Adenocarcinoma of the Colon and Rectum

Question 1

One of ealiest mutations in sporadic cancers is

Answer 1

the inactivation of of the adenomatous polyposis coli (APC) gene on chromosome 5q

Question 2

Microsatellite instability (MSI) is

Answer 2

an alternative pathway for genomic instability and subsequent colorectal carcinogenesis

Question 3

MSI arises from

Answer 3

defects in mismatch repair genes

Question 4

MSI in hereditary nonpolyposis colorectal cancer (HNPCC) is most commonly attributable to germline mutations in

Answer 4

hMLH1 and hMSH2 genes

Question 5

The vast majority of colorectal cancers (CRCs) are

Answer 5

sporadic (5% are associated with known genetic syndromes)

Question 6

Most common genetic syndrome associated with CRC is

Answer 6

HNPCC, which acounts for the majority of patients wiht familial CRC

Question 7

The lifetime risk of CRC for patients with UC is

Answer 7

3.7%

Question 8

The Dukes classification was initially develooped as a

Answer 8

prognostic tool for rectal cancer in the 1930s

Question 9

The modified Astler-Coller system

Answer 9

a modified Dukes classification introduced in the 1950s

Question 10

The TNM classification is

Answer 10

the preferred staging system

Question 11

TNM - Primary tumor (T)

Answer 11

T0 - no evidence of primary tumor, Tis - carcinoma-in-situ (intraepithelial or invasion of lamina propia), T1 - tumor invades submucosa, T2 - tumor invades muscularis propria, T3 - tumor invades through muscularis propia, T4 - tumor invades other organs or perforated visceral peritoneum

Question 12

TNM - Regional lumph nodes (N)

Answer 12

N0 - no regional LN metastases, N1 - metastases in 1 to 3 regional LNs, N2 - metastases in 4 or more regional LNs

Question 13

TNM - Distant metastasis (M)

Answer 13

M0 - no distant metastasis, M1 - distant metastasis

Question 14

Stage 0 CRC

Answer 14

Tis, N0, M0

Question 15

Stage I CRC

Answer 15

T1 or T2, N0, M0

Question 16

Stage IIA CRC

Answer 16

T3, N0, M0

Question 17

Stage IIB CRC

Answer 17

T4, N0, M0

Question 18

Stage IIIA CRC

Answer 18

T1 or T2, N1, MO

Question 19

Stage IIIB CRC

Answer 19

T3 or T4, N1, M0

Question 20

Stage IIIC CRC

Answer 20

Any T, N2, M0

Question 21

Stage IV CRC

Answer 21

Any T, Any N, M1

Question 22

Alternative to colonoscopy

Answer 22

air-contrast barium enema

Question 23

Mainstay of therapy for colon cancer

Answer 23

surgery with curative intent

Question 24

An adequate margin of resection is ___ cm of normal bowel on each side of the tumor

Answer 24

5 cm

Question 25

For tumors of the cecum and ascending colon, a

Answer 25

right hemicolectomy that includes the right branch of the middle colic artery at its origin should be performed

Question 26

For tumors of the hepatic flexure, an

Answer 26

extended right colectomy that includes the entire middle colic artery

Question 27

For tumors of the transverse colon, an

Answer 27

extended right or left colectomy or a transverse colectomy may be performed

Question 28

For tumors of the splenic flexure region, a

Answer 28

left hemicolectomy is performed

Question 29

For sigmoid tumors, a

Answer 29

sigmoid colectomy is performed

Question 30

The incidence of synchronous CRCs is reported to range from

Answer 30

3 to 5 %

Question 31

Postoperative systemic adjuvant therapy is

Answer 31

the standard of care in patients with stage III disease

Question 32

With rectal cancer, surgical treatment alone results in recurrence rates of

Answer 32

16.2% after LAR and 19.3 after APR

Question 33

Anastomotic leakage rates vary widely after radical rectal resection

Answer 33

10 to 30%

Question 34

Preoperative chemoradiation therapy ___ been shown to increase anastomotic leakage rates.

Answer 34

has not

Question 35

Criteria for transanal excision (TAE):

Answer 35

lesion < 4 cm in diameter, < 1/3 circumference of rectum, < 8 cm from anal verge

Question 36

Adequate distal margin for rectal cancer

Answer 36

2 to 5 cm

Question 37

Peritoneal carcinomatosis develops in ~

Answer 37

13% of all CRC patients

Question 38

Recurrence surveillance recommendations

Answer 38

CEA levels every 2-3 months for 2 years then every 3-6 months for 3 years then annualy; clinical exam every 3 to 6 months for 3 years than annually; colonoscopy perioperatively then every 3 to 5 years

Question 39

The most common sites of metastasis in CRC patients are

Answer 39

liver and peritoneal cavity