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Clin Med 3 > Colon Polyps, Intestinal Polyposis Syndromes, Colorectal Screening, Colorectal Cancer, Anal Cancer > Flashcards

Colon Polyps, Intestinal Polyposis Syndromes, Colorectal Screening, Colorectal Cancer, Anal Cancer Flashcards

1
Q

what is the first part of the large intestine?

A

the cecum which is connected to the ileum and is located in the RLQ

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2
Q

what 4 portions make up the colon?

A
  1. Ascending
  2. Transverse
  3. Descending
  4. Sigmoid – just before the rectum
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3
Q

what is the proximal colon?

A

Refers to the ascending and transverse colon

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4
Q

what are the functions of the colon?

A

The colon (part of the large intestine) does not play a major role in absorption of nutrients

  • It’s functions are to remove water, salt and some nutrients during stool formation
  • The colon absorbs vitamin K
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5
Q

what is a colon polyp?

A

a growth in the inner lining of the colon which protrudes into the colon

very common

size, number, and histology are all important

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6
Q

how do you dx colon polyps?

A

colonoscopy, barium enema, sigmoidoscopy

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7
Q

do colon polyps usually cause problems?

A

no, but may become malignant

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8
Q

shapes of colon polyps

A

pedunculated (mushroom cap), sessile, or flat/depressed

flat and depressed are concerning for malignancy

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9
Q

colon polyps signs (PE)

A

typically asymptomatic unless causing obstruction or bleeding

GI bleeding

Intestinal obstruction

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10
Q

colon polyps sx’s

A
  • asymptomatic
  • BRBPR
  • rectal tenesmus (sensation you need to move your bowels, but nothing there)
  • change in bowel habits
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11
Q

non-neoplastic colon polyps classifications

A

mucosal polyps

inflammatory polyps

hyperplastic polyps

submucosal polyps

hamartamous polyps

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12
Q

neoplastic colon polyps classifcations

A

adenomatous polyps

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13
Q

mucosal polyps

A

non-neoplastic colon polyps (resemble normal colonic-type tissue)

  • Small <5mm
  • Resemble adjacent tissue
  • Histologically normal tissue – No increased risk of turning into cancer
  • No clinical significance
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14
Q

inflammatory pseudopolyps

A

non-neoplastic colon polyps (resemble normal colonic-type tissue)

  • Irregularly shaped islands of intact mucosa (result of mucosal ulceration and regeneration)
  • Inflammatory Bowel Disease process (common in Ulcerative Colitis, Crohn’s Disease)
  • Presence can complicate recognition of true adenomas
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15
Q

what are inflammatory pseudopolyps caused by?

A

inflammatory bowel disease process (UC, Crohn’s disease)

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16
Q

hyperplastic polyps

A

non-neoplastic colon polyps (resemble normal colonic-type tissue)

  • MOST COMMON NON-NEOPLASTIC POLYPS
  • Normal cellular components but may be indistinguishable from adenomatous polyps
  • NEED TO BE CUT OUT B/C SMALL CHANCE CANCEROUS
  • Serrated/Sawtooth pattern
  • Most found rectosigmoid and <5mm, typically do not exhibit dysplasia or develop into CRC
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17
Q

what is the most common non-neoplastic colon polyp?

A

hyperplastic polyps

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18
Q

what do hyperplastic polyps resemble?

A
  • Normal cellular components but may be indistinguishable from adenomatous polyps
  • NEED TO BE CUT OUT B/C SMALL CHANCE CANCEROUS
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19
Q

what is the pattern of hyperplastic polyps?

A

serrated/sawtooth pattern

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20
Q

where are hyperplastic polyps found? size? dysplasia? develop into CRC?

A

rectosigmoid

<5mm

don’t exhibit dysplasia or develop into CRC

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21
Q

submucosal polyps

A

non-neoplastic colon polyps (resemble normal colonic-type tissue)

-Looks like lymphoid tissue, Fribromas

-Lipoma
Most common submucosal
-Yellow in color and soft
-“Pillow sign” – indentation with forceps (squeeze it and it goes back to its normal shape/pops back)

-No increased risk of colorectal cancer

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22
Q

what is the most common submucosal polyp?

