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Small & Large Intestine > Cancer > Flashcards

Cancer Flashcards

1
Q

Margins of resection for colon adenocarcinomas:

A

5cm proximal and distal

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2
Q

Medication that is a radioprotectant of the intestine during radiation tx that acts by binding free radicals to prevent cellular damage?

A

amifostine

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3
Q

Preferred adjuvant chemotherapy for colon cancers who have T3 or greater disease, nodal metastasis, or distant metastasis:

A

FOLFOX: 5FU, leucovorin, and oxaliplatin

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4
Q

treatment of small intestinal neuroendocrine tumors <1cm without lymphadenopathy:

A

segmental resection

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5
Q

treatment of small intestinal neuroendocrine tumors >1cm with multiple or regional lymph node metastasis:

A

wide excision of bowel and mesentery

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6
Q

risk factors for NonHodgkin lymphoma of the small blowel:

A

history of transplant, HIV, or celiac disease

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7
Q

What mutation is associated with poorly differentiate colon cancer with signet ring components?

A

microsatellite instability

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8
Q

high risk features of appendiceal carcinoid tumors:

A

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

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9
Q

treatment of high risk appendiceal carcinoid tumors:

A

right hemicolectomy

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10
Q

treatment of neoplasms at the tip of the appendix:

A

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

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11
Q

Where are small bowel lymphomas most commonly found?

A

terminal ileum

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12
Q

True or false. Neuroendocrine tumors of the duodenum are rare and have poor prognosis.

A

False. have excellent prognosis

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13
Q

Symptoms of carcinoid syndrome:

A

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)

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14
Q

What medication significantly decreases nausea and vomiting in patients with malignant bowel obstruction?

A

octreotide

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15
Q

Endoscopic findings of radiation enteritis:

A

pale, friable mucosa with extensive telangiectasis; bx shows occlusive vasculitis with acute inflammatory infiltration

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16
Q

Which appendiceal carcinoids should be treated with right hemicolectomy?

A

those with high risk features on pathologic exam, >2cm size, associated with metastasis, or located at the base of the appendix

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17
Q

Most common appendiceal mass:

A

appendiceal carcinoid

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18
Q

What is a Krukenberg tumor?

A

metastatic adenocarcinoma to ovary, usually from the stomach, but also can be from colon, appendix, and breast; usually bilateral

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19
Q

True or false. Even in the face of metastatic disease, there is a role for surgical debulking of small bowel neuroendocrine tumors.

A

True

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20
Q

Surgical treatment of metastatic small bowel neuronedocrine tumors:

A

small bowel resection to include primary tumor in addition to wide lymphadenectomy to include regional nodal disease

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21
Q

True or false. During an APR, the coccyx is used to guide dissection of the levator ani muscles from the perineum into the pelvis.

A

True

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22
Q

treatment of a stage 1 rectal cancer (Tis, T1, or T2 without nodal involvement)

A

surgery upfront; no neoadjuvant

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23
Q

treatment of stage 2 and above rectal cancer (T3 +/- nodes):

A

neoadjuvant chemo followed by surgery

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24
Q

Which rectal cancer patients are candidates for transanal excision:

A 
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
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25
Q

True or false. Tumor size correlates well with the likelihood of metastasis for carcinoid:

A

True; most >2cm will be metastatic at diagnosis

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26
Q

most common benign neoplasm of the small intestine:

A

adenomas

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27
Q

What does neoadjuvant chemoradiation consist of for rectal cancer?

A

4500-5000 cGy radiation plus infusion of 5FU and capecitabine

28
Q

Celiac disease increases likelihood of developing ___ lymphoma of the intestine.

A

T cell

29
Q

Diagnostic test for carcinoid tumors:

A

24 hr urine 5HIAA

30
Q

What test should be considered after diagnosis of carcinoid tumor is made and curative resection is being considered?

A

somatostatin receptor scintigraphy

31
Q

Treatment of stage IV colon cancer with isolated metastatic disease to liver or lung:

A

surgical resection and adjuvant chemo

32
Q

ideal number of lymph nodes resected during colon cancer surgery:

A

12

33
Q

Most common type of lymphoma that occurs at the terminal ileum:

A

nonHodgkin B cell lymphoma

34
Q

Which colon cancers require adjuvant chemotherapy with FOLFOX or capecitabine/oxaliplatin?

