Appendix and colon tumors Flashcards
Appendix tumors are very ___ and are usually discovered accidently post ___.
rare
appendectomy
What is the most and second most common tumors in the appendix?
carcinoid
AC
The ___ of the appendix tumor is the best predictor to the level of its aggressiveness and malignancy
size
Appendix carcinoid tumor < 1 cm should be treated as a ___ tumor- treating with regular ___
benign
appendectomy
Appendix carcinoid tumor > 2 cm should be treated aggressively with ____ and regional ___
right hemicolectomy
lymphadenectomy
Appendix AC should be treated like AC of the cecum with- ____ and regional ___. We can also use adjuvant treatment of ____
right hemicolectomy
lymphadenectomy
FOLFOX (5 fu, leucovorin, oxaliplatin)
When finding cyst in the appendix, we should consider ___ tumor. Beware of leakage to prevent ___
mucinous
seeding
Colon polyps frequency increase with ___
age
__% of the polyps are found in the ___
50
rectum-sigmoid
Most colon polyps are ____, but may cause rectal ___ and ___
asymptomatic
bleeding
constipation
How can we characterize polyps as ___ or ___
non-neoplastic
neoplastic
Non-neoplastic polyps can be: (3)
inflammatory
hamartomatous
hyperplastic
Neoplastic polyps can be: (2)
adenomas
adenocarcinoma
2/3 of all polyps in the colon are of ___ type
adenoma
Inflammatory polyps develop in the ___ are called solitary ___ ___ syndrome and may lead to damage to the ___ sphincter, long lasting ___ leading to ___
rectum rectal ulcer anorectal constipation ulceration
Juvenile tumors are ___, usually found in the ___ and characterized with rectal ___, usually in children < age of ___
pedunculated
rectum
bleeding
5
Peutz- Jeghers syndrome is __ with large ___ polyps scattered all around the GI. It leads to increased risk for different cancers
AD
pedunculated
Cronkhite–Canada syndrome ____tumors all along the GI with cutaneous ___, alopecia, nail ___, and ___ atrophy. This has no genetic disorder and not malignancy potential.
hamartomatous
hyperpigmentation
atrophy
tonsils
Name the 3 hamartomatous polyps
juvenile polyps
Peutz- Jeghers syndrome
Cronkhite–Canada syndrome
What are the most common non neoplastic polyps?
Hyperplastic
Hyperplastic polyps are usually found at the ages of __-__. It is an epithelial hyperplasia with ___ malignancy potential. Their hallmark is ___, usually located on the __ colon.
50-60
no
serrated
left (recto sigma)
Adenomatous polyps has ___ characteristics with risk to convert into ___
dysplastic
CRC
What are the macroscopic strictures of polyps? (2)
sessile :(
pedunculated :)
What kind of histological types adenomas can present with?
___ (65-80%)
___ (5-10%)
___ (10-25%)
Tubular (peduncular)
villous (sessile)
mixed
When performing pathology to the polyp, we need > __% to determine the type. If < ___% then mixed
80
60
The ___ the adenoma, the ___ likely it will progress to malignancy
bigger
more
Advanced (invasive) adenoma is defined by high grade ___ / > __cm / ___
dysplasia
1
villous
Treating all polyps includes ___ using ___ when performing ___
resection
snare
colonoscopy
Safe removal of polyp requires __ mm of clean margins
2
Invasive adenocarcinoma penetrates through the MM (___) and can ___
muscularis mucosa
metastasize
Non-invasive adenocarcinoma = carcinoma _____
in situ
Which classification is used for cancerous polyps?
Haggitt
Every sessile polyp with invasive carcinoma is considered level __
4
Pedunculated polyps levels - should be removed.
Every polyp level __ should be considered as CRC
3-4
4
Give 10 risk factors to CRC: old \_\_\_ Westman \_\_\_ personal \_\_\_ family history (remember syndromes (3)) IBD (2) strep bovis bacteremia radiation obesity smoking
age diet history FAP/HNPCC/MYH UC/CD
Name 4 protective factors from CRC:
aspirin
estrogen
calcium/folic acid
low BMI
What is the relevant marker for CRC?
CEA (Carcinoembryonic antigen)
FAP is an ___ disease due to a mutation in the __ gene on chromosome __
AD
APC
5
We must find at least ___ polyps to diagnose FAP. The mean age at diagnosis is __
100
29
Although FAP adenomas do not have higher malignancy potential than sporadic adenomas, ___% of untreated patients will develop cancer, usually by the age of ___
100
30
What is the preferred treatment for FAP
total proctocolectomy with ileoanal pouch
FAP can also appear in the ___ or ___, therefor EGD (___) should be performed every __ years
Esophagogastroduodenoscopy
2
Patients with FAP are recommended to go through surgery by the age of
20
Describe the screening in FAP patients:
yearly colonoscopy starting at the age of 10-12 EGD every 2 years from the age of 30 thyroid every year abdominal US (pancreas cancer) yearly physical examination
HNPCC= ____ and __
hereditary non polyposis colon cancer
lynch
HNPCC may lead mostly to __ and ___, but also (3)
CRC endometrium stomach ovary small bowel
HNPCC is more common in the ___ colon, and at younger (__) age
right
46
What are the common mutations in Lynch syndrome? (2)
MLH1
MSH2
Describe the Amsterdam classification for Lynch (5)
CRC in 3 family members (at least 1 first degree)
2 generations involved
at least 1 of the mentioned above <50 when diagnosed
FAP ruled out
pathology
How do you treat Lynch?
abdominal colectomy + ileorectal anastomosis
hysterectomy +BSO
Who has better CRC prognosis? HNPCC or regular patient?
