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X Clin Med III Exam 2 > Colon Polyps and Cancer > Flashcards

Colon Polyps and Cancer Flashcards

1
Q

What is a polyp?

A

Growth on inner surface of colon

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2
Q

How a polyp might look on endoscopy

A

Pedunculated (attached by stem/stalk)
Sessile (flat)
*they influence the screening tests

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3
Q

Histologic classifications of polyps

A

Hyperplastic (non-neoplastic and benign)
Pseudopolyps (nonneoplastic-IBD/UC)
Adenomas (neoplastic and pre-cancerous)
Sessile serrated polyps (pre-cancerous)

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4
Q

Types of adenomatous polyps

A

Tubular adenoma (most common)
Tubulovillous adenoma
Villous adenoma

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5
Q

Tell me about colon adenomas

A

2/3 of all polyps
Common in adults>50
Usually asymptomatic (large may bleed)
More than half of colorectal cancers arise from these (progression about 10 yrs so early detection and removal)

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6
Q

When is a polyp a high risk adenoma?

A

“Advanced”

>1 cm, villous component, high grade dysplasia

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7
Q

When does the risk of colorectal cancer increase with adenomatous polyps?

A

The number, size and histology (influence surveillance intervals)

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8
Q

Sites of colorectal cancer

A

Left sided is most common presentation

Right sided rates are rising tho

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9
Q

Non-modifiable risk factors of colorectal cancer

A

Personal or family hx (adenomas or colon cancer, FAP or HNPCC-hereditary sxs)
Age >50
IBD>8-10 yrs
African American

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10
Q

Modifiable risk factors of colorectal cancer

A 
Tobacco use
Excess alcohol consumption
Diet (high fat and low fiber or more red meat)
Obesity
Diabetes
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11
Q

Red flags in the presentation of colorectal cancer

A 
Change in BH
Hematochezia or occult blood in stool
Iron deficiency anemia
Anorexia/weight loss
Abd pain
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12
Q

Presentation of colorectal cancer

A

Often asymptomatic
Cachetic, pallor, LAD
Abd distension, ascites, mass, organomegaly
DRE-hemoccult positive or rectal mass

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13
Q

Diagnostics for colorectal cancer

A 
CBC-for IDA
Liver tests (alk phos with liver mets)
Carcinoembryonic antigen 
Colonoscopy
Chest/abd/pelvic CT to look for tumor
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14
Q

What is carcinoembryonic antigen used for?

A

Prognostic indicator and monitor for recurrence of colorectal cancer

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15
Q

Colon cancer on imaging

A

Classic apple core lesion

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16
Q

How to stage colon cancer

A

Depth of tumor invasion
Status of regional nodes
Presence of absence of mets

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17
Q

Surveillance needed for colorectal cancer

A

Serial CEA levels
Annual surveillance with CT chest/abd/pelvis
Periodic colonoscopy

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18
Q

Screening vs surveillance

A

Screening is early detection looking for early stage of precancerous lesions in asymptomatic ppl with no history
Surveillance (follow up testing in pts with polyps, CA or IBD)

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19
Q

Types of preventative tests for colon cancer

A

*detect colon polyps and CRC

Colonoscopy, flex sig, CT colonography, double contrast barium enema no longer used!

20
Q

Stool tests for colon cancer

A

*detect but don’t precent cancer
gFOBT
FIT (fecal immunochemical test)
FIT-DNA (cologuard)

21
Q

Colonoscopy for colon cancer

A

Gold standard (diagnostic and therapeutic)

  • See whole colon, remove polyps and take biopsies
  • Detect precancerous lesions and CRC
22
Q

Downside to colonoscopy

A

Invasive
Risk of major complications like perf or bleeding
Operator dependence

23
Q

Colonoscopy following a polypectomy

A

Surveillance depends on number, size and histoloy

Check with the endoscopist

24
Q

Flex sig for colon cancer

A

Lower benefit in protection against right sided colon CA
If find polyps, probably need colonoscopy to r/o proximal lesions
-Limited prep, no sedation, lower cost and lower risk of perf

25
Q

Downside to CT colonograpy for colon cancer

A

Can miss flat or small polyps (virtual)

There is also radiation exposure (no sedation but need bowel prep)

26
Q

What must be done with a positive CT colonography

A

Colonoscopy

27
Q

What is gFOBT?

