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MK SR INDEX CASES CANCER CARE > Colon and rectal cancer > Flashcards

Colon and rectal cancer Flashcards

1
Q

Risk Factors for colon cancer

A

• Age >50 yrs
• High fat, low fiber diet
• IBS – Chronic ulcerative colitis and Crohn’s disease
• Familial adenomatous polyposis (FAP)
• Heriditary nonpolyposis colorecal cancer (HNPCC)
• Hamartomatous polyposis syndromes
• Peutz-Jeghers syndrome
• Juvenile polyposis
• Family history – Colorectal adenomas, Colorectal cancer
• Personal history of Colorectal adenomas, Ureterosigmoidostomy,
Breast, Ovarian and Uterine cancers

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2
Q

Lifestyle Factors associated with increased risk for Colorectal cancer

A
  • Lack of physical activity
  • Consumption of red meat
  • Obesity
  • Cigarette smoking
  • Alcohol use
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3
Q

Lifestyle Factors associated with decreased risk for Colorectal cancer

A 
• MVI containing folic acid
• ASA and other NSAID’s
• Post menopausal HRT
• Ca supplementation
• Selenium
• Consumption of fruits,
vegetables and fiber
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4
Q

Clinical Presentation of right sided colorectal cancers

A

Proximal (right sided) lesions present with symptoms caused by
anemia – fatigue, weight loss, shortness of breath, lightheadedness,
mahagony feces caused by occult bleeding

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5
Q

Clinical Presentation of left sided colorectal cancers

A

Distal (left sided) lesions present with symptoms of obstruction,
changes in BM pattern, postprandial colicky abdominal pain,
hematochezia

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6
Q

Most common CLINICAL MANIFESTATIONS of colorectal cancer

A

• Abdominal pain 44%
• Change in bowel habit 43%
• Hematochezia or melena 40%
• Weakness 20%
• Anemia without other gastrointestinal symptoms 11%
• Weight loss 6%
• Some patients have more than one abnormality
• 15 to 20% of patients have distant metastatic disease at the time of
presentation

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7
Q

What is the most common type of colorectal tutor?

A

Adenocarcinomas compromise >95% of all colorectal tumors

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8
Q

Colorectal tumor markers

A

Carcinoembryonic antigen (CEA)
Carbohydrate antigen (CA) 19 9, CA 50, and CA 195
• Have a low diagnostic ability to detect primary colorectal cancer,
overlap with benign disease
• low sensitivity for early stage disease
• An expert panel on tumor markers recommended that serum CEA levels not be used as a screening test for colorectal cancer
• Have prognostic utility

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9
Q

TNM Staging Classification of Colorectal Cancer: T stage

A

• TX - Primary tumor cannot be assessed
• T0 - No evidence of primary tumor
• Tis - Carcinoma in situ: intraepithelial or invasion of lamina propria
• T1 - Tumor invades submucosa
• T2 - Tumor invades muscularis propria
• T3 - Tumor invades through the muscularis propria into the subserosa or into
nonperitonealized pericolic or perirectal tissues
• T4 - Tumor directly invades other organs or structures, and/or perforates visceral
peritoneum

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10
Q

TNM Staging Classification of Colorectal Cancer: N stage

A

Regional lymph nodes (N)
• NX - Regional lymph nodes cannot be assessed
• N0 - No regional lymph-node metastasis
• N1 - Metastasis in 1 to 3 regional lymph nodes
• N2 - Metastasis in 4 or more regional lymph nodes

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11
Q

Prognosis and 5 yr survival rates for Colon Cancer

A

Ranges from 8 to 93% based on stage

  • Stage I (T1-2N0) - 93%
  • Stage IIA (T3N0) - 85%
  • Stage IIB (T4N0) - 72%
  • Stage IIIA (T1-2 N1) - 83%
  • Stage IIIB (T3-4 N1) - 64%
  • Stage IIIC (N2) - 44%
  • Stage IV - 8%
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12
Q

Colorectal Cancer: Guidelines for screening average risk adults aged 50 years or older

A
  • Fecal occult blood test (FOBT) every year
  • Flexible sigmoidoscopy every five years
  • FOBT every year combined with flexible sigmoidoscopy every five years.
  • Double-contrast barium enema every five years
  • Colonoscopy every ten years
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13
Q

Colorectal Cancer: Key elements in screening average risk people

A
  • Symptoms require diagnostic work up
  • Offer screening to men and women aged 50 and older
  • Stratify patients by risk
  • Options should be offered
  • Follow up of positive screening test with diagnostic colonoscopy
  • Appropriate and timely surgery for detected cancers
  • Follow up surveillance required after polypectomy and surgery
  • Providers need to be proficient
  • Encourage participation of patients
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14
Q

Colorectal Cancer: Screening for high-risk people

A

Screening Guidelines differ for:
- A first-degree relative (sibling, parent, child) who has had colorectal cancer or an adenomatous polyp:
- Family history of FAP or
HNPCC
- Personal history of adenomatous polyps
- Personal history of colorectal cancer
- Personal history of inflammatory bowel disease

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15
Q

Colorectal Cancer: Differential diagnosis of malignant lesions

A 
Adenocarcinoma
Lymphoma
Carcinoid tumor
Kaposi’s sarcoma
Prostate cancer
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16
Q

Colorectal Cancer: Differential diagnosis of benign lesions

A 
Crohn’s colitis
Diverticulosis
Endometriosis
Solitary rectal ulcer
Lipoma
Tuberculosis
Amebiasis
Cytomegalovirus
Fungal infection
Extrensic lesion
Arterio-venous malformations
Adenomatous polyps-
• Premalignant neoplasm
• Morphological types- tubular, tubulovillous,
villous
Ischemic colitis
Infarcted colon
Megacolon
Hemorrhoid
17
Q

Colorectal Cancer: Treatment Options

A

Surgical excision: Mainstay of curative Rx

Radiation therapy:
Postoperative radiation, with or without chemotherapy, significantly reduces local recurrence rates

Systemic Chemotherapy

Electrocoagulation

18
Q

Colorectal Cancer Treatment: What is the role of Surgical excision?

A

Mainstay of curative Rx
• Specific procedure depends on the anatomic location of the cancer, but typically involves
hemicolectomy
• Surgical resection of affected bowel with clear margins, along with the adjacent mesentery
and at least 12 regional nodes
• For rectal tumors, total mesorectal excision with a distal surgical margin of at least 2 cm is recommended
• For tumors that are located within 6 cm of the anal verge, or involve the anal sphincter, wide
surgical resection with abdomino-perineal resection and permanent colostomy is
recommended
• Local excision, for palliative treatment or simple polyp removal

19
Q

Colorectal Cancer Treatment: What is the role of radiation therapy?

A

• Postoperative radiation, with or without chemotherapy, significantly reduces local recurrence
rates
• Common regimen incorporates infusional 5-fluorouracil (5-FU) as a radiosensitizer to boost
the efficacy of pelvic radiation
• Administered as 45 to 55 Gy over 5 weeks
• Repeated as needed

20
Q

Colorectal Cancer Treatment: What is the role of systemic chemotherapy therapy?

A
  • 5-FU has been the mainstay of systemic chemotherapy for CRC
  • Capecitabine was approved in 2001 as first-line therapy for metastatic CRC
  • Irinotecan (Camptosar), Oxaliplatin (Eloxatin), Bevacizumab, Cetuximab
21
Q

Colorectal Cancer Treatment: What is the role of systemic electrocoagulation?

A
  • Mostly palliative treatment for rectal carcinomas

* Curative for small subset of patients

MK SR INDEX CASES CANCER CARE (16 decks)

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