A

lipoma

  • yellow in color and soft
  • “pillow sign”
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23
Q

hamartamous polyps

A

non-neoplastic colon polyps (resemble normal colonic-type tissue)

  • Grow in disorganized fashion
  • Classified as non-neoplastic, but can develop dysplasia and lead to CRC

Many polyposis syndromes derive from this polyp (seen in familial autosomal dominant syndromes)

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24
Q

what derives from hamartamous polyps?

A

Many polyposis syndromes derive from this polyp (seen in familial autosomal dominant syndromes)

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25
Q

do hamartamous polyps lead to CRC?

A

Classified as non-neoplastic, but can develop dysplasia and lead to CRC

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26
Q

adenomatous polyps

A

neoplastic colon polyps (can turn malignant)

PRECANCEROUS

benign tumor of glandular tissue

2/3 of all colonic polyps

Personal history of colon adenomas increases risk of CRC

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27
Q

how many years for adenomatous polyps transition to cancer?

A

7-10 years = Average time to transition from adenoma to cancer – ADENOCARCINOMAS

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28
Q

what is the most common colonic polyps?

A

adenomatous polyps

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29
Q

risk factors of adenomatous polyps

A
  • Older age
  • Increased BMI – increased abdominal girth
  • Lack of physical activity
  • Men > women
  • Smoking
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30
Q

preventive methods for adenomatous polyps

A
  • Low fat diet, high in fruit, vegetables and fiber
  • Normal body weight and exercise
  • Decrease consumption of ETOH, especially beer
  • Aspirin
  • COX-2 agents reduction in advanced adenomas
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31
Q

histological classification of adenomatous polyps?

A

♣ AS GO FROM TUBULAR TO VILLOUS MALIGNANCY POTENTIAL INCREASES

Tubular Adenoma – 80% of colonic adenomas (MOST COMMON)

Tubulovillous Adenoma – 5-15% of adenomas

Villous Adenoma – Highest risk of becoming cancerous compared to the other 2 which also have increased cancer risk

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32
Q

what adenomatous polyp has the highest risk of becoming cancerous?

A

villous adenoma

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33
Q

what is the most common adenomatous polyp?

A

tubular adenoma

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34
Q

characteristics associated w/increased CRC risk for adenomatous polyps

A
  1. villous histology
  2. high grade dysplasia
  3. number and size
    - >1 or more advanced size (>1cm)
    - >3 of any size
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35
Q

removal of Adenomatous polyps associated with what?

A

with reduced CRC incidence

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36
Q

colon polyp screening/dx

A

I. FOBT - Fecal Occult Blood Testing

II. Double-Contrast Barium Enema

III. CT Colonography (“Virtual” Colonoscopy)

IV. Flexible Sigmoidoscopy

V. **Colonoscopy
**GOLD STANDARD!!!

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37
Q

Fecal Occult Blood Testing (FOBT)

A

colon polyp screening/dx tool

Take stool and test with reagent and tells you if blood is present in the stool by changing color

Not always positive b/c they don’t always bleed

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38
Q

Double-Contrast Barium Enema

A

colon polyp screening/dx tool

Old standard, can only see 50% of polyps >1cm

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39
Q

Flexible Sigmoidoscopy

A

colon polyp screening/dx tool

Good b/c a majority of colon cancers happen in the Descending Colon and the Sigmoid Colon

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40
Q

what is the GOLD STANDARD of colon polyp screening/dx?

A

Colonoscopy!!!

CAN REMOVE POLYP ON SITE!!!

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41
Q

risks of colonoscopy

A

-Perforation – can perforate mucosa in colon
-Significant bleeding
Intolerance to sedation
-Dehydration/electrolyte imbalance in elderly
-Need to prep for colonoscopy beforehand – can cause you to be dehydrated

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42
Q

polyp management/treatment?

A

polypectomy

-Eradication of colon polyps is key for minimizing cancer risk and mortality

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43
Q

what are intestinal polyposis syndromes?

A

caused by genetic mutations and can be inherited

autosomal dominant

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44
Q

types of intestinal polyposis syndromes?

A

I. Lynch Syndrome/Hereditary Nonpolyposis Colorectal Cancer (HNPCC)

II. Familial Adenomatous Polyposis (FAP)

III. Hamartomatous Polypsis Syndromes
A) Familial Juvenile Polyposis
B) Peutz-Jehgers Syndrome

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45
Q

what are the indications to consider hereditary intestinal polyposis syndrome?

