Colon polyps/CA

Question 1

Define polyp

Answer 1

Growth on inner surface of colon

Question 2

Define pedunculate polyp

Answer 2

Attached by stem/stalk

More likely to bleed

Question 3

Define sessile polyp

Answer 3

Flat

Proximal colon

Question 4

Are hyperplastic polyps malignant or not?

Answer 4

Non-neoplastic: Benign

Question 5

What are considered pre-cancerous polyps?

Answer 5

Adenomas

Question 6

MC type of adenoma?

Answer 6

Tubular adenoma

Question 7

List the criteria for an “advanced” adenoma?

Answer 7

1. Size: >10 mm
2. # of polyps: Vilious components
3. Histology: High grade dysplasia

Question 8

What type of polyps do you find in Inflammatory/IBD?

Answer 8

Pseduopolyps

Question 9

What is also considered a pre-cancerous polyp?

Answer 9

Sessile serrated polyp

Question 10

What is the MC colorectal cancer?

Answer 10

Adenocarinoma: >95%

Question 11

What is the MC side of CRC?

Answer 11

Left sided

Question 12

NON-MODIFIABLE CRC risk factors

Answer 12

1. Personal or FHx: Adenoma or colon cancer, FAP, HNPCC
2. Age >50
3. IBD >8-10 yrs
4. African American

Question 13

MODIFIABLE CRC risk factors

Answer 13

1. Smoking
2. Excess alcohol
3. Diet: High fat/lower fiber, red meat
4. Type II DM
5. Obesity

Question 14

MC CRC presentation

Answer 14

ASX!

Question 15

CRC red flags

Answer 15

1. Change in bowel habits
2. Hematochezia or occult blood in stool
3. Iron Deficiency Anemia
4. Anorexia/Weight loss
5. Abdominal Pain

Question 16

Barium enema findings ni CRC?

Answer 16

“Apple core” lesion

Question 17

CRC treatment

Answer 17

Partial Colectomy + LN removal

Question 18

When would chemotherapy be recommended in CRC?

Answer 18

Metastasis present

Question 19

What blood test do we use to monitor CRC for recurrence?

Answer 19

CEA

NOT used for screening

Question 20

How do we stage CRC?

Answer 20

TNM System

1. Tumor (depth)
2. Node
3. Metastasis

Question 21

What is the gold standard screening test in CRC? Why?

Answer 21

Colonoscopy: Diagnostic AND therapeutic

Question 22

What are the disadvantages of Flex Sigmoidoscopy?

Answer 22

1. Does not visualize the entire colon: Only reaches 1/3 of distal colon
2. Can miss right-sided colon CA
3. If polyp found, will need a colonoscopy

Question 23

What are the advantages of Flex Sigmoidoscopy?

Answer 23

1. Limited prep
2. No sedation
3. Lower risk of perforation

Question 24

What are the disadvantages of CT colonography?

Answer 24

1. Can miss flat or smaller polyps
2. Radiation exposure
3. Still need bowel prep
4. If positive, still need a colonoscopy

Question 25

What is the main disadvantage of gFOBT?

Answer 25

High False +

Leads to many colonoscopies

Question 26

Based on ACG, what is the preferred CRC detection test?

Answer 26

FIT test: less false +, single specimen

Question 27

What is the gene mutation in Familial Adenomatous Polyposis (FAP)

Answer 27

APC gene mutation

Autosomal dominant

Question 28

Peak age of FAP emergence?

Answer 28

16 y.o.

Question 29

What is the recommended FAP screening?

Answer 29

Sigmoidoscopy/Colonoscopy annual starting @ age 10-12

Question 30

FAP Treatment

Answer 30

Prophylactic colectomy

Question 31

What side of the colon does Hereditary NonPolyposis Colon Cancer (HNPCC) MCly effect?

Answer 31

Right sided

Question 32

What is the MC cancer that pt’s with HNPCC are at risk for?

Answer 32

Endometrial Cancer

Question 33

HNPCC screening recommendations

Answer 33

Colonoscopy:
every 1-2 yrs. @ age 20-25 OR
2-5 yrs prior to earliest age of onset of affected family member

Question 34

FAP is at an increased risk for which extracolonic malignancies?

Answer 34

Duodenal/ampullary CA