Cancer Flashcards
Margins of resection for colon adenocarcinomas:
5cm proximal and distal
Medication that is a radioprotectant of the intestine during radiation tx that acts by binding free radicals to prevent cellular damage?
amifostine
Preferred adjuvant chemotherapy for colon cancers who have T3 or greater disease, nodal metastasis, or distant metastasis:
FOLFOX: 5FU, leucovorin, and oxaliplatin
treatment of small intestinal neuroendocrine tumors <1cm without lymphadenopathy:
segmental resection
treatment of small intestinal neuroendocrine tumors >1cm with multiple or regional lymph node metastasis:
wide excision of bowel and mesentery
risk factors for NonHodgkin lymphoma of the small blowel:
history of transplant, HIV, or celiac disease
What mutation is associated with poorly differentiate colon cancer with signet ring components?
microsatellite instability
high risk features of appendiceal carcinoid tumors:
mucosal cellular origin, associated with mucin production, lymphovascular invasion, involvement of lymph nodes of mesoappendix, positive margins,k high proliferation rate (grade II or higher), mixed histology such as goblet cell carcinoid or adenocarcinoid
treatment of high risk appendiceal carcinoid tumors:
right hemicolectomy
treatment of neoplasms at the tip of the appendix:
if less than or equal to 15mm perform simple appy
tumors 20mm or larger should undergo right hemicolectomy
there is some debate on extent of operation for tumors 15-20mm
Where are small bowel lymphomas most commonly found?
terminal ileum
True or false. Neuroendocrine tumors of the duodenum are rare and have poor prognosis.
False. have excellent prognosis
Symptoms of carcinoid syndrome:
flushing, wheezing, nonbloody watery diarrhea, abdominal pain, right sided heart failure
serotonin produced by tumor overwhelms hepatic clearance and causes hypotension that is poorly responsive to vasopressors and fluids (treatment of hypotension is IV or subQ somatostatin analog)
What medication significantly decreases nausea and vomiting in patients with malignant bowel obstruction?
octreotide
Endoscopic findings of radiation enteritis:
pale, friable mucosa with extensive telangiectasis; bx shows occlusive vasculitis with acute inflammatory infiltration
Which appendiceal carcinoids should be treated with right hemicolectomy?
those with high risk features on pathologic exam, >2cm size, associated with metastasis, or located at the base of the appendix
Most common appendiceal mass:
appendiceal carcinoid
What is a Krukenberg tumor?
metastatic adenocarcinoma to ovary, usually from the stomach, but also can be from colon, appendix, and breast; usually bilateral
True or false. Even in the face of metastatic disease, there is a role for surgical debulking of small bowel neuroendocrine tumors.
True
Surgical treatment of metastatic small bowel neuronedocrine tumors:
small bowel resection to include primary tumor in addition to wide lymphadenectomy to include regional nodal disease
True or false. During an APR, the coccyx is used to guide dissection of the levator ani muscles from the perineum into the pelvis.
True
treatment of a stage 1 rectal cancer (Tis, T1, or T2 without nodal involvement)
surgery upfront; no neoadjuvant
treatment of stage 2 and above rectal cancer (T3 +/- nodes):
neoadjuvant chemo followed by surgery
Which rectal cancer patients are candidates for transanal excision:
T1 cancer within 8 cm of anal verge <3cm in size well-differentiated <30% circumference involved mobile, nonfixed no lymphovascular or perineural invasion margin clear >3mm
True or false. Tumor size correlates well with the likelihood of metastasis for carcinoid:
True; most >2cm will be metastatic at diagnosis
most common benign neoplasm of the small intestine:
adenomas
What does neoadjuvant chemoradiation consist of for rectal cancer?
4500-5000 cGy radiation plus infusion of 5FU and capecitabine
Celiac disease increases likelihood of developing ___ lymphoma of the intestine.