A
  1. Patient with family history of CRC affecting >1 family member
  2. Personal or family history of colorectal cancer developing early age <50 years
  3. Personal or family history of multiple polyps (>20)
  4. Personal or family history of multiple extracolonic malignancies (have polyps and endometrial cancer, etc.)
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46
Q

what is the most common intestinal polyposis syndromes/

A

Lynch syndrome/hereditary nonpolyposis colorectal cancer

MOST COMMON OF THE INHERITED COLON CANCERS

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47
Q

what is the CRC risk of Lynch syndrome?

A

CRC risk is 80% - so if get polyp, likely to turn malignant

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48
Q

average age of onset and more common in who for Lynch syndrome?

A

Avg. onset 45 years old

Moderately higher in men

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49
Q

what is Lynch syndrome/hereditary nonpolyposis colorectal cancer caused by? predominantly what type of tumors? involves what part of the colon?

A

caused by DNA mismatch repair

Predominantly adenomas

Preferential involvement right colon

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50
Q

do pts with Lynch syndrome/hereditary nonpolyposis colorectal cancer develop repeat colon cancer?

A

20-40% develop repeat colon cancer of remaining colon

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51
Q

what may people with Lynch syndrome/hereditary nonpolyposis colorectal cancer also have?

A

metachronous cancer

-may have another cancer as well as colon cancer

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52
Q

extracolonic malignancies of Lynch syndrome/hereditary nonpolyposis colorectal cancer

A

***Endometrial Carcinoma (MOST COMMON)

Uterine, Ovarian, Stomach, Small Bowel, Hepatobiliary, Urinary tract, Brain and Skin cancers

  • **Turcot Syndrome
  • variant typically involving brain tumors gliomas (pt prone to developing glioblastomas)
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53
Q

what is the most common extracolonic malignancy of Lynch syndrome/hereditary nonpolyposis colorectal cancer?

A

Endometrial Carcinoma

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54
Q

HPI of Lynch syndrome/hereditary nonpolyposis colorectal cancer

A

***Presenting at young age – 45 years old

History of rectal bleeding, bowel obstruction, perforation

Family history

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55
Q

what will you find on PE of Lynch syndrome/hereditary nonpolyposis colorectal cancer?

A
  • Poorly differentiated tumors in the right colon

- pt may be asymptomatic

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56
Q

Lynch syndrome/hereditary nonpolyposis colorectal cancer Diagnosis

A
  • Colonoscopy
  • Genetic Testing
  • Masses (cancers) tested for microsatellite instability – used for prognosis
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57
Q

Lynch syndrome/hereditary nonpolyposis colorectal cancer Treatment

A

Colectomy – cut out as much of colon as you can

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58
Q

Lynch syndrome/hereditary nonpolyposis colorectal cancer Surveillance

A

Yearly colonoscopy 1-2 years starting age 20-25 years of age

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59
Q

familial adenomatous polyposis caused by?

A

Germline mutation of the APC gene

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60
Q

familial adenomatous polyposis epidemiology

A
  • affects both sexes equally
  • average onset age 16 y/o
  • 1% of inherited polyposis syndrome
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61
Q

what is familial adenomatous polyposis characterized by?

A

Characterized by colon having >100 adenomas

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62
Q

what is the chance of getting cancer if have familial adenomatous polyposis?

A

cancer is 100%, average age of 39 y/o

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63
Q

extracolonic manifestations with familial adenomatous polyposis

A

Gardner Syndrome – FAP patient with extracolonic manifestations

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64
Q

Gardner syndrome presentation

A

Desmoid tumors - M/C
-benign tumor in the abdomen that comes from connective tissue in the belly – common after pregnancy

-supernumerary or missing teeth, skin cysts/lesions

CHRPE (congenital hypertrophy of the retinal pigment)

Duodenal adenomas

Fundic Gland Polyps – in fundus of the stomach

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65
Q

familial adenomatous polyposis Turcot syndrome

A

FAP with brain tumors - RARE!!!

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66
Q

desmoid tumors in Gardner syndrome with familial adenomatous polyposis

A
  • M/C extracolonic feature in FAP
  • 2nd most common cause of death in FAP pts
  • locally invasive, fibromatous tumors, can metastasize
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67
Q

what is the 2nd most common cause of death in FAP pts?