HNPCC, why? unclear…
Describe the recommended screening for Lynch patient: (3)
colonoscopy every 2 years age 20-40 + every year when >40 or 10 years before the age the family member was diagnosed
pelvic examination (US) every 1-2 years from ages 25-35
renal/urinary US every 1-2 years ages 30-35
Sporadic CRC adenocarcinoma is the ____ common GI tract malignancy
most
The leading way CRC spreads is through the ___ to the regional ___ ___. If ___ than we will find tumors in the ___
lymph system
lymph nodes
hematogenic
liver
____ has a protective effect from CRC through COX-2 inhibition
aspirin
Name the common late symptoms for CRC: (7)
constipation hematochezia iron deficiency anemia abdominal pain tenesmus bowel obstruction fistulas
Left colon tumors tend to be more ___
obstructive
Sigma tumors may imitate ___- (3)
LLQ pain
fever
leukocytosis
Right colon tumors usually ____ and cause ___ and ___
bleed
iron deficiency
lethargy
The gold standard for CRC is ____
colonoscopy
Colon with complete obstruction due to tumor should be treated with ___ ___
urgent
surgery
Why we should not perform primary anastomosis in urgent surgery due to complete bowel obstruction due to tumor?
lack of preparation which will lead to anastomotic leak
Hartman procedure:
sigmoidectomy + end colostomy + rectal stump
When dealing with a patient with a partial obstruction due to a tumor there is no indication for an ___ ___, ___ imaging, ___ functions, ___ levels, full ___, CT and MRI
urgent surgery
CXR
liver
colonoscopy
Preoperative colon preparation includes: 1) mechanical (___), 2) ABx (PO (__,__,__)
PEG (laxative)
neomycin, erythromycin, Flagel
When removing CRC we should strive for clean margin of ___ cm + ___ + ___
5
lymph nodes
mesentery
Right hemicolectomy surgery requires the dissection of the ___ branches (3) and the right branch of the middle colic.
SMA
ilio-colic
middle colic
right colic
Left hemicolectomy surgery requires the dissection of the left ___ artery + left branch of mid ___
colic
colic
Staging of CRC: 1- \_\_\_ 2- \_\_\_ 3- \_\_\_ 4- \_\_\_
T1/2 + N0 + M0
T3/4 + N0 + M0
any T + N1/2 + M0
any T + any N + M1
What are the 5 years survival of CRC? 1- \_\_\_% 2- \_\_\_% 3- \_\_\_% 4- \_\_\_%
90
75
50
<5
Treating stage 1 colon cancer is with ___ alone, ___ after 1 year. If no polyp, next colonoscopy after ___ years, if we find polyps- after 1 year. ___ levels should be monitored every ___ months in the first 2 years. If increased- CT/MRI/PET
surgery colonoscopy 5 CEA 3
Treating stage 2 colon cancer is with ___ + consider adjuvant chemotherapy (___) only in very severe patients. Monitor like in stage 1, but add CEA for 5 years every 6 months, and chest/abdomen CT once a year for ___ years
surgery
FOLFOX
3
Name the 4 criteria for very severe colon cancer patient:
less than 12 nodes were resected
T4 tumor
poorly differentiated tumor
perforation
Treating stage 3 colon cancer is with ___ and ___ for all patients. monitor like stage 2. ___ chemotherapy with FOLFOX4 (___)
surgery
chemotherapy
adjuvant
5fu+oxaliplatin+leucovorin
Treating stage 4 colon cancer involves __ + __ + __
chemotherapy
biological
palliative surgery
What does the stage 4 biological treatment include? (3)
Avastin (anti VEGF)
Erbitux
Panitumumab (anti EGFR)
The best prevention test for CRC is ___ every __ years over the age of ___
colonoscopy
10
50
For patients refusing colonoscopy- flexible ___/ coronographic __ every 5 years
sigmoidoscopy
CT
If patients prefer to avoid all prevention tests- we move to ___ tests: (3)
detection
FIT- fecal immunochemical test
FOBT- fecal Occult Blood Test
Fecal DNA testing
When performing colonoscopy and finding >__small adenoma + __ grade -> repeat colonoscopy within the next - years
1
low
5-10
What is an advanced adenoma? > \_\_cm \_\_\_ \_\_\_ _-_ small ones in the colonoscopy
1
villous
high grade
3-9
When finding 3-9 small adenomas-> repeat ___ every __ years
colonoscopy
3
When finding >10 small adenomas-> repeat ___ every __ year + ___ study
1
genetic
