Clinical Aspect of CRC

Question 1

Epidemiology of colon cancer: Lifetime risk, age, 5 yr survival,

Answer 1

Lifetime risk=5%
90% CRC >50yo
5 yr survival is 90% but only 12% for metastasis

Question 2

Disparities in CRC Epidemiology?

Answer 2

Racial disparities: 
Advanced stage at dx
Higher incidence of MSI CRC
Higher prevalence in polyps and right sided polyps
Access to care

Question 3

What are risk factors for CRC? (6)

Answer 3

Family history
IBD
DM
Obesity
Diet (red meat)
Alc/Smoking

Question 4

Screening methods:

Answer 4

Double-contrast barium enemas
Fecal occult blood testing/FIT
Stool DNA analysis
CT colonography/virtual colonoscopy

Question 5

What is relationship between adenoma detection rate and CRC risk?

Answer 5

Increase in Adenoma detection rate= lower risk of colon cancer

Question 6

What factors are associated with better colonoscopy results?

Answer 6

Getting a colonoscopy=reduced cancer
Having a GI doc perform the colonoscopy
How far up they look
How long they look at the colon

Question 7

What is typical clinical presentation of colon cancer?

Answer 7

Early: No symptoms or exam findings
As they grow, increasing blood (in stool), obstruction
Can also see cramping, abdominal pain, constipation/diarrhea, weight loss

Question 8

In which types of CRC do you see the following:

Changes in bowel habits, hematochezia, anemia, tenesmus, rectal pain

Answer 8

Bowel habits and hematochezia: L sided CRC

Anemia: R sided CRC

Tenesmus, rectal pain, changes in calibert: rectal cancer

Question 9

What infection is associated with increased CRC risk?

Answer 9

Step Bovis, strep gallolyticus

Question 10

Stage I Colon Cancer: How is it defined? How is it treated?

Answer 10

Localized in mucosa/submucosa

Treat with endoscopic polypectomy or endoscopic mucosal resection

Question 11

Stage II Colon Cancer: Definition and treatment

Answer 11

Stage II involve muscle layer

Treatment: Surgical resection with LN removal and consideration of adjuvant chemo

Question 12

Stage III Colon Cancer: Definition and treatment

Answer 12

Lymph node involvement

Treatment: Surgical resection + chemo/radiotherapy

Question 13

Stage IV Colon Cancer: Definition and treatment

Answer 13

Distant metastases

Treatment: Surgically resect isolated liver/lung mets with primary tumor + chemo (neoadjuvant/adjuvant)