A

desmoid tumors (m/c extracolonic feature in FAP)

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68
Q

HPI of familial adenomatous polyposis

A

Presenting at young age

History of rectal bleeding, bowel obstruction, perforation

Family history

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69
Q

PE of familial adenomatous polyposis

A

Asymptomatic

> 100 adenomas on colonoscopy

Extracolonic Manifestations

70
Q

Screening/Dx of familial adenomatous polyposis

A

Genetic testing patient and family

Age 10-12 yearly flexible sigmoidoscopy

Yearly colonoscopy once polyps detected

71
Q

Tx and Surveillance of familial adenomatous polyposis

A
  • Prophylactic Colectomy
  • Remaining rectum or ileal pouch will need to be screened q6mo-2 years
  • Age 20-25 EGD q1-3 years

Chemoprophylaxis with NSAIDs and COX2

  • FDA approved Celecoxib as adjunctive therapy to polypectomy and surgical resection
  • Increased risk of stroke and MI with COX2
72
Q

what are the two types of Hamartomatous Polyposis syndromes?

A

Familial Juvenile Polyposis

Peutz-Jehgers Syndrome (PJS)

73
Q

Familial Juvenile Polyposis, what is it? caused by? what does “Juvenile” mean? present where?

A

Type of hamartomatous polyposis syndromes

  • benign polyps at risk for malignancy
  • “Juvenile” = histology of the polyps

caused by mutation in SMAD4 or BMPR1A

present in small bowel, stomach, colon, and rectum

74
Q

HPI & PE in Familial Juvenile Polyposis

A

Asymptomatic

***Painless rectal bleeding

Rectal prolapse

Failure to thrive

Family history

75
Q

Familial Juvenile Polyposis Surveillance

A

Screening age 15 yos q1-3 years colonoscopy

76
Q

Familial Juvenile Polyposis Diagnosis

A

> 5 Juvenile polyps of the colon

Multiple juvenile polyps throughout the GI tract

Family history of juvenile polyps

Genetic testing

77
Q

Peutz-Jehgers Syndromes (PJS)

A

Type of hamartomatous polyposis syndromes

-rare, inherited GI disorder

  • mutations of a gene
  • pts may present with GI bleeding, intussusceptions or obstruction
78
Q

what do pts with Peutz-Jehgers Syndromes develop?

A

polyps on the mucous lining of the intestine and dark discolorations on the skin and mucous membranes

Lips and inside of cheeks have dark discolorations

79
Q

cancer risk for Peutz-Jehgers Syndromes

A

Overall cancer risk is 50% by age 50

80
Q

what extracolonic malignancies occur in Peutz-Jehgers Syndromes

A

breast and testicular cancer are most common

also get GI malignancies in stomach, small bowel and colon

81
Q

age of onset for Peutz-Jehgers Syndrome

A

24 years old

82
Q

Peutz-Jehgers Syndrome dx and surveillance

A
  • Genetic testing available: STK11 gene
  • Colonoscopy every 2-3 years starting age 18 years old
  • EGD q2-3 years starting age 10
  • Breast exam and testicular exam
  • Routine mammogram and breast ultrasound
83
Q

hx of pt that should be obtained when doing colorectal screening

A

Start obtaining family history in patients starting at age 20

Update history every 5-10 years

Questions to ask:
-Family history of CRC <50 y/o, etc.

84
Q

when should you start obtaining fam hx for colorectal screening

A

starting at age 20

85
Q

when should you update your hx for colorectal screening?

A

every 5-10 years

86
Q

PE findings for colorectal screening/cancer

A

asymptomatic

***Any patient over 40 y/o that presents with bowel changes, hematochezia r/o for colorectal cancer via at least a colonoscopy or sigmoidoscopy

87
Q

average risk pt for colorectal cancer

A

> 50 y/o

> 45 y/o for African Americans

88
Q

average risk pt timeline for screening

A

50-75 years old – screen

76-85 years old – screening is at providers discretion

> 85 years old – stop screening

89
Q

when do you screen a pt for colorectal cancer?

A

50-75 y/o

90
Q

when do you stop screening a pt for colorectal cancer?

A

> 85 y/o

91
Q

when is screening for colorectal cancer at the providers discretion?

