Colon Cancer

Question 1

Incidence of CRC

Answer 1

2nd leading cause of deaths
3rd most common cancer in men and women
African American and Ashkanazi Jews

Question 2

Risk factors for CRC

Answer 2

Diet high in fat, processed, fried foods and red meats
Inactivity
Obesity
Smoking
Etoh use
Race
Age
Family hx (1st degree relatives)
FAP and Lynch syndrome

Question 3

What is the number 1 risk factor for CRC

Answer 3

Age >50

Question 4

Characteristics of FAP

Answer 4

Autosomal dominant
Mutation of APC gene
TONS of polyps
Usually occurs in teens and early 20’s

Question 5

Characteristics of Lynch syndrome

Answer 5

Autosomal dominant
Many polyps but not as many as FAP
Mutation in MLH1 or MLH2
Proximal location of colon
Most patients

Question 6

Screening recommendations for CRC

Answer 6

Beginning at age 50
OR 10 years earlier than age of family member diagnosed
OR 45 if African American
OR 7yrs after diagnosis of UC

Question 7

Why do screening for CRC?

Answer 7

Most CRC develop from polyps

Reduction in cancer risk by 90%

Question 8

Clinical presentation of CRC

Answer 8

Often ASYMPTOMATIC

• change in bowel habits
• bleeding/occult blood
• unexplained weight loss

Question 9

Gold standard screening modality for CRC

Answer 9

Colonoscopy

Question 10

Most CRC are at what stage when diagnosed?

Answer 10

39% are Localized (stage 1-2)

Question 11

Treatment options for CRC

Answer 11

Surgery

Chemotherapy

Question 12

Advantages of a Laprascopic colon resection

Answer 12

*Faster return of bowel function
Faster recovery
Minimally invasive

Question 13

Treatment for rectal cancer

Answer 13

Surgery (LAR vs APR)
Neoadjuvant XRT and chemo
Possible ileostomy or colostomy

Question 14

Difference between 2 types of Rectal Cancer surgery

Answer 14

LAR

• temporary diverting ileostomy
• no sphincter involvement

APR

• permanent colostomy
• sphincter involvement

Question 15

Differences between Ileostomy and Colostomy

Answer 15

Ileostomy (small bowel).

• high liquid output (diarrhea)
• usually located in RLQ.
• no control of BM

Colostomy (colon)

• lower solid output
• can control BM

Question 16

What is a surgical complication of an ileostomy?

Answer 16

-dehydration

Question 17

Signs and symptoms of Anastomosis

Answer 17

Sepsis
Tachycardia
Leukocytosis
Hypotension
Abd pain
N/v

Question 18

What are some possible Parastomal complications?

Answer 18

Retraction
Bleeding
Necrosis

Question 19

Treatment options for liver mets

Answer 19

Surgery

RFA

Question 20

Common sites of Mets in CRC

Answer 20

*Liver
Lung
Brain
Bone
Soft tissue
Local

Question 21

Cytotoxic chemo used for CRC

Answer 21

FOLFOX

Question 22

What is VEGF Inhibitor?

Answer 22

Used to stop VGEF from forming new blood vessels

• Avastin
  
  • s/e: bleeding, clots, hypertension

Question 23

What is a EGFR Inhibitor?

Answer 23

• attack EGFR
• Used in people who DO NOT have KRAS mutation
• Erbitux & Vectibix
• high incidence of infusion reaction

Question 24

What is a Kinase Inhibitor?

Answer 24

Blocks several kinase proteins to stop cancer growth

*Stivarga

Question 25

Surveillance after treatment

Answer 25

CEA q3 months x2yrs
Colonoscopy one year after surgery
Annual CT C/A/P x3yrs

Question 26

Majority of CRC occur where?

Answer 26

30% occur in right colon