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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
Gold standard for CRC screening
Colonoscopy (diagnostic and therapeutic)
26
Cons of colonoscopy
requires bowel prep requires sedation/chaperone time off work Invasive/risk of complications (perforation/bleeding) not inflallible - operator dependent, poor prep precludes visualization
27
Complications of colonoscopy
perforation | bleeding
28
Polypectomy
removal of polyp for bx during colonoscopy
29
Con of flex sig
only reaches distal 1/3 of colon -- no protection against right-sided colon CA if polyps found, most likely will need colonoscopy
30
Pros of flex sig
limited prep (enema) no sedation lower cost lower risk of perforation
31
Cons of CT colonography
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
Pros of CT colonography
"virtual" 2D/3D images of bowel mucosa | no sedation, still need bowel prep
33
When to use colongraophy
``` tortous colon (hard to navigate) pt refuses colonoscopy ```
34
gFOBT aka
stool guaiac
35
what is gFOBT
identifies hbg by peroxidase rxn (if + paper turns blue) Hemoccult SENSA- take home guaiac test (better sensitivity)
36
Cons for gFOBT
2 specimens on 3 consecutive stools False + Special diet before test: avoid red meat, iron, Vit C, NSAIDs
37
pros of FIT screening test
``` noninvasive tests for presence of human hemoglobin less false + than FOBT SINGLE SPECIMEN of stool no diet restrictions ```
38
Preferred CRC detection test
FIT
39
FIT-DNA (cologuard) test
``` FIT + altered DNA biomarkers shed by CRC noninvasive excellent negative predictive value > false positives than FIT no diet restrictions ```
40
cons of cologuard
false positives > FIT requires entire BM $$$$$$
41
Diet restriction
gFOBT (stool guaiac)
42
Screening for average risk, no risk factors
Age 50 (45 for african americans) *colonoscopy and FIT for screening
43
Screening for increased risk: single 1st degree relative w/ CRC or advanced adenoma dx <60 or > two 1st degree relative dx at any age`
colonoscopy every 5 years beginning at 40 YO or 10 years younger than youngest 1st degree relative was diagnosed (which ever comes first)
44
Single 1st degree relative w/ CRC or advance adenoma >60 or two 2nd degree relatives
begin at 40 YO and if normal screen as average risk individual (~10 years)
45
When to discontinue CRC screening?
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
Overall initiation and discontinuation of CRC screening
50-75 YO
47
How often should screening tests be performed?
Colonoscopy - 10 CT Colonography - 5 Flex sig - 5-10 years (10 w/ annual FIT) gFOBT: annually FIT: annually Cologuard: every 3 years
48
T/F: Most polyps bleed
false
49
Familial Adenomatous Polyposis (FAP)
auto dominant | APC gene mutation
50
Characteristics of FAP
>100 adenomatous polyps begins ~16 YO nearly 100% develop CRC by 39 YO if left untreated genetic testing/counseling recommended
51
Tx for FAP
prophylactic colectomy
52
Concern for FAP
increased risk of extracolonic malignancies
53
Extracolonic malignancies associated with FAP
gastric/duodenal/ampullary carcinoma follicular or papillary thyroid CA Hepatoblastoma (children) CNS tumors
54
Screening for FAP
Sigmoidoscopy/Colonoscopy starting at age 10-12 ANNUALLY until 40 if negative Routine EGD Screen for extracolonic malignancies (thyroid US, etc.)
55
"Lynch syndrome"
Hereditary Nonpolyposis Colon CA (HNPCC)
56
HNPCC onset/location
increased risk of CRC (right-sided); aged 45-60
57
Increased risk of those with HNPCC
endometrial CA (most common) also: ovarian, gastric, small bowel, hepatobiliary system, renal/ureter/bladder, brain
58
Dx of HNPCC
Amsterdam Criteria (3-2-1 Rule): - 3 relatives - 2 successive generations - 1 diagnosed before age 50
59
Screening for HNPCC
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
Proximal/right-sided CRC
HNPCC
61
endometrial CA
HNPCC ("lynch")
62
hepatoblastoma
FAP
63
duodenal/ampullary CA risk
FAP
64
Criteria for HNPCC
amsterdam

Clin Med III Exam 2 (8 decks)

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