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GK F3 E3 > Colon > Flashcards

Colon Flashcards

1
Q

a growth on the inner surface of the colon is referred to as

A

a polyp

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2
Q

some polyps undergo what type of transformation?

A

malignant transformation, others do not

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3
Q

types of colon polyps

A

pedunculated which are attached by stem or stalk

sessile which are flat

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4
Q

three type of colon adenomas? which of these is most common

A

tubular adenoma, the most common
tubulovillous adenoma
villous adenoma

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5
Q

which types of colon polyps are neoplastic (precancerous)

A

adenomas (2/3 of all colon polyps), and sessile serrated adenomas

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6
Q

which types of colon polyps are non-neoplastic

A

hyperplastic and pseudopolyps (associated with inflammation/ IBD)

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7
Q

large polyps may

A

bleed

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8
Q

70% of ________ arise from adenomas

A

colorectal carcinomas (CRC), this takes about 10 years therefore early detection and removal is key

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9
Q

what is considered an advanced adenoma (3 criteria)

A

greater than 10 mm, villous component, high grade dysplasia

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10
Q

what increases the risk of colorectal cancer

A

the number of adenomas, the size, and the histology

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11
Q

malignant growth on the inner wall of the colon and/or rectum is called

A

colorectal cancer

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12
Q

over 95% of colorectal cancers are

A

adenocarcinomas

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13
Q

what is the non screen rate

A

1/4 of adults aged 50-75

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14
Q

pertaining to colorectal cancer, what are the left side and right side differences

A

left side is most common, but right side is on the rise

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15
Q

risk factors for colorectal cancers (9)

A 
age
personal or family history 
IBD after 8 to 10 years 
African American 
Smoking 
ETOH 
diet 
obesity 
diabetes
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16
Q

diet factors for colorectal cancers risk

A

high fat low fiber

increased amounts of red and processed meats

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17
Q

colorectal cancer red flags (5)

A 
changes in bowel habits 
hemattochezia 
IDA (iron deficiency anemia)
anorexia or weight loss
abdominal pain
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18
Q

colorectal cancers patients are often?

A

asymptomatic, why screening is important

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19
Q

when presenting with symptoms what are the common colorectal cancers presentations

A

cachectic, pallor of the skin, lymphadenopathy, abdominal distention, ascites, mass, oragnomegaly, positive hemocult, rectal mass

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20
Q

colorectal cancer- why are we performing a CBC?

A

used to check for IDA due to chronic blood loss

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21
Q

colorectal cancer- what abnormalities may be seen on a liver function test?

A

Alk phos may be elevated with liver metastasis

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22
Q

what is CEA used for and what is it not used for?

A

can be a helpful prognostic indicator and allow for monitoring for recurrence, it is not used for screening

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23
Q

what test. allows for both biopsy and pathologic confirmation?

A

colonoscopy

24
Q

why would you order a chest/abdominal/ pelvic CT when assessing for colorectal cancer?

A

to asses for tumor extension or complication, regional lymphatic metastases and distant metastases

25
Q

what type of lesion is classic on colonoscopy for colorectal cancers

A

a classic apple core lesion

26
Q

what is the colectomy management of colorectal cancers

A

Partial colectomy with wide margins and adjacent lymph node removal

27
Q

when is chemotherapy used for CRC treatment

A

use when metastasis are present

28
Q

when is radiation therapy commonly used for CRC

A

rectal adenocarcinomas

29
Q

CRC surveillance consist of what 3 things

A

serial CEA levels
annual surveillance CT
periodic colonscopy

30
Q

gold standard for CRC screening

A

colonoscopy, it is both diagnostic and therapeutic

31
Q

In what way is a colonoscopy therapeutic?

A

Able to detect and remove polyps to PREVENT them from turning into cancer

Post polypectomy surveillance interval depends on endoscopist recommendations, size number, histologic features

32
Q

complications of colonoscopy

A

perforation/bleeding

33
Q

what can influence results of a colonscopy

A

bowel prep and operator skill

34
Q

flex sigmoidoscopy reaches, this causes limited detection of what area?