A

76-85 y/o

92
Q

colorectal cancer prevention tests for average risk pts

A

***COLONOSCOPY q10 YEARS

Flexible Sigmoidoscopy q5 years or Flex sig PLUS FIT q10 years

CT colongraphy q5 years

CANCER PREVENTION TEST SHOULD BE OFFERED FIRST

93
Q

colorectal cancer detection tests for average risk pts

A

***Annual fecal immunochemical test annually

Annual fecal occult blood testing (gFOBT) annually

Fecal DNA q1-3 years

***IF CANCER DETECTION TEST +, MUST THEN HAVE A CANCER PREVENTION TEST

94
Q

if the colorectal cancer detection test is positive, what must be done?

A

pt then must have a cancer prevention test

95
Q

High risk colorectal cancer pts based on personal characteristics

A
  1. Previous Colorectal Cancer
  2. Large (>1cm) adenomatous polyps
  3. Adenoma Polyps of villous, tubovillous, histology
  4. IBD disease – Ulcerative Colitis and Crohn’s after 8 years active disease
  5. Intestinal Polypsosis syndrome (e.g. FAP, Lynch)
  6. African Americans
96
Q

High risk colorectal cancer pts based on family history

A
  1. One 1st degree relative with CRC or advanced adenoma <60 years of age
  2. ≥Two 1st degree relatives with CRC or advanced adenoma @ any age

***IMPORTANT – One 1st degree relative with CRC or adenoma >60 y/o: screen SAME as average risk

97
Q

what pt do you screen SAME as average risk pt?

A

One 1st degree relative with CRC or adenoma >60 y/o

98
Q

colorectal screening recommendations for general population AND pt with any distant relative with CRC or polyps

A

average risk screening tests

99
Q

colorectal screening recommendations for pt with 1st degree relative CRC <60 y/o or two 1st degree relatives at any age

A

begin screening at age 40 or at age 10 years younger

colonoscopy every 5 years

100
Q

colorectal screening recommendations for pt with 1st degree relatives with CRC >60 years, or in two 2nd degree relatives

A

same risk as average risk

colonoscopy strongly suggested as screening method

101
Q

colorectal screening recommendations for pt with Lynch Syndrome risk

A

age 20-25 or 10 years younger than youngest affected relative - colonoscopy q1-2 years, then yearly age 40

genetic testing

102
Q

colorectal screening recommendations for pt with FAP risk

A

age 10-12 sigmoidoscopy yearly

colonoscopy yearly after polyp discovered

genetic testing and counseling

103
Q

colorectal screening recommendations for pt with personal history of CRC

A

total colon exam w/in 1 year after resection, repeat at 3 years

repeat 5 years if normal

104
Q

colorectal screening recommendations for pt with personal hx of adenoma

A

polyps removal

colonoscopy timeline based on timeline

105
Q

colorectal screening recommendations for pt with inflammatory bowel disease

A

begin 8 years after onset of pancolitis, colonoscopy 1-2 years

106
Q

in what pts should you do a DRE and test stool b/c may be colon cancer?

A

ANY PATIENT THAT IS POSTMENOPASUAL OR ADULT MALE THAT HAS NO REASON BE IRON DEFICIENT – NEED TO DO DRE AND TEST STOOL B/C MAY BE COLON CANCER

107
Q

age onset of colorectal cancer? more common in who?

A

age 50 years and peaks at age 65

more common in males > females

108
Q

___ sided colorectal cancers are most common

A

left sided colorectal cancers are most common

1/2 in rectum and rectosigmoid

109
Q

right sided colorectal cancer more common in?

A

inherited colon cancers

110
Q

proximal colon carcinoma rates are higher in who?

A

African Americans > Caucasians

111
Q

is it common to have metastatic disease with colorectal cancer? Common sites of metastases? most common site of metastases?

A

YES!!! 1 out of 5 CRC diagnosed will have metastatic disease

***Common sites are regional lymph nodes, liver, lungs, and peritoneum

***Liver is most common site of metastases b/c mesenteric veins drain through the portal vein

112
Q

what is the most common site of metastases in colorectal cancer?

A

Liver is most common site of metastases b/c mesenteric veins drain through the portal vein

113
Q

modifiable risk factors for colorectal cancer?

A

“Western” diet – red meat, increased fats

Obesity/waist circumference

Smoking

Alcohol consumption

114
Q

non-modifiable risk factors for colorectal cancer?

