Colon cancer

Question 1

Diagnostic flags for colon cancer

Answer 1

• anorexia
• weight loss
• anemia
• fever
• heme-stools
• nocturnal stools
• onset ofsymptoms after age 45

Question 2

Endocarditis due to _ _ or__ (organisms) warrants a colonoscopy to search for colon carcinoma.

Answer 2

Endocarditis caused by either Strep bovis or Clostridium septicus is often associated with colon cancer

Question 3

Adenomas with “advanced” features are defined as:

Answer 3

1) > 1 cm

2) histology is villous or tubulovillous. (Note:just tubular is usually benign-especially if <I cm.)

Question 4

True or False: Hyperplastic polyps have malignant potential

Answer 4

False

Hyperplastic polyps have no malignant potential and contain no features of dysplasia

Question 5

FAP

Answer 5

Familial adenomatous polyposis (FAP)-hundreds of adcnomas in the colon -I00% risk of cancer if not treated. These patients require a proctocolectomy at age 20!

Question 6

Gardner syndrome

Answer 6

Gardner syndrome–avariant of FAP with more extra intestinal benign growths. The adenomas have the same risk or cancer as FAP (100%). These patients often have bone lesions(osteomas)and soft tissue tumors

Question 7

Patient has multiple osteomas found incidentally on an x-ray. What do you do?

Answer 7

Colonoscopy

Question 8

Peutz-Jeghers syndrome

Answer 8

multiple hamartomatous polyps throughout the small bowel, and occasionally in the colorectum and stomach, plus melanotic pigmentation (freckles)on the lips and buccal mucosa. Eventhough these polyps are hamartomas,there is still some risk of cancer because there are occaional adenomas that can become carcinomas.The most common presentation is with abdominal pain due to intussusception or bowel obstruction by a large polyp

Question 9

Juvenile polyposis

Answer 9

Juvenile polyposis also consists of hamartomas, This is the only one of these syndromes with no malignant potential. No follow-up needed

Question 10

HNPCC or Lynch syndrome can be defined as

Answer 10

the occurrence of colon cancer in at least three 1st degree relatives over at least 2 generations, and with at least 1 person diagnosed < age 50.

Question 11

Women in families with HNPCC often have greatly increased incidence of

Answer 11

ovarian and endometrial cancer, as well as renal, ureteral, stomach, and biliary tree cancers .

Question 12

screening in low risk patients

Answer 12

do yearly fecal occult blood testing (FOBT) in low-risk patients

Question 13

colorectal cancer screening:

Answer 13

• yearly FOBT
• flexible sigmoidoscopy or air-contrast BE at 4-5 year intervals
• colonoscopy at 10-year intervals

Question 14

If flexible sigmoidoscopy reveals a polyp

Answer 14

biopsy it!
A full colonoscopy is then indicated if the polyp has “advanced” features,
Repeat colonoscopy every 3 years there after if polyp is benign.

Question 15

Increased-risk patients screening

Answer 15

Onset of surveillance (colonoscopy) should be at age 50 years or 10 years before age at which index case is diagnosed

Question 16

screening if several 1st degree relatives had colon cancer at a young age.

Answer 16

start screening at age 20

Question 17

screening procedure of choice if any 1st degree relatives have had colon cancer or an adenomatous polyp. or if an adenornatous polyp has ever been found in the patient

Answer 17

Colonoscopy

Question 18

Time between surveillance colonoscopies (after finding a polyp)

Answer 18

1-2 years after a less benign polyp. but every 3-5 years for more benign polyps

Question 19

after diverticulitis in older patients, what to do?

Answer 19

Sigmoid colon cancer can perforate the bowel wall and simulate diverticulitis. So survey for colon cancer after diverticulitis in older patients.

Question 20

If there is positive FOBT

Answer 20

do a colonoscopy

Question 21

can FOBT be negative in person with colon cancer?

Answer 21

Remember: The FOBT is negative in up to 66% of patients with colon cancer

Question 22

usage of CEA

Answer 22

Carcinoembryonic antigen (CEA) levels are good only in checking for recurrence of colon cancers-and only if levels were elevated before surgery and reduced after surgery.

Question 23

Dukes classification of colorectal cancer

Answer 23

Dukes stage A: Cancer confined to the mucosa and submucosa
Cancer extending to the muscularis (B1) or through the serosa (B2)
Stage C: Cancer extends to the regional lymph nodes
Stage D : Distant metastase

Question 24

colon cancer metastasize to

Answer 24

virtually always metastasizes to the liver first
If it involves the rectum, it can bypass the portal circulation, and so the patient may have lung, bone, and brain mets without liver mets.

Question 25

Treatment for intestinal cancer

Answer 25

Surgery for cure in Dukes A and B. Surgery with adjuvant chemotherapy in Dukes C increased survival to 60%, compared to 40% with surgery alone. Surgery is only palliative in stage D.

Question 26

Adjuvant chemo is effective for

Answer 26

is effective only for Dukes C or local advanced B.

Question 27

Radiation therapy prior to surgery is helpful for

Answer 27

rectal lesions