Carsep Flashcards
What is considered a positive polypectomy margin?
% chance of residual disease when positive margin?
Rate of node met?
<1mm
16% chance of residual disease
7% node met
When someone has at least one first degree relative with colon cancer, what is the risk of developing colorectal cancer?
What if the age at diagnosis of the first degree relative is <50?
2x higher than those without FHx
3x higher if relative diagnosed <50
Screening recommendation for pt with a first-degree relative with CRC who is younger than 60 years or two or more first-degree relatives with CRC at any age?
When to do next colonoscopy if normal?
Age 40 or 10 years before the earliest CRC
if normal then every 5 years
Juvenile polyposis syndrome screening guideline if one polyp found in first colonoscopy?
polyps are found on the initial studies, a colonoscopy should be repeated annually until negative, then surveillance should be repeated every 3 years.
Survival rate of anal cancer with chemoradiation
Survival rate if inguinal nodes
Survival rate if distant mets
80%
60% if inguinal nodes
30% if distant mets
5FU + cisplatin + radiation can work for inguinal nodes or mets too.
What to do for anal melanoma
Thickness <1mm
Thickness 1-4mm
Thickness >4mm
<1mm: WLE with 1cm margin
1-4mm: WLE with 2cm margin
>4mm: APR
After FAP J-pouch, 10-year risk of developing adenomatous disease in the pouch
10 yr risk of adenocarcinoma?
45% risk of adenoma at 10 yrs
1% risk of adenocarcinoma
For FAP after J-pouch how often should you scope the ileum?
How often to do pouchoscopy?
Q 2 yrs. Small risk of adenomas developing near the stoma
Pouchoscopy annually
For rectal neuroendocrine tumors what are the criteria for local excision?
What are the chances of node met with these features?
tumor invasion into mucosa and submucosa (T1)
size less than 2 cm
well-differentiated profile (<3% Ki-67 index, <2 mitoses per high-power field [hpf])
With these low-risk features, the risk of lymph node metastases still is 10% to 15%
For neuroendocrine tumors if the rectum, what ki-67 %s are considered low grade, intermediate grade, high grade?
Low grade: less than 3% or <2 mitoses
Intermediate grade: 3-20% or 2-20 mitoses
High grade: >20% or >20 mitoses
What is the LAR syndrome?
What are the available options for an ultra low LAR? Which one has the worst function during the first post-op year?
increased bowel frequency, urgency, and fecal incontinence after coloanal reconstruction
Straight coloanal (worst function)
Colonic j pouch
Transverse coloplasty
Side to end anastomosis
Screening recommendation for APC(+) FAP child?
Flexible sigmoidoscopy should be performed every 1 to 2 years starting at age 10 to 15 years in patients with FAP to document the onset of polyposis.
Once polyps are detected, annual colonoscopic surveillance is recommended to remove large polyps in patients who have not had an operation
After neoadj chemo with folfiri + avastin, how long should you wait before doing surgery?
If avastin is to get started post-op, how long should they wait?
6-8 weeks
Wait 4 weeks post-op to start avastin
Cetuxonab is used for colon cancer with what KRAS status?
KRAS wild type.
KRAS mutation: bevacizumab (avastin)
Which of the following pathologic features in colorectal cancer is associated with improved survival?
- Perineural invasion
- Focal neuroendocrine differentiation
- Presence of signet ring cells
- Lymphocyte infiltration
Lymphocyte infiltration
Compared to adjuvant chemo, how does neoadjuvant chemo for rectal cancer in terms of:
- overall survival?
- disease free survival?
- local recurrence?
- overall survival: no difference
- disease free survival: no difference
- local recurrence: lower local recurrence (6% vs 13%)
What is the most common acute toxic effects of chemoradiation for rectal cancer?
What % of patients complete chemoradiation pre- vs post-op?
Diarrhea
Neoadj: 90% completion rate. Less toxic effects
Adj: 50% completion rate
Rate of APR for adj vs neoadj chemoradiation for rectal cancer?
Sphincter preservation rate?
Similar APR rate (26% vs 23%)
Neoadj: higher sphincter preservation rate (39% vs 19%)
For patients with isolated pulmonary mets what is the survival with and without surgery
resection of pulmonary metastases had a 60% overall survival at 3 years compared with 31% among those who did not undergo resection.
A man with a history of anoreceptive intercourse complains of a diffuse maculopapular rash and moist, perianal wartlike lesions. He notes that a nonpainful ulcer had been present at the anal verge 6 weeks previously but resolved on its own without treatment.
Which of the following is the most likely infecting organism?
Herpes simplex virus type 2
Human papillomavirus
Troponema pallidum
Neisseria gonorrhea
Syphilis is a sexually transmitted disease caused by the spirocheteTreponema pallidum. Primary syphilis develops 2 to 6 weeks after exposure, typically with a nonpainful ulcer at the site of exposure. Nontender inguinal adenopathy is frequently present. Anorectal syphilis may also cause tenesmus and discharge. Untreated ulcers, or chancres, of primary syphilis typically resolve within a few weeks. The clinical signs of secondary syphilis include a diffuse maculopapular rash.Condylomata lataare moist, wartlike lesions that develop in the intertriginous regions. Without treatment, the manifestations of secondary syphilis will also resolve within weeks. Tertiary syphilis presents after a prolonged, 1- to 5-year latency period and include neurologic and cardiovascular signs and symptoms.
Syphilis can be diagnosed with dark-field microscopy of scrapings of the primary or secondary lesions looking for the characteristic corkscrew shape of the spirochete. Treatment is a single intramuscular dose of 2.4 million units of benzathine penicillin.