A

Race – African Americans > Caucasians

Hereditary Polyposis Syndromes (ex: FAP, Lynch)

Family history of colon cancer

Patient age

Inflammatory Bowel Disease (UC and Crohn’s)

Childhood Abdominal Radiation – for another malignancy

115
Q

modifiable prevention factors for colorectal cancer?

A

Diet and Macronutrients

  • Rich in fruit, vegetables
  • Adequate fiber
  • Limited amount of red meat

Physical activity
NSAIDs - Low dose aspirin

116
Q

clinical presentation for colorectal cancer

A
  1. Patients with suspicious symptoms and/or signs
    - Change in bowel habits
    - Change in caliber of stool (ex: stools are now pencil thin)
  2. Asymptomatic individuals discovered by routine screening
  3. Emergency admission with intestinal obstruction, peritonitis, or rarely, an acute GI bleed
117
Q

symptoms of right sided colon cancer

A
  • Vague abdominal pain
  • Iron deficiency anemia
  • Fatigue
  • GI bleeding
  • Weakness from chronic blood loss
118
Q

symptoms of left sided colon cancer

A

-Obstructive symptoms
-Colicky abdominal pain
<b>-***Change in bowel habits</b>
-Constipation alternating with loose stools
-Stool streaked with blood

119
Q

symptoms of rectal cancer

A
  • Rectal tenesmus
  • Urgency
  • Recurrent hematochezia
  • Narrow caliber stools
120
Q

what symptoms for colorectal cancer are concerning for metastatic disease?

A

weight loss, cachexia, and ascites

121
Q

colorectal cancer PE findings

A
  • Rectal Bleeding
  • Abdominal Pain
  • Cachexia, weight loss, back pain, urine or bowel changes, ascites, pallor indicative of progressive disease
122
Q

what is the GOLD STANDARD for dx of colorectal cancer?

A

COLONOSCOPY WITH BIOPSY

123
Q

preoperative staging for colorectal cancer

A
  • CBC with differential
  • Liver Function Tests
  • Carcionembryonic antigen (CEA) level - Not used for dx, but used for recurrence
  • CT Chest/Abdomen and Pelvis
  • Endorectal ultrasonography may guide operative management of rectal cancer)
124
Q

what is the carcionembryonic antigen (CEA) level for colorectal cancer

A

Not used for dx, but used to monitor progression pre-post surgery, indicator of recurrence of colon cancer (tumor marker)

Expect to normalize after surgery

125
Q

what must you do when staging?

A

need to dissect at least 12 lymph nodes

126
Q

what is T1?

A

tumor invades submucosa

127
Q

what is T2?

A

tumor invades muscular propria

128
Q

what is T3?

A

tumor invades thru muscular propria into pericolorectal tissues

129
Q

what is T4a?

A

tumor penetrates to the surface of the visceral peritoneum

130
Q

what is T4b?

A

tumor directly invades or is adherent to other organs or structures

131
Q

what is the treatment of choice in all stages of colorectal cancer?

A

Surgery

132
Q

colorectal cancer treatments

A
  • ***SURGERY - Tx of choice
  • Chemotherapy - stages III & IV colon cancer
  • Radiation + Chemotherapy - rectal cancer stages II-IV
133
Q

chemotherapy tx for what stages of colon cancer?

A

stages III and IV colon cancer

134
Q

radiation + chemotherapy for what stages of rectal cancer?

A

stages II-IV

135
Q

what is the function of the rectum?

A

to store stool and give the patient the sensation that the stool is ready to be evacuated

136
Q

where is the colon located?

A

in the abdominal wall cavity

137
Q

where is the rectum located?

A

in the peritoneal space which is a much smaller tighter space next to other organs such as the uterus, prostate, bladder, and ureters

This makes the surgical approach much more difficult

138
Q

what does rectal cancer benefit from for tx?

A

neoadjuvant therapy prior to surgical excision

139
Q

for rectal cancer, why do you want to give chemo and radiation?

A

b/c it is much easier to spread since in peritoneal space and close to many other organs

140
Q

what does primary management of localized colon cancer involve?

