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colon polyps Flashcards

1
Q

screening has reduced colorectal cancer incidence and mortality

A

yep

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2
Q

colorectal cancer has a high incidence in

A

african american men

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3
Q

colorectal cancer over the age of 50

A

has gone down thought to be due to colonoscopy

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4
Q

between the ages of 20-49 in both men and women in colorectal cancer

A

has gone up but cause is unknown

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5
Q

colorectal cancer types (5):

A
  1. sporadic
  2. family history
  3. HNPCC/lynch syndrome
  4. FAP- fmailial adenomatous polyposis
  5. other rare syndromes
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6
Q

types of colorectal polyps

A
  1. sessile- found on the left side of the colon
  2. pedunculated
  3. Flat- found on the right side of the colon, hard to find requiring a high degree of prep before colonoscopy
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7
Q

colorectal polyps are what type of lesions

A

mucosal

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8
Q

what type of histology are serrated polyps

A

neoplastic except hyperplastic polyp

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9
Q

two types of hamartomatous polyps

A
  1. sporadic- known as a juvenile polyp found in the rectum have benign course with rectal bleeding or prolapse
  2. syndromic: associated with hereditary inheritance has two different types (1) juvenile polyposis syndrome and (2) Peutz- Jeghers syndrome
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10
Q
  • Autosomal dominant
  • 50-100 hamartomatous polyps
  • 39% risk colon cancer (increased incidence of adenomas)
A

Polyposis Syndrome Juvenile

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11
Q
  • Autosomal dominant: STK11 gene
  • Oral and lip pigmentation
  • Polyps in colon, small intestine, and stomach
  • Risk for GI and non-GI cancers
A

Peutz-Jeghers Syndrome

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12
Q

types of adenomatous polyps (3)

A
  1. tubular adenoma
  2. tubulovillous adenoma
  3. villous adenoma
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13
Q

greater cancer risk with adenomatous polyps correlates swith how

A

villous it is

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14
Q

what type of treatment is needed for high grade dysplasia or intramucosal carcinoma polyps

A

surgery

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15
Q

serrated polyps types

A
  1. hyperplastic polyp
  2. sessile serrated adenoma/polyp
  3. traditional serrated polyp
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16
Q

serrated polyp found in the rectum and sigmoid

A

usually hyperplastic and non-neoplastic

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17
Q

proximal to sigmoid on the right colon

A

usually sessile serrated lesion and neoplastic

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18
Q
  • Small (<5 mm), on top of mucosal folds
  • Usually multiple, common in rectosigmoid
  • Composed of mature cells
  • No malignant potential
A

NON-NEOPLASTIC SERRATED POLYP: Hyperplastic Polyp

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19
Q

boot like appearance in histo polyp slide

A

sessile serrated adenoma/polyp

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20
Q

Innumerable colon adenomas
Duodenal (periampullary) adenomas,
100% progression to colon CA and its altered gene is APC

A

Familial adenomatous polyposis (FAP) - Classic

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21
Q

80% lifetime risk of colon CA;
CA stomach, small intestine, urinary tract, brain, skin, endometrium, ovary and the altered gene defect in DNA repair gene leading to microsatellite instability

A

Hereditary non-polyposis colon cancer (HNPCC)

= Lynch syndrome

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22
Q

when polyps are associated with syndromes then they have a risk for

A

colorectal cancer

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23
Q

amsterdam criteria

A

it is the way we can diagnose lynch syndrome through generations

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24
Q

stain that shows MLH1+ signifies that

A

there is activation of the mismatch repair genes which is normal it si when there is an absence of them that we suspect there is an inactivation of the genes

