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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
Q

what do we need to so if a patient has FAP syndrome showing innumerable adenomatous polyps

A

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

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26
Q

most common pathology for sporadic colon cancer

A

chromosomal instability leading to a loss of heterozygosity at multiple loci

27
Q

colorectal cancer on the left side of the colon

A

chromosomal instability

28
Q

colorectal cancer on the right side of the colon

A

microsatellite instability associated with lynch syndrome and MLH1 silencing

29
Q

Most tumors occur sporadically
Absence of well-defined familial syndromes
Characterized by chromosomal instability
Morphologically identifiable stages

A

adenoma-carcinoma

30
Q

K-ras at 12p12

A

target of a chemotherapy for colorectal cancer

31
Q

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
A
  1. MLH1 inactivation
32
Q

primary tumor (T) staging

A

depth of invasion

33
Q

Tx

A

tumor cannot be assessed

34
Q

Tis

A

carcinoma in situ

35
Q

T1

A

tumor invades submucosa

36
Q

T2

A

tumor invades muscularis propria

37
Q

T3

A

tumor invades subserosa

38
Q

T4

A

tumor directly invades adjacent organs/structures or through the visceral peritoneum

39
Q

Colorectal tumor with wild-type K-ras:

A

benefit from cetuximab / panitumimab

improves overall and progression-free survival

40
Q
  • A well-differentiated neuroendocrine neoplasm
  • Appendiceal and rectal carcinoids rarely metastasize
  • Ileal and colonic tumors may invade deeply and metastasize
A

carcinoid tumor

41
Q
  • MALT lymphoma is most common; t(11;18) translocation
  • T-cell lymphoma; associated with malabsorption
  • Good prognosis (other than T-cell)
A

lymphoma

42
Q

Lipoma, leiomyoma, GIST (c-KIT expression)

A

mesenchymal tumors

43
Q

Primary melanoma may arise in the

A

anal canal

44
Q

Pure anal canal squamous carcinomas associated with

A

chronic HPV

45
Q

tumors of the anal canal may be (30

A
  1. adenocarcinoma
  2. basaloid
  3. squamous
46
Q

Appendiceal tumors:

Enlargement by inspissated mucus due to obstruction

A

mucocele

47
Q

Appendiceal tumors:

  • Most common mucinous neoplasm
  • Perforation may cause intraperitoneal mucin
A

Mucinous Cystadenoma (benign)

48
Q

Appendiceal tumors:

  • Grossly similar to cystadenoma
  • May cause pseudomyxoma peritoneii
A

Mucinous Cystadenocarcinoma

49
Q

anal cancer treatment

A

surgery with or w/out radiation

50
Q

endometriosis is associated on which side in women

A

left side

51
Q

why screen for colon cancer?

A

treatment before symptoms show a better survival prognosis and there is a slow progression from adenoma to carcinoma

52
Q

tests that detect cancer 2

A
  1. stool based test

2. blood-based test: detect ciruclating methylated septin 9 DNA

53
Q

tests that detect cancer and pre-cancerous polyps

A

structural tests

54
Q

Guaiac based fecal occult blood testing

A

detects peroxidase activity of heme (not specific for human blood)

not used

55
Q

FIT - Fecal immunochemical test (FIT)

A

antibodies specific for human hemoglobin, albumin, or other blood components

56
Q

Stool DNA tests

A

Detect mutations associated with colon neoplasia in stool samples

Cologuard

57
Q

structural tests used

A
  1. colonoscopy- standard pf care
  2. CT colonography
  3. capsule colonoscopy
58
Q

CT clonography cannot see

A

flat serrated polyps

59
Q

when do we start screening individuals for colonoscopy

A

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
Q

Inflammatory bowel disease for CRC:

  1. Pancolitis
  2. Higher risk in PSC patients
A
  1. Pancolitis – begin 8 years after diagnosis – annual colonoscopy
  2. Higher risk in PSC patients – begin annual colonoscopy at time of diagnosis
61
Q

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
A
  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
Q

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

A

Begin screening at age 40
or 10 years younger than age
at first diagnosis, repeat every
5 years

63
Q

One first degree relative with CRC or advanced adenoma > 60

Two second degree relatives with CRC or adenoma

A

Begin age 40, repeat

every 10 years

GI (26 decks)

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