C12-CCR

Question 1

Factori de risc-CCR

Answer 1

> 50 de ani
APP si AHC de cancer sau adenoame
AHC de cancer ereditar (cancer colonic non-polipos) sau de polipoza adenomatosa familiala(FAP)
BII
obezitate
DZ
fumat
Alcool
carne rosie/procesata

Question 2

Risc scazut-CCR

Answer 2

AINS
fructe si legume proaspete
activitate fizica
consumul de lactate

Question 3

Micronutrimente protectoare CCR

Answer 3

doza de Ca= IMPORTANTA: 2g de Ca elemental
vitamina A: 30000 UI
vitamina C: 1-4 g
vitamina E: 400 mg
(seleniu - constituient al glutation-peroxidazei)

Question 4

Cancerul colorectal ereditar non-polipozic (HNPCC)
(sindrom Lynch)

Answer 4

● Afectiune autozomal dominanta
● Cea mai frecventa forma de cancer ereditar
● Genele de susceptibilitate: gene de stabilitate
(anti-mutatoare): hMLH1, hMSH2
● Caracteristici fenotipice:
● CCR aparute la varsta tanara (< 45 ani)
● localizare prox (70% proximal de flexura
splenica)
● CCR multiple in 35% (sincrone, metacrone)
● forme histologic agresive (mucinoase,
nediferentiate)
● secventa adenom-carcinom accelerata (2-3 ani)
● asocierea a variate localizari maligne
extracolonice (endometru, ovar, uroteliu, stomac)

Question 5

Criteriile Amsterdam pt diagnosticul HNPCC

Answer 5

● Minimum 3 rude cu CCR sau cancere Lynch-asociate
● Una dintre acestea ruda de gradul I cu celelalte doua
● Minimum 2 generatii succesive afectate
● Cel putin una dintre tumori diagnosticata la varsta tanara (< 50 ani)
● Fenotip polipozic (FAP) absent
● Adenocarcinomul confirmat prin examen histopatologic

Question 6

Aspecte macroscopice CCR

Answer 6

-polipoid/exofitic
-vegetant
-infiltrativ-ulcerat
-stenozant
+aspectele “plate” (bed flower) caracteristice CCR in IBD

Question 7

Aspecte microscopice CCR

Answer 7

● adenocarcinom bine, moderat, slab diferentiat si nediferentiat
● adenocarcinom mucinos “in inel cu pecete” si coloid
● carcinom schiros (reactie desmoplastica importanta)

Question 8

Distributia tumorilor colorectale

Answer 8

Preponderent distal ( rect, sigmoid), dpdv al incidentei la nivelul cecului

Question 9

Stadializarea CCR

Answer 9

▪ Sistemul de stadializare simplificat TNM
▪ T: Tis = carcinom in situ
T1 = tumora invadeaza submucoasa
T2 = tumora invadeaza musculara propria
T3 = tumora invadeaza subseroasa
T4 = tumora invadeaza intreg peretele pana la peritoneul visceral sau invadeaza direct structuri invecinate
▪ N (minimum 12 ganglioni trebuie inclusi in rezectie): N0 = fara metastaze ganglionare loco-regionale
N1 = metastaze in 1-3 ganglioni loco-regionalí
N2= metastaze in ≥4 ganglioni loco-regionali
▪ M: M0 = fara metastaze la distanta; M1 = prezenta metastazelor la distanta

Question 10

Populatia asimptomatica cu risc standard

Answer 10

Colonoscopie la 10 ani interval incepand de la 50 de ani

Question 11

Urmarire postop CCR

Answer 11

CEA, US/CT, colonoscopie