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Summer FDTN Exam 5 > Colon cancer > Flashcards

Colon cancer Flashcards

1
Q

What is a colon polyp

A

Growth on the inner surface of the colon

Can undergo malignant transformation, but not always

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2
Q

What are endoscopic features of colon polyps

A

Pedunculated (attached by stem/stalk)

Sessile (flat)

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3
Q

How can you histologically classify polyps

A

Hyperplastic (non-neoplastic)
Pseudopolyps (non-neoplastic)- ass. w/ IBD
Adenomas (neoplastic, pre-cancer)
Sessile serrated (pre-cancer)

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4
Q

What are the types of adenomatous polyps

A

Tubular adenoma (MC)- may bleed if large, but not common for any polyp to bleed
Tubulovillous adenoma
Villous adenoma

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5
Q

Key to surviving an adenoma in the colon is

A

Early detection and removal

It takes appx 10 years for a polyp to morph into adenocarcinoma

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6
Q

What is an “advanced” carcinoma

A

> 10mm in size
Villous component (villous, tubulovillous)
High grade dysplasia
(risk of colorectal cancer is higher 2/2 size, #, and histology)

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7
Q

Highlight:::

A 
Go over the "take away" slides in this ppt to review
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65
66
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8
Q

What is colorectal cancer

A

malignant growth on the inner wall of the colon/rectum

>95% are adenocarcinomas

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9
Q

Where is CRC MC found

A 
Left colon (sigmoid) 
however right sided colon cancer rates are rising
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10
Q

What are some RF for CRC

A

FHx of adenomas, colon cancer, FAP, HNPCC
>50
Hx of IBD x 8-10 years
African American
Smoking, excess alcohol, high fat low fiber diet, a lot of red meat, T2DM, obesity

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11
Q

How does CRC present

A 
ASx!! So watch for red flags: 
Change in bowel habits
Hematochezia/Occult blood in stool 
Iron deficiency anemia 
Anorexia, weight loss 
Abdominal pain
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12
Q

On PE for CRC what may you find

A 
Cachectic 
skin pallor 
LAD 
Abdominal distention, ascites, mass, organomegaly 
DRE: hemoccult +, rectal mass
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13
Q

What diagnostics should you complete for CRC

A

CBC: iron deficiency anemia
LFT: Elevated Alk Phos
Carcinoembryonic antigen (CEA) a prognostic indicator and monitoring marker
Colonoscopy
Chest, Abd/pelvic CT: tumor extension, complication, regional lymphatic and distant mets

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14
Q

Classic CRC finding on imaging is

A

Apple core lesion

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15
Q

How do you stage colon cancer

A

Based on TNM system; Tumor, Nodes, Mets

Stage 0-4

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16
Q

How do you manage colon cancer

A

Partial colectomy w/ wide margins and adjacent lymph node removal
Chemotherapy (if mets present)
Radiation (for rectal carcinoma)

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17
Q

What does CRC surveillance include

A

Serial CEA q3-6 months for 3-5 years
CT chest, A&P yearly
Colonoscopy w/in 1 yr of resection. If normal, repeat in 3 years. If normal, q5 years

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18
Q

How are screening and surveillance different

A

Screen: detecting early stage CRC and precancerous lesions in ASx people with NO prior Hx
Surveillance: follow up testing in pt w/ Hx of polyps, CA, or IBD

19
Q

What tests can be used for screening

A 
Preventive: colonoscopy, flex sig, CT colonography 
Stool test (detect but do not prevent): gFOBT, FIT, FIT-DNA
20
Q

What is gold standard diagnostic AND therapeutic test

A

Colonoscopy
Can visualize the entire colon, remove polyps, take biopsies
Detect precancerous lesions and CRC

21
Q

What does a colonoscopy require

A

Bowel prep (if not done correctly, can block masses)
Sedation
Chaperone
Time off from work
-Invasive and has risk of complications. Also depends on operator efficacy

22
Q

What is a polypectomy

A

Ligation and resection of a pedunculated polyp

23
Q

Do you need surveillance after a polypectomy

A

Yes, frequency depends on # of polyps, size, and histologic features

24
Q

What is a Flex Sigmoidoscopy

A

limited colonoscopy that reaches distal 1/3 of colon (less protection against right sided cancer)
If you do find polyps, need to do a colonoscopy to assess proximal colon
Only need an enema prep
No sedation required
Lower cost
Lower risk of perforation

