Chapter 17- Small Intestine And Colon Cancers

Question 1

What is the most common neoplastic polyp

Answer 1

Adenoma, which is able to progress to cancer

Question 2

When are colonic hyperplastic polyps commonly discovered

Answer 2

60/70s

Question 3

What is the cause of hyperplastic polyps and what is the prognosis

Answer 3

Piling up of goblet cells and parietal cells, but do not have malignant potential

Question 4

What location are hyperplastic polyps most commonly found

Answer 4

Left colon

Question 5

What is the histological hallmark of the hyperplastic polyps

Answer 5

Serrated surface architecture

Question 6

What is the triad of symptoms that lead to the diagnosis of inflammatory polyps

Answer 6

Rectal bleeding, mucus discharge, inflammatory lesion on the anterior rectal wall

Question 7

What is that cause of inflammatory polyps

Answer 7

Impaired relaxation of the anorectal sphincter leads to a sharp angle of the anterior rectal shelf and leads to abrasion and ulceration

Question 8

What are the histological hallmarks of an inflammatory polyp

Answer 8

• Mixed Inflammatory infiltrates
• Erosion
• epithelial hyperplasia with fibromuscular hyperplasia

Question 9

Inflammatory polyps develop as part of which syndrome

Answer 9

Solitary rectal ulcer syndrome

Question 10

What is the cause of the formation of hamartomatous polyps

Answer 10

Germline mutations in the tumor suppressor genes or protooncogenes

Question 11

What is the ability of harmartomous polyps to malignancy

Answer 11

There is an increased risk of cancer and they are characterized as pre-malignant

Question 12

In which patients do the juvenile polyps form

Answer 12

Patients younger than 5

Question 13

What is the main location of juvenile polyps and how do the typically preset

Answer 13

Rectum and present with rectal bleeding

Question 14

What are complication of juvenile polyps

Answer 14

• Intussusception
• Intestinal obstruction
• polyp prolapse

Question 15

Patients with autosomal dominant syndrome of juvenile polyposis commonly have what characteristic of polyps and what is the treatment

Answer 15

Multiple (3 to 100) and must have colectomy to prevent perforation

Question 16

What are the extraintestinal malformation of juvenile polyposis

Answer 16

Pulmonary arteriovenous malformation and other congenital abnormalities

Question 17

What are the morphological findings of juvenile polyps

Answer 17

Pedunculated, smooth surfaced, reddish lesions with characteristic cystic spaces after sectioning, usually filled with mucin and inflammatory debris

Question 18

What is the most common mutation found in juvenile polyps

Answer 18

SMAD4, which codes for the BMPR1A of the TGF pathway

Question 19

Patients with juvenile polypropsis are most at risk for which condition

Answer 19

Development of colonic adenocarcinoma (30-50% of patients)

Question 20

What is the clinical presentation of pests-jeghers syndrome

Answer 20

Multiple GI hamartomatous polyps and mucocutaneous hyperpigmentation

Question 21

What are the characteristics of the mucocutaneous hyperpigmentation seen in Peutz-Jeghers syndrome

Answer 21

Dark blue, brown macules on the lips, nodules, buccal mucosa, hands, genitals and perianal regions

Question 22

What is the complication seen with Peutz-Jeghers polyps

Answer 22

Can cause intussuseption and multiple malignancies

Question 23

Which tumors are monitored for in those with Peutz-Jeghers syndrome

Answer 23

• Sex cord tumors of the testes (birth)
• gastric and small intestine cancers (late childhood)
• colon, pancreatic, breast, lung, ovarian, and uterine cancer (20s)

Question 24

What is the mutation in Peutz-Jeghers

Answer 24

Loss of function mutation in STK11

Question 25

What is the histological finding in Peutz-Jeghers syndrome

Answer 25

Arborizing network of connective tissue, smooth muscle

Question 26

What are colorectal adenomas characterized by

Answer 26

Presence of epithelial dysplasia

Question 27

What are the histological hallmarks for epithelial dysplasia in colon polyps

Answer 27

Nuclear hyperchromasia, elongation, and stratification

Question 28

How are sessile serrated adenomas secreted from the hyperplastic polyps

Answer 28

Located on the right side of the colon

Question 29

What are the histological findings of the sessile serrated adenomas

Answer 29

Have malignant potential, but tend to not have the cytological features of dysplasia -have the serrated architecture through the full length of the glands, including the crypt base, dilation and lateral growth

Question 30

What are the histological characteristics of the intramucosal carcinoma

Answer 30

Dysplasia epithelial cells breach the membrane to invade the lamina propria

Question 31

What is the malignant potential of intramucosal carcinoma

Answer 31

Non metastatic because the lymphatic channels are absent in the colonic mucosa

Question 32

What is the most important characteristic of colorectal adenomas that correlates with malignancy

