Colon polyps/CA Flashcards
Define polyp
Growth on inner surface of colon
Define pedunculate polyp
Attached by stem/stalk
More likely to bleed
Define sessile polyp
Flat
Proximal colon
Are hyperplastic polyps malignant or not?
Non-neoplastic: Benign
What are considered pre-cancerous polyps?
Adenomas
MC type of adenoma?
Tubular adenoma
List the criteria for an “advanced” adenoma?
- Size: >10 mm
- # of polyps: Vilious components
- Histology: High grade dysplasia
What type of polyps do you find in Inflammatory/IBD?
Pseduopolyps
What is also considered a pre-cancerous polyp?
Sessile serrated polyp
What is the MC colorectal cancer?
Adenocarinoma: >95%
What is the MC side of CRC?
Left sided
NON-MODIFIABLE CRC risk factors
- Personal or FHx: Adenoma or colon cancer, FAP, HNPCC
- Age >50
- IBD >8-10 yrs
- African American
MODIFIABLE CRC risk factors
- Smoking
- Excess alcohol
- Diet: High fat/lower fiber, red meat
- Type II DM
- Obesity
MC CRC presentation
ASX!
CRC red flags
- Change in bowel habits
- Hematochezia or occult blood in stool
- Iron Deficiency Anemia
- Anorexia/Weight loss
- Abdominal Pain
Barium enema findings ni CRC?
“Apple core” lesion
CRC treatment
Partial Colectomy + LN removal
When would chemotherapy be recommended in CRC?
Metastasis present
What blood test do we use to monitor CRC for recurrence?
CEA
NOT used for screening
How do we stage CRC?
TNM System
- Tumor (depth)
- Node
- Metastasis
What is the gold standard screening test in CRC? Why?
Colonoscopy: Diagnostic AND therapeutic
What are the disadvantages of Flex Sigmoidoscopy?
- Does not visualize the entire colon: Only reaches 1/3 of distal colon
- Can miss right-sided colon CA
- If polyp found, will need a colonoscopy
What are the advantages of Flex Sigmoidoscopy?
- Limited prep
- No sedation
- Lower risk of perforation
What are the disadvantages of CT colonography?
- Can miss flat or smaller polyps
- Radiation exposure
- Still need bowel prep
- If positive, still need a colonoscopy
What is the main disadvantage of gFOBT?
High False +
Leads to many colonoscopies
Based on ACG, what is the preferred CRC detection test?
FIT test: less false +, single specimen
What is the gene mutation in Familial Adenomatous Polyposis (FAP)
APC gene mutation
Autosomal dominant
Peak age of FAP emergence?
16 y.o.
What is the recommended FAP screening?
Sigmoidoscopy/Colonoscopy annual starting @ age 10-12
FAP Treatment
Prophylactic colectomy
What side of the colon does Hereditary NonPolyposis Colon Cancer (HNPCC) MCly effect?
Right sided
What is the MC cancer that pt’s with HNPCC are at risk for?
Endometrial Cancer
HNPCC screening recommendations
Colonoscopy:
every 1-2 yrs. @ age 20-25 OR
2-5 yrs prior to earliest age of onset of affected family member
FAP is at an increased risk for which extracolonic malignancies?
Duodenal/ampullary CA
