Colon Cancer: Surgical Management and Neoplasia

Question 1

Answer 1

adenocarcinoma of the colon

Question 2

warning signs of colon cancer

Answer 2

1. unexplained anemia
2. middle age
3. family history
4. blood in stool
5. change in stool consistency (ex/ pencil stools)
6. mucus discharge, tenesmus.
7. pain. (from local irritation, perforation and obstruction)
8. mucous discharge, tenesmus

Question 3

best way to stage cancer after colonoscopy

Answer 3

1. CT scan of chest, abdomen and pelvis to see any other tumors
2. CEA (carcinoembryonic antigen)

Question 4

maintypes of polyps

Answer 4

1. adenomatous (neoplastic, glandular, premalignant)
2. non-adenomatous (hyperplastic, hamartomas, lipomas, not neoplastic, never malignant)

Question 5

3 main types of adenomatous/neoplastic polyps

Answer 5

1. tubular
2. villous
3. serrated adenomas

4th is tubulovillous which is.a mix between tubular and villous.

Question 6

type of polyp

Answer 6

adenomatous polyp (premalignant, neoplastic)

Question 7

technically, adenomatous polyps are benign, but they are premalignant. what is th esignificance of adenomatous polyps?

Answer 7

they can become precursors of colorectal cancer by following the adenoma-carcinoma sequence, a process by which adenomas evolve into invasive carcinomas over 5-10 years.

all colon cancers start from polyps, but not all polyps are cancer.

Question 8

what two risk factors are tehre for polyps to become cancers?

Answer 8

1. size
2. villous component (as opposed to tubular)

Question 9

2 branches of IBD

Answer 9

ulcerative colitis

crohns disease.

• Ulcerative Colitis (UC) increased relative risk 6
• For pancolitis: relative risk 15
• 20% at 20 years, 50% at 30 years
• Crohn’s disease of colon: relative risk 5-6 times

overall, there is an increased risk of colon cancer if you have IBD, or a family history of CRC.

Question 10

any older person with unexplained iron deficiciency anemia should have a:

1. fit test
2. colonoscopy or
3. CT

Answer 10

colonoscopy

Question 12

4 modes of spread of CRC

Answer 12

Direct Continuity into adjacent organ
• Transperitoneal Spread (trans Coelomic)
• Lymphatic Spread to regional lymph nodes ***
• Hematogenous Spread, especially to liver ***

Question 13

what is transperitoneal spread

Answer 13

cells slough off and anchor to other organs.

Question 14

hematogenous spread

Answer 14

cancerous cells go into blood stream (notably the portal vein collecting blood) and causes metastasis.