A

the distal 1/3 of the colon, lower benefit in protection again right sided colon cancer

35
Q

if a polyp is found on a flex sig, what is the next step?

A

They will then need a colonoscopy to rule out proximal lesions

36
Q

Which less invasive test can miss flat or smaller polyps (less than 6 mm)?

A

CT colonography

37
Q

gFOBT sensitivity and use

A

sensitivity for one time screening is not ideal, annual use is recommended which can influence compliance

38
Q

diet modifications of gFOBT (what food must be avoided)

A

avoidance of red meat, iron supplements, Vitamin C and NSAIDS

39
Q

what are the 3 stool based screenings

A

gFOBY, FIT, abd FIT DBA

40
Q

When do we start CRC screening in IBD patients

A

8 to 10 years after onset of symptoms

41
Q

when to start CRC screening in patients with Single 1st degree relative w/ CRC or documented advanced adenoma dx > 60 y/o

A

age 40 and if it is normal screen as average risk

42
Q

when to start CRC screening in patients with Single 1st degree relative w/ CRC or documented advanced adenoma dx < 60 y/o or ≥ two 1st degree relatives dx at any age

A

Colonoscopy every 5 years beginning at age 40 or 10 years younger than the age at which the youngest 1st degree relative was diagnosed
whichever comes first

43
Q

Which colorectal cancer screening test is used in individuals with increased risk?

A

colonoscopy

44
Q

which condition is autosomal dominant with a mutation in the APC gene? what does this put them at an increased risk for?

A

Familial Adenomatous Polyposis, Increased risk of extracolonic malignancies

45
Q

how many adenomatous polyps are common in Familial Adenomatous Polyposis? What age do these polyps being to form?

A

over 100, they typically begin at age 16

46
Q

with Familial Adenomatous Polyposis, nearly all of them will develop what by age 39? How do we manage this risk?

A

CRC, therefore a prophylactic colectomy is typically recommend

47
Q

4 examples of increased risk of extracolonic malignancies which Familial Adenomatous Polyposis

A

Gastric/Duodenal/Ampullary carcinoma
Follicular or Papillary thyroid cancer
Hepatoblastoma
CNS tumors

screen for these with FAP Screening

48
Q

FAP screening

A

Sigmoidoscopy/Colonoscopy starting at age 10-12 and repeating every 1-2 years

Routine EGD recommended

49
Q

what is “Lynch syndrome”

A

Hereditary NonPolyposis Colon Cancer (HNPCC), multiple family members will be affected

50
Q

Hereditary NonPolyposis Colon Cancer patients have an increased risk for what? and at what age?

A

for CRC (usually right-sided); aged 45-60 years and other cancers

51
Q

what is the most common additional cancer for Hereditary NonPolyposis Colon Cancer

A

Endometrial cancer

52
Q

Hereditary NonPolyposis Colon Cancer 321 rule (Amsterdam criteria)

A

3 relatives associated with Lynch syndrome associated cancer, 2 successive generations affected and 1 should be diagnosed before age 50

53
Q

Hereditary NonPolyposis Colon Cancer screening

A

Annual colonoscopy beginning between the ages of 20-25

or 2-5 years prior to the earliest age of CRC diagnosis in the family (whichever comes first)

54
Q

other exams for patents diagnosed with HNPCC

A

pelvic exam with endometrial bx and transvaginal US

55
Q

any screening regime is better than _________?

A

nothing, but advised patients that colonoscopy is required for further evaluation if anything is found on the less invasive test

56
Q

diet modifications to decrease CRC risk (6)

A 
encourage fiber rich foods 
limit red and processed meats 
limit ETOH (1-2 savings a day)
exercise 
maintain healthy body weight 
stop smoking
57
Q

pseudopolyps are associated with what condition?

A

IBD

GK F3 E3 (24 decks)

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