Colon polys and Cancer Flashcards
1
Q
Proximal colon
A
ascending and transverse colon
2
Q
What are the 4 parts of the colon
A
- ascending
- transverse
- descending
- sigmoid
3
Q
What vitamin does the colon absorb
A
vitamin K
4
Q
What is a polyp
A
growth in the inner lining of the colon
5
Q
How are polyps diagnosed
A
- colonoscopy
- barium enema
- sigmoidoscopy
6
Q
Physical exams signs common with polyps
A
usually asymptomatic
can have GI bleed or intestinal obstruction
7
Q
Symptoms of polyps
A
- BRBPR
- rectal tenesmus
- change in bowel habits
8
Q
What are the 4 morphologic characteristic of polyps
A
- sessile
- flat
- pedunculated (polypoid)
- depressed
9
Q
Which two shapes of polyps are associated with malignancy
A
flat and depressed
10
Q
Classifications of non- neoplastic polyps
A
- mucosal
- inflammatory pseudopolyps
- hyperplastic
- submucosal
- hamartamous
11
Q
Classification of neoplastic polyps
A
adenomatous polyps
12
Q
What are muscoal polyps
A
small polyps that resemble adjacent tissue and are histologically normal
13
Q
What are inflammatory pseudopolyps?
A
irregularly shaped islands of intact mucosal
14
Q
What causes inflammatory pseudopolyps
A
mucosal ulceration and regeneration (inflammatory bowel disease process)
15
Q
What are the most common non-neoplastic polyps
A
hyperplastic
16
Q
What pattern do hyperplastic polyps present with
A
serrated or sawtooth pattern
17
Q
Where are most hyperplastic polys found?
A
rectosigmoid
18
Q
What are the types of submucosal polyps
A
- lymphoid
- fibromas
- lipoma (most common)
19
Q
Why do hyperplastic polyps have to be removed
A
they are impossible to distinguish from adenomatous polys so they need to be biopsied
20
Q
Which type of polyps do most polyposis syndromes derive from
A
hamartamous polyps
21
Q
How long does it take adenomatous polyps to develop into cancer? What type of cancer?
A
7-10 years
adenocarcinoma
22
Q
What are some risk factors for adenomatous polyps
A
- older age
- increased BMI
- lack of physical activity
- smoking
- men>women
23
Q
What are the histological classifications of adenomatous polpys
A
- tubular
- tubulovillous
- villous
24
Q
Which type of adenomatous polyp has the highest malignancy potential
A
villous
25
Which type of adenomatous polyp is most common
tubular
26
What characteristics of adenomatous polyps are associated with high CRC risk
- villous histology
- high grade dysplasia
- number and size (one or more greater than 1 cm or more than 3 of any size)
27
Screening/diagnostic tests for polyps
- FOBT
- double contrast barium enema
- CT colonography
- flex sig
- colonoscopy
28
What does an FOBT look for
blood in the stool--> bleeding polyp
29
What would a double contrast enema show if there were polyps
applecore narrowing of the colon with distension
30
What is the gold standard for examining polyps? What major benefit does it have?
colonoscopy
can remove the polyps immediately
31
What are the risk associated with colonoscopy
- perforation
- bleeding
- intolerance to sedation
- dehydration/electrolyte imbalance in elderly
32
What is a polypectomy
removal of polpys
33
What technique is used to remove a <5mm diminutive polyp
cold biopsy forceps or cold snare excision
34
What technique is used to remove a 5-10 cm polyp
standard snare excision
35
What technique is used to remove large sessile polyps (2-3cm)
piecemeal excision
or
saline assisted endoscopic mucosal resection
36
When should you do a follow up colonoscopy if you removed a polyp >2cm or you are concerned for incomplete removal of polyps
3-6 months
37
If you find >10 adenomas, when should you do a follow up colonoscopy
in less than 3 years
38
For most polyps found on endoscopy, when should a follow up colonoscopy be done?