A

surgery to remove the affected segment

141
Q

colon cancer surgical options

A

Laparoscopic colectomy

Open colectomy

  • Subtotal colectomy
  • Total colectomy
  • +/- ostomy
142
Q

rectal cancer surgical options

A
  • Total Mesorectal excision
  • ***Transanal excision = most common for localized rectal cancer
  • Transanal endoscopic microsurgery
  • Transsphinteric excision
  • Low anterior resection with colorectal anastomosis
  • Abdominoperineal resection with a colostomy
143
Q

what is the most common surgical option for localized rectal cancer?

A

Transanal excision

144
Q

Stage I colon cancer tx

A

colectomy

145
Q

stage II colon cancer tx

A

colectomy

146
Q

stage III colon cancer tx

A

colectomy + adjuvant therapy (chemo)

147
Q

stage IV colon cancer tx

A

chemotherapy (goal to slow progression of tumor)

  • +/- resect isolated liver or lung met if possible
  • +/- colectomy
148
Q

rectal cancer treatment

A

Stage I: Excellent prognosis surgery alone

Stage II & Stage III: Chemoradiation + Surgery
-Neoadjuvant Chemoradiation (preoperative) surgery chemo +/- radiation again

149
Q

what has a worse prognosis, colon or rectal cancer?

A

rectal cancer (and higher recurrence rate too)

150
Q

colorectal cancer postop surveillance - PE

A

do PE every 3-6 months for two years

then every 6 months for 3 years

151
Q

colorectal cancer postop surveillance - CT Abd/Pelvis

A

annually for 5 years

EXCEPT:
-resected metastasis - q3-6 months every 2 years -> q6 months for 5 years

152
Q

colorectal cancer postop surveillance - colonoscopy

A

do colonoscopy 1 year after surgery -> if negative then at 5 years; or 3 years???

if not done preoperatively perform colonoscopy 3-6 months postop

153
Q

rectal cancer postop surveillance - proctoscopy

A

every 6 months q3-5 years

154
Q

post op surveillance tests for colorectal cancer

A

PE, CT abd/pelvis, colonoscopy, proctoscopy (rectal cancer)

155
Q

what is anal cancer?

A

Tumors arising in mucosa (Glandular, Transitional, Squamous)

-Look like bladder and esophageal cancers

156
Q

what is peri-anal/anal margin cancer?

A

Arise/distal to the squamous mucocutaneous junction and or arise within the skin

157
Q

what correlates very strongly with anal cancer as the cause?

A

HPV

158
Q

what is the most common anal cancer histology?

A

Small cell carcinoma (SCC)

-arise from the transitional or squamous mucosa elements of anal canal

159
Q

non-keratinizing SCC anal cancer

A

Tumors arising above the Dentate line of the anal canal

160
Q

keratinizing SCC anal cancer

A

tumors arising distal to Dentate line

161
Q

other anal cancer histology

A

adenocarcinoma
melanoma
sarcoma - rarest

162
Q

anal cancer cause and more common in who?

A

Caused by HPV (Human Papilloma virus)

Women > men

163
Q

anal cancer risk factors

A

<b>-***HPV</b>

  • Female
  • lifetime number of sexual partners
  • genital warts
  • cig smoking
  • HIV
  • Receptive anal intercourse
  • chronic immunosuppressive conditions
164
Q

anal cancer symptoms

A

<b>-***RECTAL BLEEDING</b>

  • Anorectal pain
  • Rectal mass sensation
  • No symptoms
165
Q

anal cancer PE

A

Rectal mass on Digital Rectal Exam (DRE)

Condylomata (genital warts)

Bleeding

166
Q

anal cancer initial dx tools

A

Endoscopy with biopsy

Anoscopy

Rigid Proctosigmoidoscopy

167
Q

anal cancer work-up

A

CT scan or MRI abdomen/pelvis
-To look for metastatic disease

PET/CT scan
-PET CT good for SCC to see if any metastatic disease

Fine-needle aspiration or biopsy of node if noted on imaging

168
Q

anal cancer tx stages 0-III

A

Chemoradiotherapy (Neoadjuvant)

Progression of disease or persisting disease necessitates surgery

169
Q

anal cancer tx stage IV (metastatic disease)

A

Systemic Chemotherapy

Palliative Chemoradiotherapy

170
Q

anal cancer post-tx surveillance

A

Every 3-6 months for five years:

  • Digital Rectal Examination (DRE)
  • Anoscopy
  • Inguinal node palpation (looking for metastatic disease)

+/- CT chest/abdomen/pelvis annually for three years

Clin Med 3 (21 decks)

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