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MD1 GI - EXAM 1 > Côlon: pathologies tumorales > Flashcards

Côlon: pathologies tumorales Flashcards

1
Q

What are the most common tumoural pathologies of the colon?

A

Benign → polyps (found in 1/4 - 1/3 of pts during colonoscopy)

Malignant → colonic adenocarcinoma, polyposes, HNPCC

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2
Q

Macroscopically, what are the two different forms of polyps?

A

Pédiculé → au bout d’une tige

Sessile → sans tige, aplati sur le muqueuse

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3
Q

Microscopically, what are the four different forms of polyps?

A

Adénomateux

Hyperplasique/festoné

Hamaromateux

Inflammatoire

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4
Q

What is a polype adénomateux?

A

Excroissance d’épithélium glandulaire dysplasique —> risque de transformation maligne (case of abnormal cell growth/replication)

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5
Q

What are the 3 sub-types of polypes adénomateux?

A
  1. Tubuleux (80% of cases)
  2. Tubulo-villeux
  3. Villeux

IF VILLEUX/TUBULO-VILLEUX… INCREASED RISK OF MALIGNANT TRANSFORMATION

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6
Q

What increases the risk of malignant transformation of polypes adénomateux?

A
  1. Type villeux
  2. Taille → bigger = growing for longer = more likely to transform
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7
Q

What is a polype hyperplasique/festonné?

A

Excroissance de l’épithélium colique normal

5-6 mm

Plus souvent dans colon distal → rectum et sigmoïde

Sans potentiel malin et pas de signification clinique (hyperplasique)

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8
Q

Info on festonné:

A

Polypes hyperplasiques typiques BUT can have dysplastic changes or éléments adénomateux (polype mixte)

Bigger size than normal hyperplasique (> 1cm)

Mostly found in the right colon (caecum, transverse)

Able to transform → malignant… therefore considered an adénomateux (fréquence de colonoscopie de dépistage à la même fréquence que adénomateux)

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9
Q

What is a polype harmartomateux (juvénile)?

A

Stroma with hyper abundance of lamina propria and cystic glands

Usually only one

Typically found during childhood or with certain forms of polyposes

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10
Q

What is familial polyposis? (polypose)

A

Familial polyposis (familial adenomatous polyposis (FAP)) a hereditary condition marked by multiple adenomatous polyps with high malignant potential, lining the intestinal mucosa, especially that of the colon

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11
Q

What is a polype inflammatoire?

A

Muqueuse normale ou inflammée qui prolifère dans des états inflammatoires (MII)

Séquelles de colite

Pas de risque de transformation maligne

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12
Q

What are the clinical manifestations of polyps?

A

Usually asymptomatic which is why screening is so important

but if the muqueuse has ulcers and is friable or the polyps are big (> 1cm)

  • Rectorragie du côlon gauche
  • Spoliation chronique —> anémie et RSOS (recherche de sang occulte dans les selles) côlon droit
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13
Q

How are polyps treated?

A

Because they’re able to transform into something malignant.. polypectomies are done during the colonoscopie using a “pince à biopsie” or an “anse diathermique (lasso) avec/sans cautérisation”

Sent to histology → followed up with screening colonoscopies depending on type of polyp

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14
Q

Stats on malignant tumours:

A

Very common → 5% of the population

Chances increase with age, male sec, white people more than black

FDR: acromégalie, diabétieque, autres syndromes métaboliques

Prognostic: 5 year survival → 63%

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15
Q

What are some FDRs? (3 categories)

A

Épidémiologiques: visceral obesity, tabaco, alcohol, red/charred meat

Seemingly protective factors: physical activity, high fiber diet, calcium

Prédisposants: polyposis, MII, ATCD personnels de polypes, ATCD familiaux de polypes/cancer

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16
Q

What are the 5 important syndromes génétiques familiaux to know?

A
  1. Polypose familiale adénomateuse (FAP/PFA)
  2. Peutz-Jeghers
  3. Polypose familiale juvénile
  4. Polypose hyperplasique
  5. HNPCC → Lynch syndrome
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17
Q

What is polypose familiale adénomateuse (FAP/PFA)?

A

Most frequent one → 1/5000 people, H=F

APC gene → autosomal dominant on chromosome 5

Leads to development of more than 100 colonic adenomas even during childhood

100% risk of cancer at 40 w/o surgery (screening starting in childhood with prophylactic colectomy when dx)

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18
Q

What is a prophylactic colectomy?

A

Removal of part or the entire colon for the purposes of cancer prevention

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19
Q

What are the two different forms of FAP?

A
  1. Gardner syndrome:
    • FAP with desmoid tumours (benign but very big) and osteomas
    • Bénéficie d’une colectomie avec iléostomie et de multiples résections tumorales desmoïdes
  2. Turcot syndrome:
    • FAP with CNS tumours (glioblastoma, medulloblastoma)
20
Q

How is FAP investigated?

A

Gastroduodénoscopie (OGD) → visualizes the upper part of the gastrointestinal tract down to the duodenum

Sigmoidoscopie q an dès 10-12 ans → colonoscopie courte du colon gauche seulement

21
Q

How is FAP treated?

