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Oral Boards > Colon Cancer > Flashcards

Colon Cancer Flashcards

1
Q

Differential diagnosis of LUQ pain

A

Colon ca, diverticulitis, ischemic colitis (bloody diarrhea), splenomegaly (hematologic malignancies), neoplasm (pancreatic tail, adrenal/kidney cancer, RP sarcoma)

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2
Q

What percentage of colon cancer is transverse colon?

A

10%

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3
Q

Complications of colon mass

A

Perforation, fistulaization, obstruction

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4
Q

Most important thing to consider with an obstructing colon mass

A

Competent vs. Incompetent ileocecal valve
Incompetent: pressure that builds up proximal decompresses into the small bowel (decompression, rehydration)
Competent: surgical emergency; tension on proximal colon wall; LaPlace –>fourth potency of radius of cavity (largest radius / cecum will suffer the greatest tension)

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5
Q

What happens with increased tension on the cecum?

A

Collapse of intra-mural capillaries and ischemia –> perforation

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6
Q

Pre-operative staging of colon mass

A

CT A+P with IV/PO; CXR/CT chest; CEA; full colonoscopy

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7
Q

In patients with bulky splenic flexure mass in whom it is not possible to do a colonoscopy, what other options are there to r/o synchronous lesion?

A

Barium enema
On-table colonoscopy through appendiceal orifice
5% incidence of synchronous lesion
If not possible – go to OR and do a 6 month C-scope

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8
Q

Best option for an obstructive colon mass with competent ileocecal valve

A

Stent

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9
Q

During a primary resection of splenic flexure mass, what must you also resect

A

Bowel segment with R0 resection; lymphvascular pedicle (12 LN’s)
- Left colic vessels, L branches of middle colic, IMV

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10
Q

1, 2, 3 stage procedure for colon cancer

A
  1. Resection/mosis
  2. Resection/ostomy; ostomy takedown
  3. Ostomy followed by resection
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11
Q

Advantages of MIS for colon cancer

A

Smaller incisions, less pain, less narcotics, faster ROBF, shorter hospital stay, lower wound complications, lower CV complications, faster recovery, decrease overall cost

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12
Q

Who gets adjuvant CTX in colon cancer?

What CTX regimen? Any biologics?

A

Stage 3 (positive LN); stage 4 (distant mets)

  • High risk: LV/PNI, lack of MSI, Oncotype/high-risk
  • FOLFOX (Oxaliplatin, 5-Fu) CTX +/- Avastin
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13
Q

What percentage of colon cancer recur within 3 years of surgery?

A

85% (majority between 3-5)

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14
Q

Screening post colon cancer surgery

A

Annual CT C/A/P for 3 years, colonoscopy at 3 yeares, H+P every 3-6 months for 3 years & q 6 months during years 4-5; CEA every 3 month for 3 years

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15
Q

Leak rate of sigmoid colectomy

A

5%

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16
Q

Study to confirm early colectomy leak

A

Water-soluble contrast enema

17
Q

Should patients be marked by stoma nurse prior to take back for a leak?

A

Yes

18
Q

Left vs. Right leaks

A

RIGHT: resect/redo if stable; end loop stoma if unstable
LEFT: Repair/redo with proximal diversion if stable; resect/stoma if unstable

19
Q

Rectal bleeding DDX

A

Diverticular disease, hemorrhoids, anal fissure, IBD, cancer

20
Q

Objective of colonoscopy for a known/suspected colon mass

A

Visualize; tissue for pathology; exclude synchronous lesion

21
Q

Staging for known colon mass

A

CT C/A/P

22
Q

Local staging for rectal mass

A

MRI – site/involved structures, clinical T, nodal status, CRM (circumferential radial margin)

23
Q

Tumor marker for colon cancer

A

CEA

24
Q

Rectal cancer: above/below peritoneal reflection

A

Below

25
Q

Approximate distance of rectal lesion from anal verge

A

< 15 cm

26
Q

cT1-4 of rectal cancer

A

1: mucosa/submucosa
2: muscularis propria
3: peri-rectal fat/mesorectum
4: prostate/seminal vesicles/vagina

27
Q

Pain and rectal cancer may indicate

A

Sphincter involvement

28
Q

What modality is being used more frequently than MRI for local staging?

A

Endorectal ultrasound; MRI is superior for staging bulky/locally advanced lesions

29
Q

Locally advanced rectal cancer (Stage 2/3; c T3-4 or N+)

A

May require NA downstaging

30
Q

Neoadjuvant chemo/radiotherapy for rectal cancer is:

A

Oral capecitabine or infusional FU in combination of 5040 cGy 25-28 fractions M-F 5.5 weeks –> repeat staging

31
Q

When is surgery performed following NA therapy for rectal cancer?

A

8-12 weeks

32
Q

Yes or No post-op CTX for locally advanced rectal cancer?

A

Yes – Capecitabine or 5-FU with oxaliplatin

33
Q

What is post-op LAR syndrome

A

Sexual + bladder dysfunction + stool frequency/urgency/clustering (can take 12-24 months to plateau)

34
Q

When do LAR leaks present?

A

4-7 days post-op

35
Q

Highest incidence of LAR leaks (anatomic location)

A

< 7 cm from verge

36
Q

T/F post-op adjuvant CTX is standard of care for stage 3 colon cancer

A

True

37
Q

Long-term follow-up for rectal cancer

A

CEA/exam every 3-6 months for 2 years and then every 6 months for 3 years; q annual CT chest x 3 years

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