A

any colon cancer with nodal disease

35
Q

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:

A

APR

36
Q

Rectal cancer undergoing transanal excision cannot invade beyond ___

A

submucosa (T1N0)

37
Q

True or false. Small bowel carcinoids are frequently asymptomatic.

A

True

38
Q

True or false. Moderately or poorly differentiated mucinous adenocarcinoma of the appendix can be removed with appendectomy alone if completely resected.

A

False. right hemicolectomy is indicated

39
Q

Treatment of T cell lymphoma of the small bowel:

A

chemotherapy

40
Q

What medications have been shown to be proective against radiation enteritis?

A

ACE inhibitors and statins

41
Q

What is the follow up for any incompletely resected polyp?

A

any incompletely resected requires a repeat colonoscopy and second attempt at removal

42
Q

What is the follow up for <10mm hyperplastic rectal or sigmoid polyps

A

10 year follow up

43
Q

What is the follow up for 3-10 tubular adenomas:

A

5-10 year follow up

44
Q

What is the follow up for >10 tubular adenomas:

A

3 year follow up

45
Q

What is the follow up for any high risk findings (>10mm adenoma, villous features, high grade dysplasia):

A

3 year follow up

46
Q

Management of polyps that are 6-9 mm on CT colonography:

A

second CT colonography in 3 years or attempt removal by colonoscopy

47
Q

Pathologic findings concerning for lymph node metastasis in pts who have undergone endoscopic mucosal resection for mucosal colon cancer:

A

massive submucosal invasion, lymphatic or vascular invasion, poorly differentiated histology, positive margins in sessile polyps

48
Q

Most common type and treatment of colonic lymphoma:

A

diffuse large B cell; tx with bowel resection and lymphadectomy followed by chemo

49
Q

True or false. Neoadjuvant chemoradiation improves local control for stage II and III rectal cancer for low and mid rectal cancers.

A

true

50
Q

_____ cancer lymphatic drainage follows the path of the ileocolic artery and proximal ligation ensures adequate lymphadenectomy.

A

Cecal

51
Q

True or false. MRI is less sensitive at detecting nodal involvement for colorectal cancer than EUS.

A

False. MRI is more sensitive

52
Q

True or false. Laparoscopic and open resections for colon cancer have equivalent overall and recurrence-free survival rates.

A

true

53
Q

What is a Krukenberg tumor and what are the common locations?

A

metastatic adenocarcinoma to the ovary; stomach is the most common primary followed by colon, appendix, and breast

54
Q

True or false. Krukenberg tumors are usually unilateral.

A

false. usually occur in bilateral ovaries

55
Q

Negative side effects from using bevacizumab in metastatic colon cancer?

A

increased risk of GI perforation; poor wound healing

56
Q

First line medical treatment for metastatic carcinoid tumors

A

lanreotide

57
Q

Most sensitive test for detecting neuroendocrine tumors

A

Ga-dotatate PET-CT

58
Q

The strongest predictor for survival of metastatic colon cancer after resection

A

degree of pathologic response to neoadjuvant chemo

59
Q

The most common site of recurrence of colon cancer

A

liver

60
Q

The most common site of recurrence for rectal cancer

A

locoregionally

61
Q

Initial treatment of anal canal squamous cell carcinoma

A

Nigro protocol: 5FU, mitomocyin C, and radiation

evaluate for response 8-12 weeks after

62
Q

Treatment of persistent anal canal SCC after 6 months

A

salvage APR

63
Q

Treatment of local recurrence of anal canal SCC

A

salvage APR

64
Q

Most important prognostic indicator in patients with colorectal carcinoid tumors

A

size of tumor; if >2cm, most will have metastasized at the time of diagnosis

65
Q

Risk factors for recurrence of anal canal SCC:

A

tumor size >5cm, greater than 2/3 involvement of the canal circumference

66
Q

Treatment of rectal carcinoids:

A

if >2cm in size, tx with proctectomy with excision of mesorectum

Small & Large Intestine (5 decks)

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