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PATH3309 > Bowel Cancer > Flashcards

Bowel Cancer Flashcards

1
Q

What is the most common form of bowel cancer?

A

Adenocarcinoma (gland forming)

Others:
lymphomas
Sarcomas

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2
Q

Can cancer occur in small bowel?

A

Less common but yes

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3
Q

Why is bowel cancer so dam important?

A

Common
Curable if detected early
Significant morbidity due to bowel

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4
Q

Is bowel cancer more likely in men or women?

A

Men, more likely to die as well

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5
Q

What are chances of getting bowel cancer?

A

1/46

Second most common cause of death in men and women

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6
Q

What are risk factors for bowel cancer?

A

1) Family history - increases risk by 1.5x
- 3x if multiple
- 5x if under age 45
2) Inflammatory bowel disease
3) Obesity
4) Diet

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7
Q

Why has 5 year survival increased so much?

A

Early detection
Identification of high risk individuals
New drugs

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8
Q

What are the complications or symptoms of colon cancer?

A

Early = blood in stool (melaena)
Advanced =
System effects
- bowel obstruction, perforation

Systemic effects

  • Metastatic spread to other organs
  • Cachexia
  • Paraneoplastic symptoms
  • Death
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9
Q

What are the four classes of regulatory genes?

A

Growth promoting oncogenes (gain function)
Growth inhibiting tumour supressors (loss of function)
Genes that regulate cell death (pro-apoptotic)
Genes involved in DNA repair

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10
Q

What are the stages to colon cancer?

A 
Normal mucosa
Mucosa at risk
Adenoma - polyp
Advanced adenoma - large irregular polyps
Carcinoma - invade bowel wall
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11
Q

What are the 3 main pathways to colon cancer?

A

Chromosomal Instability
Microsatellite Instability (MRE deficiency)
CpG island Methylation

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12
Q

What is APC?

A

A tumour supressor gene, downregulates E cadherin and B-cantenin, Wnt siglanning

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13
Q

What is B-cantenin?

A

Proto-oncogene, upregulates multiple growth pathways

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14
Q

What are the steps to carcinoma?

A

APC at 5q21 = mucosa at risk
APC B-cadherin = adenoma
KRAS at 12p12 = advanced adenoma
p53 = carcinoma

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15
Q

What are the two main types of familial colon cancer?

A

Familial Adenomatous Polyposis (FAP)

HNPCC (Lynch syndrome)

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16
Q

What is FAP?

A

Familial Adenomatous Polyposis

  • auto dominant 1 in 30 000
  • 100% risk of CC
  • Mutation in APC at 5q21
  • Carpet of adenomas
  • Prophylactic total colectomy by age 25
17
Q

What is HNPCC?

A

Hereditary nonpolyposis colorectal cancer

  • Auto dominant 1 in 600 - 2000
  • Fewer polyps
  • Mutations in MRE genes
  • Inherited Microsatelite instability
  • Risk of bowel, endometrial, bladder, gastric + skin
18
Q

How does colon cancer usually form though?

A

Sporadic

19
Q

How is colon cancer diagnosed?

A

Personal history and family history

Clinical symptoms

  • Altered blood
  • Pain/weight loss/ bowel obstruction only when advanced

Clinical signs = usually none
- Palpable mass (advanced)

Radiological findings

  • May be none
  • Mass or obstruction (advanced)

Endoscopic findings

Pathologic Findings

  • Macroscopic
  • Microscopic
  • Immunohistochemical
  • Molecular genetic
20
Q

What is the national bowel cancer screening program and what do they look for?

A

Faecal occult blodd (not visible)
Reducing mortality rate by 30%

Immunochemical test for globin 
- 2 samples
- Uses new hemtube assay
- Offered 5 yearly to > 50 year olds
Being expanded to 2 yearly?
21
Q

What happens in national bowel cancer screening detect faecal occult blood?

A

Refer for colonoscopy
If polyp found removed via endocsopic resection
Large mass biopsied

22
Q

What does like screening even mean?

A

Screening means testing asymptomatic people for disease or precurser

23
Q

What are the advantages of bowel cancer screening?

A

Reduction in mortality and morbidity
Cost effective
Procedures for early cancer easier and safer

24
Q

What are the disadvnatages for bowel cancer screening?

A

Costly

Risk of additional intervention

25
Q

What are the requirments for a screening test to be worthwhile?

A

1) Disease must have serious consequences
2) Disease must have detectable preclinical period
3) Screening pop has high prevalence of disease
4) Test must be sensitive and specific
5) Test must be safe
6) Affordable
7) Effective treatment exists
8) Treatment more effective if earlier

26
Q

What are the benefits of examining the specimen?

A

1) Diagnosis of tumour type
2) Grading of tumour
3) TNM staging
4) Assesing margins
5) Providing prognostic info

27
Q

What is treatment for local CC?

A

Resection = high chance of cure

28
Q

What is treatment for locally advanced CC?

A

Chemo + radio + targeted

Cure possible but risk of spread

29
Q

What is treatment for systemic CC?

A

fked
Resection to improve morbidity
Chemo to restric tumour growth and increase surv

PATH3309 (14 decks)

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