3 years
39
If small tubular adenomas <10mm or sessile serrated polyps with no dysplasia are found when should a follow up colonoscopy be done?
5 years
40
If there are no polyps found or small hyperplastic polyps <10mm are found when should a follow up colonoscopy be done?
10 years
41
When do you consider that your patient might have a hereditary intestinal polyposis syndrome
- family history of CRC affecting more than one family member
- personal of family hx of CRC >50
- personal or family history of multiple polyps (>20)
- personal or familiy hx of multiple extracolonic malignancies
42
Which is the most common inherited colon cancer
lynch syndrome
43
What part of the colon does lynch syndrome typically affect? What kind of polyps does it cause?
right colon
adenomatous
44
What is the most common extracolonic malignancy with lynch syndrome
endometrial carcinoma
45
What is turcot syndrome
varient of extracolonic malignancy that affects the brain
46
What are the cancers/masses tested for if lynch syndrome is suspected
microsatellite instability
47
What is the treatment for lynch syndrome
colectomy
48
When are colonoscopies done in a patient with lynch syndrome
every 1-2 years starting at age 20-25
49
How is familial adenomatous polyposis characterized
>100 adenomas
50
What other cancers does FAP increase a patients risk for
- small bowel
- gastric
- pancreatic
- thyroid
51
What is Gardner syndrome
FAP patients with extracolonic manifestations
52
What types of extracolonic manifestations do patients with FAP have
- desmoid tumors
- extra teeth or missing teeth
- congenital hypertrophy of the retinal pigment
- duodenal adenomas
- fundic gland polyps
53
What is the most common type of extracolonic manifestation in a patent with FAP
desmoid tumor
54
When does screening begin in patients with FAP
10-12 start with yearly flex sigs
55
How are patients with FAP treated
- prophylactic colectomy
- screen remaining rectum every 6 months- 2 years
- EGD at 20 to 25 every 1 to 3 years
- use NSADI and COX2 as chemoppx
56
What types of hamartomatous syndromes
- familial juvenile polyposis
| - peutz jeghers polyposis
57
Where does familial juvenile polyposis present
- small bowel
- stomach
- colon
- rectum
58
What are the symptoms of familial juvenile polyposis
typically asymptomatic
can have
- painless rectal bleeding
- rectal prolapse
- failure to thrive
59
How are patients with familial juvenile polyposis screened
start at age 15 and every 1-3 years after
60
What things give a diagnosis of familial juvenile polyposis
- >5 juvenile polys in the colon
- multiple juvenile polys in the GI tract
- family hx/genetic testing
61
What is Peutz- Jehgers syndrome
inherited GI diorders where patients develop polyps on the mucous lining of the intestine and dark discolorations on the skin and mucous membrane
62
How to patients with PJS present
GI bleeding, intussusceptions or obstructions
63
What are the most common extracolonic malignancies associated with PJS
breast and testicular cancer
64
What screening needs to be done in patients with PJS
- colonscopy every 2-3 years at age 18
- EGD every 2-3 years at age 10
- breast and testicular exams
65
How often should you do a colonscopy? flex sig? flex sig plus fit? CT colonography?
colonoscopy: 10 years
flex sig: 5 years
flex sig with FIT: 10 years
CT colonography: 5 years
66
How often should you do cancer detection tests? What are they?
annually
- fecal immunochemical test
- fecal occult blood test
- fecal DNA
67
When should cancer prevention and cancer screening tests begin?
over 50
over 45 in African Americans
68
When do patients stop getting screened for CRC
at age 85
69
When do you begin to screen patietns with a 1st degree relative w/ CRC <60 or two 1st degree relatives of any age? When do you repeat it?
40 or 10 years before family member was diagnosed
repeat every 5 years
70
When do you screen a patient with a personal history of CRC
-total colon examination 1 year after resection
-repeat a 3 years
if normal repeat at 5
71
When should you screen a patient with IBD?
