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Gastroenterology > Colon Polyps > Flashcards

Colon Polyps Flashcards

1
Q

most polyps that are removed during colonoscopy are _____, the others are _____

A

adenomatous
serrated

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2
Q

both adenomatous and serrated polyps have an increased risk of _____

A

malignancy

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3
Q

what do most colon adenocarcinomas arise from?

A

polyps

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4
Q

polyps in which location may have an increased prevalence of advancing to advanced neoplasia?

A

polyps in proximal colon

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5
Q

what polyps are non-consequential?

A

polyps < 5mm in rectosigmoid colon region

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6
Q

have a higher risk for advancing to carcinoma, are > 1cm, have villous features (wart), and high grade dysplasia

A

advanced adenomas

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7
Q

most adenomas are _____ cm and have a ____ risk of transition to cancer

A

< 1
low

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8
Q

how long does it take for normal mucosa to turn into dysplastic polyp?

A

5 years

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9
Q

how long does it take for normal mucosa to turn into cancer?

A

10 years

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10
Q

arise from hyperplastic polyps and have a similar or greater risk of progression to cancer compared to adenomatous polyps

A

serrated polyps

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11
Q

why is screening of polyps so important?

A

they’re usually asymptomatic

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12
Q

what causes blood from rectum and indicates change from polyp to something more severe?

A

ulcerated polyp

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13
Q

what are 3 possible + labs in polyps?

A

FOBT
FIT
anemia from chronic blood loss

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14
Q

what is the diagnostic of choice and treatment for polyps?

A

colonoscopy

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15
Q

what is an acceptable screening tool that requires rectal air insufflation?

A

CT colonography

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16
Q

what is the treatment of choice for polyps?

A

colonoscopic polypectomy

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17
Q

polyp is considered completely removed and treatment completed only if: (3)

A

polyp is completely excised + submitted for histologic exam
clean margins
no vascular or lymphatic involvement

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18
Q

what is required if completely removed/treated polyp criteria is not met?

A

bowel resection

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19
Q

what is the required f/u for malignant treatment of a polyp?

A

f/u in 3 months w/ repeat colonoscopy

20
Q

when should screening for polyps begin?

A

age 45

21
Q

what is the recommended polyp surveillance if there are no findings?

A

10 years

22
Q

what is the recommended polyp surveillance if there are 1-2 small (<1cm) tubular adenomas without villous features or high-grade dysplasia?

A

5-10 years

23
Q

what is the recommended polyp surveillance if there are 3-4 adenomas, adenoma > 1cm, or adenoma w/ villous features or high-grade dysplasia?

A

3 years

24
Q

what is the recommended polyp surveillance if there are > 10 adenomas found? (2)

A

1-2 years + genetic testing (r/o familial polyposis syndrome)

25
Q

what is the recommended polyp surveillance if there are small (<1cm) serrated polyps without dysplasia?

A

5 years

26
Q

what is the recommended polyp surveillance if there are large (>1cm) serrated polyps with cytologic dysplasia?

A

3 years

27
Q

what is the recommended polyp surveillance if there are small, typical hyperplastic polyps in the distal colon and rectum?

A

no surveillance required until 50 yo

28
Q

germline genetic mutations with high risk for cancer, in which family history is very important in determining screening

A

hereditary polyposis syndrome

29
Q

what are the criteria for hereditary polyposis syndrome to be met, that need genetic counseling? (3)

A

> 1 family member affected by it
personal or FHx of colorectal cancer < 50 yo
personal or FHx of > 20 polyps

30
Q

development of 100s-1000s of colonic adenomatous polyps and extracolonic manifestations like soft tissue tumors, osteomas, or hypertrophy of retinal pigment

A

familial adenomatous polyposis (FAP)

31
Q

what are the mutated genes associated with familial adenomatous polyposis (FAP)? (2)

A

APC gene (90%)
MUTYH gene (8%)

32
Q

what is the prognosis for familial adenomatous polyposis (FAP)? (2)

A

colorectal polyps by 15 yo
cancer by 40 yo

33
Q

what is the treatment for FAP?

A

complete proctocolectomy with ileoanal anastomosis
OR
colectomy with ileorectal anastomosis

before 20 yo

34
Q

what is recommended post-resection of FAP to check for adenomas and carcinomas?

A

upper endoscopy q 1-3 years

35
Q

what size lesions found in upper endoscopy of a patient with FAP require resection?

A

> 2cm

36
Q

what 2 meds reduce the number and size of polyps in rectal stump but not in the duodenum?

A

NSAID
COX-2 inhibitor

37
Q

polyp that exists throughout the intestines (mostly small intestines), presents with pigmented macules on buccal mucosa, lips, and skin. Not malignant but increases changes of malignancy

A

peutz-jeghers syndrome

38
Q

> 10 polyps in the colon (possibly adenomatous), genetic defect of 18q and 10q gene

A

familial juvenile polyposis

39
Q

AKA cowden disease; presents as polyps and lipomas throughout GI tract, trichilemmomas, and cerebellar lesions

A

PTEN syndrome

40
Q

what 2 cancers does lynch syndrome increase the risk for?

A

colorectal (#1)
endometrial (#2)

41
Q

few adenomas that are flat w/ villous features or high grade dysplasia; has rapid transformation from benign to cancerous lesion within 1-2 years

A

lynch syndrome

42
Q

what patients should receive genetic testing for lynch syndrome?

A

all colorectal cancer patients

43
Q

what should be done if lynch syndrome gene mutations are found?

A

all 1st degree relatives should do genetic testing

44
Q

what is the bethesda criteria used for?

A

determine individuals to get genetic testing for lynch syndrome

45
Q

what is the bethesda criteria? (4)

A

colorectal cancer < 50 yo

multiple/recurrent colorectal cancer

colorectal cancer with at least 1 first degree relative before age 50

colorectal cancer with 2 or more 2nd degree relatives with colorectal CA orHNPCC

Gastroenterology (26 decks)

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