A

Fecal occult blood test- stool guaiac (indicates hgb by a peroxidase rxn)
-Hemoccult SENSA is a take home test and recommended
2 specimens on 3 consecutive stools
False positives

28
Q

Diet before gFOBT

A

Avoid red meats, iron supplements, Vit C and NSAIDs

29
Q

Preferred colon cancer detection test

A

FIT

30
Q

FIT colon cancer test

A

Non invasive
Tests for presence of human hb and less false positives than FOBT
Single specimen of spontaneous stool
No diet restrictions

31
Q

What is FIT-DNA (cologuard)?

A

Combines FIT with testing for altered DNA biomarkers in cells shed by CRC not polyps
Good - predicting value but more false positives
Expensive and requires entire bowel movement

32
Q

When to start colon cancer screening for avg risk individuals with no sxs and no risk factors?

A

Begin CRC screening at age 50 (age 45 for African Americans)–consider colonoscopy and FIT first

33
Q

When to start colon cancer screening for pt with single first degree relative diagnosed less than 60 YO?

A

Colonoscopy every 5 yrs starting at 40 or 10 yrs younger than age at which youngest 1st degree relative was diagnosed

34
Q

When to start colon cancer screening for pt with single first degree relative diagnosed older than 60 YO?

A

Begin screening at 40 and if normal, then screen as avg risk individual (every 10 yrs after that)

35
Q

When to stop colon cancer screening?

A 
When pts are:
Up to date with screening
Negative prior screening (esp with colonoscopy)
Age 75
Life expectancy <10 yrs
36
Q

At what age to stop considering colon cancer screening

A

85 (depending on comorbidities)

Another says start at 50 and continue until 75

37
Q

After how many years should all the tests be performed?

A 
Colonoscopy- 10 
CT- 5
Flex sig- 5-10
gFOBT- annual
FIT- annual
FIT-fecal- 3 yrs
38
Q

What is familial adenomatous polyposis (FAP)?

A

Autosomal dominant due to APC gene mutation

>100 adenomatous polyps (began about 16 YO)

39
Q

At when do pts with FAP develop colon cancer?

A

Usually by 39 YO if untreated (need prophylactic colectomy)

–Increased risk for extracolonic malignancies

40
Q

Extracolonic malignancies seen in FAP

A

Gastric/duodenal/ampullary carcinoma
Follicular or papillary thyroid cancer
Hepatoblastoma (kids)
CNS tumors

41
Q

Screening recommended for FAP

A

Those who are gene carriers or have family hx w/o genetic confirmation
Need colonoscopy or flex sig starting at 10-12 YO until 40 YO if negative
Also routine EGD

42
Q

What is hereditary nonpolyposis colon cancer (HNPCC)?

A

Autosomal dominant lynch syndrome due to germline mutation in DNA mismatch repair genes
Multiple family members are affected

43
Q

Risk associated with HNPCC

A

Increased risk for colon cancer (usually right sided) at about ages 45-60

44
Q

What types of cancers are pts with HNPCC at risk for?

A

Endometrial (most common), ovarian, gastric, small bowel, hepatobiliary system, renal/ureter/bladder, brain

45
Q

Amsterdam criteria to diagnose HNPCC

A

3-2-1 rule (3 affected members, 2 generations and 1 under 50)

46
Q

Screening for HNPCC

A

Annual colonoscopy starting between 20-25 or 2-5 yrs prior to earliest age of colon cancer diagnosis in family
Also for extra colonic malignancies (pelvic exam, EGD etc)

47
Q

When to consider hereditary colon cancer syndromes

A

FH or CRC in >1 family member
Personal or FH or CRC at early age (<50 YO)
Personal or FH of multiple adenomas (>10-20)
Personal of FH of multiple extracolonic malignancies

X Clin Med III Exam 2 (9 decks)

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