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Cancer Y2 > Cancer as a Disease - Colorectal Cancer > Flashcards

Cancer as a Disease - Colorectal Cancer Flashcards

1
Q

What is the 4th most common cancer

A

Colorectal

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2
Q

What is the leading cancerous cause of death

A

Lung

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3
Q

What is the second leading cancerous cause of death

A

Colorectal

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4
Q

Colon cancer corresponds to cancer between the ….

A

ileocecal valve up to the anus, not including the appendix.

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5
Q

Why are colorectal cells particularly vulnerable to cancer

A

High proliferation

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6
Q

What is a polyp

A

is any projection from a mucosal surface into a hollow viscus, and may be hyperplastic, neoplastic, inflammatory, hamartomatous, etc.

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7
Q

What are the cancer causing polyps known as

A

Adenomatous

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8
Q

What are benign and common polyps known as

A
  • Metaplastic/Hyperplastic
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9
Q

What mutation causes Metaplastic/Hyperplastic polyps

A

K-Ras

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10
Q

Colonic adenoma types? Commonness? Describe each? (3)

A
  • Tubular (test tubes) - most common >75% of the tumour is tubular
  • Tubulovillous (mix of tubular and villous) 25-50% tubular and villous
  • Villous (fingery things) - larger and worse >50% of the tumour is villous

AKA PEDUNCULATED or SESSILE -> Pedunculated looks like a tree, sessile looks like a thick rug

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11
Q

What type of cells are tubular adenomas? what features are displayed in the cell? (4)

A
  • Columnar cells with nuclear enlargement, elongation, multilayering and loss of polarity
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12
Q

Features of tubular adenomas? (5)

A
  • Columnar cells with nuclear enlargement, elongation, multilayering and loss of polarity
  • Stratified or pseudostratified, no nice architecture, more purple due to higher nuclear:cytoplasm ratio, increased mitotic activity.
  • Increased proliferative activity
  • Reduced differentiation
  • Complexity/disorganisation of architecture
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13
Q

Features of villous adenomas? (5)

A
  • Mucinous cells with nuclear enlargement, elongation, multilayering and loss of polarity
  • Exophytic, frond-like extensions
  • Rarely may have hypersecretory function and result in excess mucus discharge and hypokalemia
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14
Q

What type of cells are tubular adenomas?

A

Mucinous cells

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15
Q

What gene mutation causes APC

A

APC/FAP 5q21 gene mutation

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16
Q
  • X% of adults have adenomas at age 50

- Y% of these become cancers if left

A

25%

5%

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17
Q

what is micro satellite instability

A

mismatch repair genes damage

18
Q

Explain for microsatellite instability can cause cancer in the colon

A

 Cells are dividing all the time and are bound to make mistakes- but mismatch repair genes fix them usually
 If mismatch repair genes are damaged (microsatellite instability), you cannot repair DNA, so the cell loses control of growth and the risk of cancer increases

19
Q

Adenoma carcinoma sequence?

A
  1. Cumulative damage to DNA
  2. Loss of control of cell growth
  3. Leads to carcinoma (often through an adenoma first)
20
Q

2 main pathways of getting colon cancer?

A
  • FAP - inactivation of APC tumour suppressor genes

- HNPCC - microsatellite instability

21
Q

Places where colon cancer is low?

A

Japan, Mexico, Africa

22
Q

Where are HCAs found and how do they contribute to cancer

A

found in meat cooked at high temperatures

- Cooking foods at high temperatures can release/develop mutagenic chemicals from HCAs

23
Q

What lack of/excess nutrients can cause colon cancer?

A

lack of folate, High Fat, Low Fibre, High Red meat, Refined carbohydrates

24
Q

Anti cancer foods?

A
  • Vitamin C - ROS scavenger
  • Vitamin E - ROS scavenger
  • Isothiocyanates (cruciferous veg)
  • Polyphenols (green tea, fruit juice)
    Activate MAPK- regulates phase II detoxifying enzymes as well as other genes- reduces DNA oxidation
25
Q

Clinical presentation of colorectal cancer?

A
  • Change in bowel habit
  • Rectal bleeding
  • Unexplained iron deficiency anaemia The cancer bleeds
  • Mucus
  • Bloating
  • Cramps (‘colic’)
  • Weight loss
  • Fatigue
26
Q

Dukes staging?

A 
DUKES A:
-	growth limited to wall
-	nodes negative
DUKES B:
-	growth beyond muscularis propria (bowel wall)
-	nodes negative
DUKES C1:
-	nodes positive
-	apical lymph node (LN) negative
DUKES C2:
-	apical LN negative
27
Q

What is Dukes A?

A
  • growth limited to wall

- nodes negative

28
Q

What is Dukes B?

A
  • growth beyond muscularis propria (bowel wall)

- nodes negative

29
Q

What is Dukes C1?

A
  • nodes positive

- apical lymph node (LN) negative

30
Q

What is Dukes C2?

A
  • apical LN negative
31
Q

What effect on prognosis for colon cancer does rectal bleeding as a presenting symptom have?

A

Improved

32
Q

What effect on prognosis for colon cancer does bowel obstruction/perforation have?

A

Diminish

33
Q

What effect on prognosis for colon cancer does preoperative serum CEA have?

A

Diminish with high

34
Q

What effect on prognosis for colon cancer does mucinous or signet cells have?

A

Diminish

35
Q

What effect on prognosis for colon cancer does inflammation and immunologic reaction have?

A

Improve

36
Q

What effect on prognosis for colon cancer does location have?

A

Colon better than rectum

37
Q

Treatment options?

A

basically is either chemo alone, or surgery and chemo)

38
Q

Screening occurs if you have what risk factors? (6)

A
  • Previous adenoma
  • 1st Degree relative affected by colorectal cancer before the age of 45
  • 2 affected first degree relatives
  • Evidence of dominant familial cancer trait including colorectal, uterine, and other cancers
  • UC and Crohn’s disease
  • Hereditable cancer families (include other sites)
39
Q

What is required for screening to be worthwhile

A
  • Importance of the disease condition should be important in respect to the seriousness and/or frequency
  • The natural history of the disease must be known in order to:
    1. To identify where screening can take place
    2. To enable the effects of any intervention to be assessed
  • Test characteristics:
    simple and acceptable to the patient
    sensitive and selective
  • The screening population should have equal access to the screening procedure.
  • Cost effectiveness
40
Q

When does the NHS allow screening for colorectal cancer

A

offered over 55 in some areas, and offered to everyone over 64

Cancer Y2 (15 decks)

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