25
Q

What is a CT colonography

A

Virtual colonoscopy created with CT scans
Can easily miss flat or smaller polyps
Can’t remove a polyp if you find one- will need colonoscopy
Still need bowel prep, but no sedation
Get a lot of radiation exposure
Air insufflation w/ rectal tube is not comfortable

26
Q

What is a gFOBT test

A

Fecal occult blood test, ID hgb by a peroxidase reaction (+ if paper turns blue)
Hemoccult SENSA is a take home guaiac test, more sensitive
Need 2 specimens on 3 consecutive stools
False + leads to colonoscopies
Do special diet prior to testing; no red meat, iron, vitamin C, or NSAIDs

27
Q

What is a FIT test

A

non-invasive test for presence of hgb
less false + than FOBT
Single specimen of spontaneously passed stool
No diet restrictions

28
Q

What stool test is preferred for CRC detection

A

FIT test!

29
Q

What is FIT-DNA test

A 
Combines FIT with testing for altered DNA markers in cells shed by CRC 
non-invasive 
Higher rate of false + 
No diet restrictions 
Requires entire bowel involvement
30
Q

When should you start CRC screening for ASx with no RF

A

at age 50 (45 for black)
Colonoscopy and FIT tests should be considered first
(american cancer society says start in 45 for everyone)

31
Q

When should you start CRC screening in high risk pt

A

Colonoscopy q5 years starting at 40 y/o, or 10 years prior to age of family member diagnosed
-If it is one 1st degree relative dx 60+ or 2 second degree, screen at 40 and if normal, they are average risk

32
Q

When should you stop colon cancer screening per MSTF

A 
Up to date with screening 
Negative prior screening 
75+ 
Life expectancy <10 years 
No prior screening at 85 y/o
33
Q

When do you stop colon cancer screening per USPSTF

A

Start screening at 50, stop at 75

Individualize need to screen 76-85 y/o (healthy never been screened more likely to benefit)

34
Q

How often can you use screening tests

A 
colonoscopy: 10 years 
CT colonography: 5 years 
Flex Sig: every 5-10 years 
gFOBT: yearly 
FIT: yearly 
FIT-DNA: q1-3 years
35
Q

What do you have to convey well to patients when reviewing screening

A

That abnormal results require a colonoscopy for further visualization

36
Q

What is familial adenomatous polyposis

A

Auto Dom disease 2/2 ACP gene mutation
Causes polyps to emerge around 16 y/o, with almost 100% developing CRC by 39 y/o if not treated
Increased risk of extra-colonic malignancies

37
Q

How do you treat FAP

A

Prophylactic colectomy

38
Q

What extracolonic malignancies are associated with FAP

A

Gastric, duodenal, ampullary carcinoma
follicular or papillary thyroid cancer
hepatoblastoma in kids
CNS tumor

39
Q

If a family member has FAP, when should you screen the kid

A

Sigmoidoscopy or colonoscopy annually starting at 10-12 years old
Routine EGD recommended
Thyroid US and other to r/o extracolonic malignancies

40
Q

What is HNPCC

A

Auto dom syndrome (lynch syndrome) 2/2 germline mutation in 1 of several DNA mismatch repair genes
Increased risk of CRC by 45-60 y/o
Multiple family members are affected!
Increased risk of multiple cancers

41
Q

What cancer is associated with HNPCC

A

Endometrial (MC)

ovary, gastric, small bowel renal, ureter, brain

42
Q

How do yuo diagnose HNPCC

A

Amsterdam criteria for lynch syndrome has “3-1-2” rule

3: need 3 consecutive relatives
2: need 2 successive generations affected
1: one fam member diagnoses before 50

43
Q

What is the HNPCC screening crazy

A

Colonoscopy q1-2 years starting at 20-25, or 2-5 years prior to earliest stage of diagnosis of family

44
Q

HNPCC screening also manages what extra-curricular activities

A

Pelvic exam w/ endometrial bx and transvaginal US

EGD (starting at 30-35, q2-3 years)

Summer FDTN Exam 5 (12 decks)

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