8 years after onset of pancolitis, repeat every 1-2 years
72
Most common location for colorectal cancer
left side (rectum, rectosigmoid)
73
Where does colorectal cancer commonly metastasize to
lymph nodes, liver, lung, peritoneum
74
What are some modifiable risk factors for colorectal cancer?
- "western diet"
- obesity
- smoking
- alcohol consumption
- diabetes
75
What are non modifiable risk factors for colorectal cancer?
- being african american
- heriditary polyposis syndromes
- family hx
- IBD
- abdominal radiation in childhood
76
Symptoms of right sided colon cancer
- vague abdominal pain
- iron deficiency anemia
- fatigue/weakness
- GI bleeding
77
Symptoms of left sided colon cancer
- obstructive sx
- colicky abd pain
- change in bowel habits
- stool streaked with blood
78
Symptoms of rectal cancer
- rectal tenesmus
- urgency
- recurrent hematochezia
- narrow caliber stools
79
Physical exam findings of a patient with colon cancer
- rectal bleeding
| - abdominal pain
80
What physical exam findings would indicate progressive colon cancer
- cachexia/weightloss
- back pain
- urine or bowel changes
- acites
- pallor
81
What tests do you need to get before you can stage colon cancer?
- CBC with diff
- LFTs
- CEA level (tumor marker)
- CT chest/abd/pelvis
- endorectal ultrasound
82
How many lymph nodes do you need to dissect to stage colon cancer
12
83
What is the treatment for colorectal cancer
- surgery: resection is treatment of choice
- chemo (stages III or IV)
- radiation plus chemo stages II-IV
84
What are the surgical options for colon cancer?
- laprascopic colectomy
- open colectomy
+/- ostomy
85
What are the surgical options for rectal cancer
- total mesorectal excision
- transanal excision
- transanal endoscopic microsurgery
- transsphincteric excision
- low anteriorrescection with colorectal anastamosis
- abdominoperineal rescection with a colostomy
86
Treatment of stage I colon cancer
colectomy
87
Treatment of stage II colon cancer
colectomy
*adjuvent therapy typically not indicated
88
Treatment of stage III colon cancer
colectomy + adjuvent therapy
CapeOx or 5-FU/leucovorin or folfox
89
Treatment of stage IV colon cancer
chemotherapy
folfox or folfiri +/- biologic
+/- resection of lung or liver met
+/- colectomy
90
How often is a physical exam done after surgery for colorectal cancer
every 3-6 months for two years then every 6 months for three years
91
When is a abd/pelvic CT done after surgery for colorectal cancer?
anually for 5 years
EXCEPT if resceted metastasis
every 3-6 months for 2 years then every six months for 5 years
92
When are colonoscopies done after surgery for colorectal cancer
1 year after surgery then every 3 years, can do every 5 years if negative
93
When are proctoscopies done after surgery for rectal cancer
every 6 months for 3-5 years
94
What is the most common type of anal cancer
small cell carcinoma
95
Non keratinizing SCC of the anus
tumors arising above the dentate line of the anal canal
96
Keratinizing SCC of the anus
tumors arising distal to the dentate line
97
What are other types of anal cancer you can get?
- adenocarcinoma
- melanoma
- sarcoma
98
What is anal cancer caused by
HPV
99
Risk factors for anal cancer
- HPV
- HIV
- genital warts
- smoking
- receptive anal intercourse
- chronic immunosuppressive conditions
100
Initial tests for diagnosis of anal cancer
- endoscopy with biopsy
- anoscopy
- rigid proctosigmoidoscopy
101
Tests for workup of anal cancer
- CT or MRI or abd/pelvis
- PET scan
- fine need aspiration or biopsy of node if noted on imaging
102
Treatment of stage 0-III anal cancer
neoadjuvant chemotherpay and surgery
103
Treatment of stage IV anal cancer
- systemic chemotherapy
| - palliative chemoradiotherapy
104
What is the post treatment surveillance for a patient that had rectal cancer? How often is it done?
- DRE
- anoscopy
- inguinal node palpation
every 3-6 months for 5 years
+/- CT annually for three years
