist provides recommendations for repeat scope

34
Q

What CRC screening test only reaching the distal 1/3 of colon?

A

Flex sigmoidoscopy

35
Q

Why has flex sigmoidoscopy fallen out of favor for CRC screening?

A

Does not offer protection against proximal lesions (right/proximal CRC increasing)

If polyps found, will need colonoscopy to r/o proximal lesions

36
Q

What is the disadvantage of CT colonography?

A

Can miss flat or small polyps (<10 mm-1 cm)
Unable to remove polyps (will need colonoscopy if +)
Bowel prep

37
Q

What are the advantages of CT colonography?

A

Lower risk of perf vs scope
No sedation
Able to use in pts w/ comorbidities or physiological abnormality

38
Q

Do most polyps bleed?

A

NO!

Can be missed on tests that assess for hemoglobin in stool

39
Q

What stool based screening tool requires 3 consecutive stool samples, dietary modifications, and has low sensitivity for one-time screening (annual recommended)?

A

gFOBT (highly sensitivity hemoccult SENSA)

40
Q

What stool based screening tool tests for the presence of human hemoglobin, does NOT require dietary restrictions, and only requires single stool sample?

A

FIT

41
Q

What stool based screening test is preferred for initial CRC detection test?

A

FIT

42
Q

What stool based screening tool combines FIT w/ DNA testing (biomarkers for CRC), has higher false positives vs FIT and requires entire bowel movement/ is $$$$?

A

FIT-DNA

43
Q

If pt w/ positive stool sample what is the next step?

A

Timely dx colonoscopy

44
Q

What should you be mindful of with regard to stool based tests?

A

Lower sensitivity vs visualization tests, limit preventative role of screen, need multiple screens to be effective

45
Q

At what age does screening for CRC begin?

A

45-50 based on various guidelines (45 y/o for AA)

46
Q

At what ages does screening for CRC stop?

A

75 yrs or less than 10 yr life expectancy

47
Q

When do you start screening Pt for CRC if +FHx (dx < 60)?

A

Colonoscopy every 5 yrs beginning at age 40 or 10 years younger than age at which youngest 1st degree relative was DX (whichever comes first)

48
Q

When do you start screening Pt for CRC if +FHx (dx > 60)?

A

Begin screening at age 40. If normal then screen pt as avg. risk individual

49
Q

When do you start screening Pt for CRC w/ IBD?

A

8-10 yrs after onset of sx

50
Q

What hereditary disease is characterized by > 100 adenomatous polyps?

A

Familial adenomatous polyposis

51
Q

Pts w/ Familial adenomatous polyposis will develops sx at ~ 16 yo, if left untx pts will develop what by age ~39?

A

CRC

52
Q

What is the recommended tx for Familial adenomatous polyposis?

A

Prophylactic colectomy

53
Q

Pts w/ Familial adenomatous polyposis are at an increased risk for what?

A

Extracolonic malignancies

  • Gastric/duodenal/ampullary CA
  • Follicular/papillary thyroid CA
  • Hepatoblastoma (children)
  • CNS tumors
54
Q

When do you start screening for pt who are gene carriers of Familial adenomatous polyposis?

A

Sigmoidoscopy/colonoscopy starting at age 10-12 and repeating every 1-2 yrs

Routine EGD also recommended

55
Q

Hereditary Nonpolyposis colon CA (HNPCC) is aka what?

A

Lynch syndrome

56
Q

Pts w/ Hereditary Nonpolyposis colon CA (HNPCC) are at an increased risk for what?

A
  • CRC (usually right sided) by age 45-60
  • Multiple CA (endometrial = most common)

*Be sure to collect thorough FHx

57
Q

What is the Amsterdam criteria for Hereditary Nonpolyposis colon CA (HNPCC)?

A

3-2-1 rule

3 affected family members
2 generations
1 under age 50

58
Q

When should CRC screening start for pt that meets criteria for Hereditary Nonpolyposis colon CA (HNPCC)?

A

Annual colonoscopy starting at 20-25 yrs or 2-5 yrs prior to earliest age of CRC dx in family (whichever comes first)

59
Q

When should you consider hereditary colon cancer syndromes?

A
  1. FH of CRC in > 1 family member
  2. PMH or FH of CRC at age < 50 yr
  3. PMH or FH of >10-20 adenomas
  4. PMH or FH of multiple extracolonic malignancies

1. Clin Med III (29 decks)

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