Colon Cancer and Polyps

Question 1

MC polyp?

Answer 1

Hyperplastic

Question 2

Hamartomatous are associated with?

Answer 2

Associated with Peutz-Jeghers syndrome and juvenile polyposis.

Question 3

Neoplastic cells that have changed, via chromosomal instability pathway with mutations in APC and KRAS.

Answer 3

Adenomatous

Question 4

Premalignant cellsthat have changed via CpG hypermethylation phenotype pathway with microsatellite instability and mutations in BRAF

Answer 4

Serrated polyps

Question 5

Which polyps do you see “Saw-tooth” pattern of crypts on biopsy?

Answer 5

Serrated

Question 6

Can Serrated polyps go to become CRC?

Answer 6

Yes

Question 7

Autosomal dominant mutation of APC tumor suppressor gene?

Answer 7

FAP

Question 8

APC is on?

Answer 8

Chr. 5

Question 9

FAP + Bone?

Answer 9

Gardner syndrome

Gardner’s like to cut bone

Question 10

FAP+CNS

Answer 10

Turcot syndrome

Turcot = Turban.

Question 11

hyperpigmented mouth, lips, hands, genitalia+Harmatomas?

Answer 11

Peutz-Jeghers syndrome

=>Increased risk of cancers everywhere

Question 12

Autosomal dominant syndrome in children (typically

Answer 12

Juvenile polyposis syndrome

=>increased risk of CRC

Question 13

DNA mismatch repair genes with subsequent microsatellite instability?

Answer 13

Lynch syndrome (AD)

Question 14

Clinical Dx of Lynch?

Answer 14

3-2-1 rule: 3 relatives with Lynch syndrome– associated cancers across 2 generations, 1 of whom must be diagnosed before age 50 years.

Question 15

Lynch syndrome has increased risk of?

Answer 15

Endometrial, Ovarian and skin cancers

Question 16

Are lynch syndrome carcinomas de novo?

Answer 16

Yes

Question 17

Edited***

What is the risk of an adenoma to go to carcinoma (3)?

Answer 17

1. Size> 2cm
2. Sessile Growth
3. Villous adenoma

Question 18

Explain Normal Colon to a Colon at risk?

Answer 18

Normal Colon=>Loss of APC (Adhesions are gone; Proliferation Comes)=>Colon at Risk

Loss of APC=>Decreased intercellular adhesion and increased proliferation

Question 19

Colon at risk to Adenoma?

Answer 19

Colon at Risk=>KRAS mutation=>Adenoma

KRAS mutation=>Unregulated intracellular signal transduction

Question 20

Adenoma to Carcinoma?

Answer 20

Adenoma=>loss of p53 and Increased COX=> Carcinoma

Loss of p53=>tumorigenesis

Question 21

Aspirin helps which step?

Answer 21

Adenoma to Carcinoma

Question 22

What is order of events for CRC progression?

Answer 22

AK-53
APC
KRAS
p53

Question 23

CRC most common after patients are age? Esp with what symptom?

Answer 23

Iron deficiency anemia in males (especially > 50 years old) and postmenopausal females raises questions

Question 24

Rectosigmoid, ascending, descending=> put these is order of MC to Least COmmon

Answer 24

Rectosigmoid > ascending > descending.

Question 25

What bug with CRC?

Answer 25

S. Bovis

Question 26

Barium X-ray for CRC?

Answer 26

Apple core Lesion

Question 27

CEA is a good marker for?

Answer 27

Monitoring recurrence

Question 28

MC site of Metathesis?

Answer 28

Liver (same with stomach cancer)