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25
what do we need to so if a patient has FAP syndrome showing innumerable adenomatous polyps
total colectomy but we also need surveillance of stomach and duodenum with endoscopy due to increase risk of adenocarcinoma in the duodenum or ampulla of vater
26
most common pathology for sporadic colon cancer
chromosomal instability leading to a loss of heterozygosity at multiple loci
27
colorectal cancer on the left side of the colon
chromosomal instability
28
colorectal cancer on the right side of the colon
microsatellite instability associated with lynch syndrome and MLH1 silencing
29
Most tumors occur sporadically Absence of well-defined familial syndromes Characterized by chromosomal instability Morphologically identifiable stages
adenoma-carcinoma
30
K-ras at 12p12
target of a chemotherapy for colorectal cancer
31
A 75 year old man has a colonoscopy to evaluate iron deficiency anemia. A 4cm ulcerating mass is found in the cecum. Biopsies are obtained and pathology is consistent with adenocarcinoma. A flat polyp is removed from the ascending colon and pathology reveals a sessile serrated adenoma. Which of the following would you most likely find on further pathologic analysis? 1. MLH1 inactivation 2. Little lymphocytic infiltration 3. Extensive chromosomal instability 4. Low microsatellite instability 5. Germline mutation in MSH2
1. MLH1 inactivation
32
primary tumor (T) staging
depth of invasion
33
Tx
tumor cannot be assessed
34
Tis
carcinoma in situ
35
T1
tumor invades submucosa
36
T2
tumor invades muscularis propria
37
T3
tumor invades subserosa
38
T4
tumor directly invades adjacent organs/structures or through the visceral peritoneum
39
Colorectal tumor with wild-type K-ras:
benefit from cetuximab / panitumimab | improves overall and progression-free survival
40
- A well-differentiated neuroendocrine neoplasm - Appendiceal and rectal carcinoids rarely metastasize - Ileal and colonic tumors may invade deeply and metastasize
carcinoid tumor
41
- MALT lymphoma is most common; t(11;18) translocation - T-cell lymphoma; associated with malabsorption - Good prognosis (other than T-cell)
lymphoma
42
Lipoma, leiomyoma, GIST (c-KIT expression)
mesenchymal tumors
43
Primary melanoma may arise in the
anal canal
44
Pure anal canal squamous carcinomas associated with
chronic HPV
45
tumors of the anal canal may be (30
1. adenocarcinoma 2. basaloid 3. squamous
46
Appendiceal tumors: Enlargement by inspissated mucus due to obstruction
mucocele
47
Appendiceal tumors: - Most common mucinous neoplasm - Perforation may cause intraperitoneal mucin
Mucinous Cystadenoma (benign)
48
Appendiceal tumors: - Grossly similar to cystadenoma - May cause pseudomyxoma peritoneii
Mucinous Cystadenocarcinoma
49
anal cancer treatment
surgery with or w/out radiation
50
endometriosis is associated on which side in women
left side
51
why screen for colon cancer?
treatment before symptoms show a better survival prognosis and there is a slow progression from adenoma to carcinoma
52
tests that detect cancer 2
1. stool based test | 2. blood-based test: detect ciruclating methylated septin 9 DNA
53
tests that detect cancer and pre-cancerous polyps
structural tests
54
Guaiac based fecal occult blood testing
detects peroxidase activity of heme (not specific for human blood) not used
55
FIT - Fecal immunochemical test (FIT)
antibodies specific for human hemoglobin, albumin, or other blood components
56
Stool DNA tests
Detect mutations associated with colon neoplasia in stool samples Cologuard
57
structural tests used
1. colonoscopy- standard pf care 2. CT colonography 3. capsule colonoscopy
58
CT clonography cannot see
flat serrated polyps
59
when do we start screening individuals for colonoscopy
50 but ACS recommendation at age 45 - if african american at age 45 - family history of CRC age 40 - has lynch syndrome age 20 - has FAP age 12
60
Inflammatory bowel disease for CRC: 1. Pancolitis 2. Higher risk in PSC patients
1. Pancolitis – begin 8 years after diagnosis – annual colonoscopy 2. Higher risk in PSC patients – begin annual colonoscopy at time of diagnosis
61
risk reduction for colorectal cancer 1. reduction in incidence of CRC in most studies 2. useful to reduce adenoma burden in FAP 3. Post-menopausal hormone use: 4. Discontinue ______use
1. Aspirin – reduction in incidence of CRC in most studies 2. Celecoxib – useful to reduce adenoma burden in FAP 3. Post-menopausal hormone use: estrogen + progesterone 4. Discontinue cigarette use
62
Family history of CRC or colorectal adenoma First degree relative with CRC or advanced adenoma < 60 Two first degree relatives with CRC or adenoma at any age
Begin screening at age 40 or 10 years younger than age at first diagnosis, repeat every 5 years
63
One first degree relative with CRC or advanced adenoma > 60 | Two second degree relatives with CRC or adenoma
Begin age 40, repeat | every 10 years

GI (26 decks)

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