Answer 32

Size, but there is some with high grade dysplasia

Question 33

What is the hereditability of Peutz-Jeghers syndrome

Answer 33

Autosomal dominant

Question 34

What is the hereditability of Familial adenomatous polyposis

Answer 34

Autosomal dominant

Question 35

Which mutation and pathway is affected in Familial adenomatous polyposis

Answer 35

APC for Wnt pathway

Question 36

How many polyps are present for Familial adenomatous polyposis tobe diagnosis

Answer 36

At least 100, but may be 1000s

Question 37

Patients with Familial adenomatous polyposis are guaranteed to get which condition

Answer 37

Colorectal adenocarcinoma

Question 38

What is the treatment for patients with Familial adenomatous polyposis

Answer 38

Prophylactic colectomy

Question 39

Despite removal of the colon, patients with Familial adenomatous polyposis develop adenomas in which location

Answer 39

Adjacent to the ampulla of Vater in the stomach

Question 40

Which extraGI manifestation is commonly seen at birth in patients with Familial adenomatous polyposis

Answer 40

Congenital hypertrophy of the retinal pigment epithelium

Question 41

What is the condition called when Familial adenomatous polyposis also have a mutation in MYH gene

Answer 41

Autosomal recessive MYH associated polyposis

Question 42

What are the other names for Hereditary non-polyposis colorectal cancer

Answer 42

HNPCC | Lynch syndrome

Question 43

What is the most common Syndromic form of colon cancer

Answer 43

HNPCC

Question 44

In patients that have HNPCC, what cancers are common

Answer 44

Colorectal, endometrium, stomach, ovaries, urease, brain, small bowel, pancreas, and skin

Question 45

What are the clinical presentations that can give away HNPCC patients

Answer 45

Colon cancers at a younger age and are located on the right side

Question 46

What is the most common malignancy of the GI tract

Answer 46

Adenocarcinoma of the colon

Question 47

What is the relative amount of tumors in the small intestine

Answer 47

Very rare

Question 48

What dietary factors are most related to increased risk of colorectal cancer

Answer 48

Low intake of unabsorbable vegetable fiber and high intake of refined carbs and fat

Question 49

How do NSAIDs have a protective effect on colorectal cancer development

Answer 49

Inhibition of COX2, which is over-expressed in adenocarcinomas

Question 50

In colorectal cancer, what is the process of formations with the mutations that are the “hits”

Answer 50

``` First hit-loss of first APC Second hit-Loss of second APC and beta catenin Subsequent: -Protoonogene mutations in KRAS -TP53 -SMAD ```

Question 51

What is the role of APC in the Wnt pathway

Answer 51

Negative regulator of Beta-catenin

Question 52

Where in the stage of colorectal cancer do mutations in TP53 occur

Answer 52

Late

Question 53

In patients with DNA mismatch repair deficiency, mutations occur in which areas

Answer 53

Microsatallite instability (MSI)

Question 54

In colorectal cancers without mutations in DNA mismatch repair, what is commonly seen

Answer 54

CpG island hypermethylation phenotype (CIMP)

Question 55

In those colorectal cancers with CIMP, what is the promoter region commonly affected

Answer 55

MLH1, with mutations in BRAF region

Question 56

What are the mutations in the colon cancers with increased CpG methylation wihtoutthe microsatallite instability

Answer 56

KRAS mutation

Question 57

Invasive carcinomas with microsatellite instability have which characteristics

Answer 57

-Mucinous differentiation and peritumoral lymphocytic infiltrates i the right side of the colon

Question 58

How can tumors with microsatellite instability be recognized histologically

Answer 58

-Absence of Immuno histological staining for mismatch repair proteins or by molecular genetic analysis of sequences

Question 59

What is a high risk for patients with HNPCC

Answer 59

Second malignancies of the colon and other organs

Question 60

What are the characteristics of the adenocarcinomas in the proximal colon

Answer 60

Polyposis, exophytic masses, rarely causing obstruction

Question 61

What are the characteristics of adenocarcinomas of the distal colon

Answer 61

Annular lesions with “napkin ring lesions” with lumen narrowing

Question 62

Which location is common to see “napkin ring” and luminal narrowing

Answer 62

Distal colon

Question 63

What is the clinical appearance of patients with Cecil and right sided colon cancers

Answer 63

Fatigue and weakness due to iron deficiency anemia

Question 64

What are the clinical presentations of the patients with left sided colon adenocarcinomas

Answer 64

Occult bleeding, bowel habit changes, cramping, and left lower quadrant discomfort

Question 65

What are the prognostic factors for colorectal cancers

Answer 65

-Depth of invasion and lymph node metastases

Question 66

What is the most common site of metastasis in colorectal cancers

Answer 66

Liver

Question 67

What causes condylomata acuminatum

Answer 67

HPV