T cell
Diagnostic test for carcinoid tumors:
24 hr urine 5HIAA
What test should be considered after diagnosis of carcinoid tumor is made and curative resection is being considered?
somatostatin receptor scintigraphy
Treatment of stage IV colon cancer with isolated metastatic disease to liver or lung:
surgical resection and adjuvant chemo
ideal number of lymph nodes resected during colon cancer surgery:
12
Most common type of lymphoma that occurs at the terminal ileum:
nonHodgkin B cell lymphoma
Which colon cancers require adjuvant chemotherapy with FOLFOX or capecitabine/oxaliplatin?
any colon cancer with nodal disease
Treatment of rectal cancer that is less than 2 cm from the anal verge or at the dentate line with extramural spread to involve the sphincter complex or direct extension into pelvic structures:
APR
Rectal cancer undergoing transanal excision cannot invade beyond ___
submucosa (T1N0)
True or false. Small bowel carcinoids are frequently asymptomatic.
True
True or false. Moderately or poorly differentiated mucinous adenocarcinoma of the appendix can be removed with appendectomy alone if completely resected.
False. right hemicolectomy is indicated
Treatment of T cell lymphoma of the small bowel:
chemotherapy
What medications have been shown to be proective against radiation enteritis?
ACE inhibitors and statins
What is the follow up for any incompletely resected polyp?
any incompletely resected requires a repeat colonoscopy and second attempt at removal
What is the follow up for <10mm hyperplastic rectal or sigmoid polyps
10 year follow up
What is the follow up for 3-10 tubular adenomas:
5-10 year follow up
What is the follow up for >10 tubular adenomas:
3 year follow up
What is the follow up for any high risk findings (>10mm adenoma, villous features, high grade dysplasia):
3 year follow up
Management of polyps that are 6-9 mm on CT colonography:
second CT colonography in 3 years or attempt removal by colonoscopy
Pathologic findings concerning for lymph node metastasis in pts who have undergone endoscopic mucosal resection for mucosal colon cancer:
massive submucosal invasion, lymphatic or vascular invasion, poorly differentiated histology, positive margins in sessile polyps
Most common type and treatment of colonic lymphoma:
diffuse large B cell; tx with bowel resection and lymphadectomy followed by chemo
True or false. Neoadjuvant chemoradiation improves local control for stage II and III rectal cancer for low and mid rectal cancers.
true
_____ cancer lymphatic drainage follows the path of the ileocolic artery and proximal ligation ensures adequate lymphadenectomy.
Cecal
True or false. MRI is less sensitive at detecting nodal involvement for colorectal cancer than EUS.
False. MRI is more sensitive
True or false. Laparoscopic and open resections for colon cancer have equivalent overall and recurrence-free survival rates.
true
What is a Krukenberg tumor and what are the common locations?
metastatic adenocarcinoma to the ovary; stomach is the most common primary followed by colon, appendix, and breast
True or false. Krukenberg tumors are usually unilateral.
false. usually occur in bilateral ovaries
Negative side effects from using bevacizumab in metastatic colon cancer?
increased risk of GI perforation; poor wound healing
First line medical treatment for metastatic carcinoid tumors
lanreotide
Most sensitive test for detecting neuroendocrine tumors
Ga-dotatate PET-CT
The strongest predictor for survival of metastatic colon cancer after resection
degree of pathologic response to neoadjuvant chemo
The most common site of recurrence of colon cancer
liver
The most common site of recurrence for rectal cancer
locoregionally
Initial treatment of anal canal squamous cell carcinoma
Nigro protocol: 5FU, mitomocyin C, and radiation
evaluate for response 8-12 weeks after
Treatment of persistent anal canal SCC after 6 months
salvage APR
Treatment of local recurrence of anal canal SCC
salvage APR
Most important prognostic indicator in patients with colorectal carcinoid tumors
size of tumor; if >2cm, most will have metastasized at the time of diagnosis
Risk factors for recurrence of anal canal SCC:
tumor size >5cm, greater than 2/3 involvement of the canal circumference
Treatment of rectal carcinoids:
if >2cm in size, tx with proctectomy with excision of mesorectum