A

Prophylactic proctocolectomy (rectum and colon)

Familial counselling with genetics doctor

It’s impossible to remove 100-1000s of polyps during colonoscopy so colectomy when polyps are present or transforming

22
Q

What is Peutz-Jeghers?

A

Hamartomateux polyps in the intestin grêle

Taches brunâtres a/n muqueuse buccale (E/P)

Risk of neoplasia → 90% at 40-50 years

Dx between 20-40 years old

23
Q

What gene causes Peutz-Jeghers?

A

STK11/LKB1 on chromosome 19

24
Q

Which cancers are associated with Peutz-Jeghers?

A

Stomach or pancreas → 40%

Breast → 50%

Ovarian → 10-20%

25
What is polypose familiale juvénile?
**Rare** Hamartomatous polyps Incidence accrue de néoplasie malgré le caractère de polypes
26
What is polypose hyperplasique?
Still quite new dx ## Footnote **Multiple big polypes festonnée (≥ 5) in the colon proximal**
27
What is HNPCC (Lynch syndrome)?
The most frequent of all the genetic anomalies leading to colon cancer \> 10 polyps
28
What genes cause Lynch syndrome?
MLH-1 and MSH-2 which are normally implicated in repairing genetic anomalies
29
What are the Amsterdam Criteria?
Used to dx HNPCC **Presence of colorectal cancer:** * Younger than 50 * 3 members of the same family → other "lynch cancers" counted too * 2 successive generations Présence d'instabilité microsatellite en histopathologie
30
Recommendations for "suivi" for HNPCC:
Colonoscopy every 2-3 years starting at 25 Surveillance de l'endomètre/ovaires, estomac, et voies urinaires (other lynch cancers)
31
What are the two types of Lynch syndrome?
1. Neo only in colon 2. Neo in other organs (small intestine, uterus, ureter)
32
Link between MII and colonic neoplasia: REVIEW
Acquired risk depending on: * Étendue de la colite (pancolite vs gauche) * Duration of colitis * Uncontrollable inflammation * Association with hepatic disease (CSP) Typically many aggressive tumours Screening strategy with "multiétagées" biopsies searching for dysplasia
33
Histoire familiale et tumeurs coliques malignes:
80% of cases are sporadic 20% have family history * 5% have polyposis * 15% have unknown genetic factors → risk couples if cancer/polyps in 1st degree relative (parent)
34
When is screening done according to personal history of polyps?
1-2 petits adénomes tubulaires → **5 years** 3-10, polype \> 1cm, éléments villeux/dysplasie de haut grade → **3 years** 10 polypes → refer to genetics and redo colono in **less than 3 months**
35
What is the physiopathology that leads to development of ADK?
adénome —\> carcinome * progressive accumulation of mutations that affect many genes that regulate normal cell growth/multiplication * evolution over many years which shows the importance of screening to reduce the amount of cancer and chances of death
36
Where are most colon cancers located?
30% → right colon 15% → transverse 5% → descending 25% → sigmoid 20% → rectum
37
What is the difference between the clinical presentation of neoplasm in the proximal and distal colon?
38
What is the TNM classification of colon cancer?
**T**: envahissement de la tumeur localement **N**: envahissement des lymphatiques → ADP **M**: envahissement veineux → métastases * Ganglions → stade 3, pas de ganglions → stades 0-2 * Métastase = stade 4
39
How is colon cancer dx?
**Coloscopie**: méthode la plus sensible et permet la confirmation par bx **Other radiological techniques**: lavement baryté, colonoscopie virtuelle
40
What is the bilan d'extension?
**All done in one visit after finding cancer** TDM thoraco-abdo-pelvien Dosage CEA (suivi oncologieque) Cancer du rectum: echo/IRM pour voir si interaction pelvienne
41
How is colon cancer tx? (4)
**Treated according to stage (TNM)** * Surgery if no metastasis * In situ: polypectomie * Otherwise, segmentary excision of colon including lymphatics * Chemotherapy: * Stage 1 → not required * Stage 2 → open for discussion * Stage 3 → if net advantageous (ADP+ —\> métastases ganglionnaires) * Stage 4 → palliative treatment * Radiotherapy: * Pre-op for rectal cancer * **What to do if hepatic metastasis:** * If solitary or unilobaire → resection chirurgicale à l'occasion
42
How to prevent colon cancer?
Séquence adénome —\> ADK: 5-10 years **When?** Starting at 50 years old in general population If ATCD fam +: 10 years before age dx in family member * What is considered ATDC fam? * Fam \> 60 → NO * 2+ fam \> 60 → YES * Close fam (sibling, parent, etc.) → YES
43
How is screening done... what are the available options?
44
What is a FIT test?
Fecal Immunochemical Test (FIT) ## Footnote **FIT detects blood (only coming from lower intestines) in your stool which can be a sign of pre-cancer**
45
What are the advantages of colonoscopies?
Excellente SE Allows for polyp resection
46
What are the disadvantages of colonoscopies?
Costly, long waiting list Uncomfortable Bleeding post polypectomy in 1-3% of cases Risk of perforation: 1/1000
47
What are some other forms of colonic tumours? (4)
1. Lipomas 2. GIST (stromal tumours) 3. Carcinoid tumours 4. Lymphoma

MD1 GI - EXAM 1 (15 decks)

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