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Clin Med III Exam 2 > Colon CA > Flashcards

Colon CA Flashcards

1
Q

Pre-cancerous polyps

A

Adenomas**

sessile serrated polyps

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2
Q

Used to monitor recurrence of colon CA

A

CEA

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3
Q

CA-125

A

marker of ovarian cancer

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4
Q

Types of polyps

A

hyperplastic (non-neoplastic)
Pseudopolyps- IBD (non-neoplastic)
Adenomas (pre-cancerous)
Sessile serrated polyps (pre-cancerous)

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5
Q

Associated w/ IBD

A

pseudopolyps (inflammatory)

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6
Q

Types of adenomas

A

Tubular adenoma (most common)
Tubulovillous adenoma
Villous adenoma

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7
Q

Adenoma epidemiology

A

2/3 of all colon polyps
common >50 YO
asymptomatic (large may bleed)
70% of CRC arise from adenomas (~10 years)- early detection

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8
Q

Time from adenoma to CRC

A

10 years

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9
Q

High risk “advanced” adenomas

A

> 1 cm
villous component
high grade dysplasia

need more frequent colonoscopies

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10
Q

Increase risk of CRC

A

, size and histology of adenomas

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11
Q

Most common site of CRC

A

left-sided colon (r. sided rates rising)

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12
Q

Most common side of diverticular bleed

A

right sided

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13
Q

Risk factors for CRC

A

Personal/Family Hx

  • adneomas or colon CA
  • Familial adenomatous polyposis (FAP)
  • HNPCC (hereditary non-polyposis colon CA; “lynch”)

Age >50
IBD >8-10 years
African American

Tobacco use*
Excess alcohol consumption
Diet: high fat/low fiber, increased red meat
Obesity
DM
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14
Q

Presentation of CRC

A

often asymptomatic

red flags

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15
Q

Red flags of CRC

A 
change in BM
hematochezia/occult blood
IDA
Anorexia/weight loss
abdominal pain
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16
Q

Signs of CRC

A 
cachectic
pallor (IDA)
LAD
Abdomen: distention, ascites, mass, organomegaly
DRE: hemoccult positive, rectal mass
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17
Q

Dx of CRC

A

CBC - r/o IDA
LFT: liver mets
Carcinoembryonic antigen (CEA) - prognostic and monitor for recurrence (not screening)
Colonoscopy (bx for confirmation)*
Chest/A/P CT - tumor extension/complication, metastases

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18
Q

Colon CA on imaging

A

“apple-core” lesion

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19
Q

Staging of CRC

A

TNM staging:

  • tumor: depth of invasion
  • Node: regional node involvement
  • Metastasis: presence of absence of

Staged 0-4

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20
Q

Tx of CRC

A

Partial colectomy w/ wide margin/adjacent lymph node removal

Chemo- if metastasis

Radiation- commonly used for rectal adenocarcinoma

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21
Q

Rectal adenocarcinoma tx

A

radiation

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22
Q

Surveillance of CRC

A

serial CEA levels
Annual CT of chest/A/P
Periodic colonoscopy

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23
Q

CRC preventative tests

A

 Colonoscopy
 Flex Sigmoidoscopy
 CT Colonography

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24
Q

Stool tests for CRC detection (not prevention)

A

 gFOBT (Hemoccult SENSA)
 FIT (Fecal Immunochemical Test)
 FIT-DNA (Cologuard®)

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25
Q

Gold standard for CRC screening

A

Colonoscopy (diagnostic and therapeutic)

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26
Q

Cons of colonoscopy

A

requires bowel prep
requires sedation/chaperone
time off work
Invasive/risk of complications (perforation/bleeding)
not inflallible - operator dependent, poor prep precludes visualization

27
Q

Complications of colonoscopy

A

perforation

bleeding

28
Q

Polypectomy

A

removal of polyp for bx during colonoscopy

29
Q

Con of flex sig

A

only reaches distal 1/3 of colon – no protection against right-sided colon CA
if polyps found, most likely will need colonoscopy

30
Q

Pros of flex sig

A

limited prep (enema)
no sedation
lower cost
lower risk of perforation

31
Q

Cons of CT colonography

A

detects polyps >1cm (can miss flat/smaller polyps)
unable to remove polyp or perform bx
if positive –> colonoscopy
radiation exposure
incidental extracolonic findings
air insufflation w/ rectal tube (uncomfortable)

32
Q

Pros of CT colonography

A

“virtual” 2D/3D images of bowel mucosa

no sedation, still need bowel prep

33
Q

When to use colongraophy

A 
tortous colon (hard to navigate)
pt refuses colonoscopy
34
Q

gFOBT aka

A

stool guaiac

35
Q

what is gFOBT

A

identifies hbg by peroxidase rxn (if + paper turns blue)

Hemoccult SENSA- take home guaiac test (better sensitivity)

36
Q

Cons for gFOBT

A

2 specimens on 3 consecutive stools
False +
Special diet before test: avoid red meat, iron, Vit C, NSAIDs

37
Q

pros of FIT screening test

A 
noninvasive
tests for presence of human hemoglobin
less false + than FOBT
SINGLE SPECIMEN of stool
no diet restrictions
38
Q

Preferred CRC detection test

A

FIT

39
Q

FIT-DNA (cologuard) test

A 
FIT + altered DNA biomarkers shed by CRC
noninvasive
excellent negative predictive value
> false positives than FIT
no diet restrictions
40
Q

cons of cologuard

A

false positives > FIT
requires entire BM
$$$$$$

41
Q

Diet restriction

A

gFOBT (stool guaiac)

42
Q

Screening for average risk, no risk factors

A

Age 50
(45 for african americans)

*colonoscopy and FIT for screening

43
Q

Screening for increased risk: single 1st degree relative w/ CRC or advanced adenoma dx <60 or > two 1st degree relative dx at any age`

A

colonoscopy every 5 years beginning at 40 YO or 10 years younger than youngest 1st degree relative was diagnosed (which ever comes first)

44
Q

Single 1st degree relative w/ CRC or advance adenoma >60 or two 2nd degree relatives

A

begin at 40 YO and if normal screen as average risk individual (~10 years)

45
Q

When to discontinue CRC screening?

A

UTD w/ screening
negative prior screen
age 75
life expectancy <10 years

  • those w/o prior screenings should be considered for screening up to 85 YO
46
Q

Overall initiation and discontinuation of CRC screening

A

50-75 YO

47
Q

How often should screening tests be performed?

A

Colonoscopy - 10
CT Colonography - 5
Flex sig - 5-10 years (10 w/ annual FIT)

gFOBT: annually
FIT: annually
Cologuard: every 3 years

48
Q

T/F: Most polyps bleed

A

false

49
Q

Familial Adenomatous Polyposis (FAP)

A

auto dominant

APC gene mutation

50
Q

Characteristics of FAP

A

> 100 adenomatous polyps
begins ~16 YO
nearly 100% develop CRC by 39 YO if left untreated
genetic testing/counseling recommended

51
Q

Tx for FAP

A

prophylactic colectomy

52
Q

Concern for FAP

A

increased risk of extracolonic malignancies

53
Q

Extracolonic malignancies associated with FAP

A

gastric/duodenal/ampullary carcinoma
follicular or papillary thyroid CA
Hepatoblastoma (children)
CNS tumors

54
Q

Screening for FAP

A

Sigmoidoscopy/Colonoscopy starting at age 10-12 ANNUALLY until 40 if negative

Routine EGD

Screen for extracolonic malignancies (thyroid US, etc.)

55
Q

“Lynch syndrome”

A

Hereditary Nonpolyposis Colon CA (HNPCC)

56
Q

HNPCC onset/location

A

increased risk of CRC (right-sided); aged 45-60

57
Q

Increased risk of those with HNPCC

A

endometrial CA (most common)

also: ovarian, gastric, small bowel, hepatobiliary system, renal/ureter/bladder, brain

58
Q

Dx of HNPCC

A

Amsterdam Criteria (3-2-1 Rule):

  • 3 relatives
  • 2 successive generations
  • 1 diagnosed before age 50
59
Q

Screening for HNPCC

A

annual colonoscopy beginning 20-25 YO or 2-5 years prior to earliest age of CRC diagnosis in family (whichever comes first)

screen for extracolonic malignancies:

  • pelvic exam w/ endometrial bx and transvaginal US
  • EGD (30-35 YO; q 2-3 years)
60
Q

Proximal/right-sided CRC

A

HNPCC

61
Q

endometrial CA

A

HNPCC (“lynch”)

62
Q

hepatoblastoma

A

FAP

63
Q

duodenal/ampullary CA risk

A

FAP

64
Q

Criteria for HNPCC

A

amsterdam

Clin Med III Exam 2 (8 decks)

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