Colon/Rectum/Anus Cancers Dr. Frankhouse

Question 1

what % of the general population is at risk for colorectal ca

Answer 1

5%

Question 2

what are the risk factors for colorectal ca

Answer 2

> 50 y/o, hx of adenomas, high fat low-fiber diet, IBD, FH of CRC

Question 3

most cases of CRC are caused by:

Answer 3

sporadic

Question 4

How does CRC rank in commonality? Cause of death?

Answer 4

3rd most common, 2nd leading cause of death

Question 5

whats the advantage of FIT testing over fecal occult/Guiac test

Answer 5

it only detects blood from colon and not upper GI

Question 6

whats the disadvantage of flexible sigmoidoscopy vs. colonoscopy

Answer 6

only detects certain area screened….

Question 7

what is the expected % for the Adenoma Detection Rate

Answer 7

20% and the Dr. with less is at increased risk for “interval ca” btw the 10 years. Criticized for lack of skill/technique/diligence -8 minutes min.

Question 8

what are the recommendations for getting a colonoscopy

Answer 8

age 50 q 10 years. (88% decrease in CRC)

Question 9

A male pt has had a father at the age of 48 develop CRC when would u screen him?

Answer 9

age 38 and q 5yrs since he would be at higher risk

Question 10

what is the rule used to diagnose HNPCC or Lynch syndrome?

Answer 10

3, 2, 1 = 2 generations and 1 <50 yrs.

Question 11

this is used to separate the anus from the rectum

Answer 11

dentate line

Question 12

at what age would u start screening someone with familiar adenomatous polyposis (FAP)

Answer 12

age 12 with a flexible sigmoidoscopy

Question 13

what do u suspect a pt has if her family has a hx of uterine ovarian and stomach cancers

Answer 13

HNCPP, Lynch syndrome (5%)

Question 14

what are the two common places that colorectal ca mets to

Answer 14

Liver & lungs

Question 15

How is the TNM staging based off….

Answer 15

depth w/ 1. mucosa 2. submucosa 3. muscle 4. internal structures/organs

Question 16

how is stage 1 & 2 classified

Answer 16

NO nodes

Question 17

stage 3

Answer 17

positive nodes

Question 18

stage 4

Answer 18

mets

Question 19

how is one ruling out rectal ca?

Answer 19

rigid proctoscopy if >15 cm above dentate line…

Question 20

why does rectal cancer have an increased risk/rate of lung mets

Answer 20

venous return can bypass liver and go to the lungs

Question 21

why do they stage rectal ca before surgery?

Answer 21

since it is in a crowded area (pelvis) they will add a neoadjucant chemoradiotherapy if stage 3 to shrink it b4 surgery

Question 22

how does anal ca differ from colorectal

Answer 22

anal is squamous cell carcinoma vs. colorectal is adenocarcinoma

Question 23

what is the cause of anal ca

Answer 23

related to HPV (STD)

Question 24

how do u work up someone expected of anal ca to differentiate it from something else

Answer 24

HIV test

Question 25

how is staging different for anal ca

Answer 25

size not depth

Question 26

how would u treat anal ca

Answer 26

chemoradiation has good response against sq.cc rather than surgery unlike colon -80%

Question 27

how can you differentiate btw anal ca and hemorrhoids.

Answer 27

pain & bleeding seen with ca. vs. no pain with hemorrhoids.

Question 28

u visualize a rip/tear in the anoderm and upon DRE-u feel hypertonic sphincter spasm and tenderness

Answer 28

anal fissure

Question 29

80-90% of anal fissures appear where

Answer 29

posterior midline

Question 30

how would u tx someone with hypertonic sphincter spasm in anal fissure

Answer 30

stool softenor, sitz bath, NTG/Diltiazem for smooth muscle relaxation/dilation; botox to paralyze it or LIS (lateral internal sphincterectomy)-removing muscle to relief pain

Question 31

where are internal hemorrhoids located?

Answer 31

above the dentate line

Question 32

are the internal hemorrhoids palpable?

Answer 32

no

Question 33

how are internal hemorrhoids diagnosed…sx

Answer 33

no pain but bleeding.

Question 34

what are your PE findings with internal hemorrhoids

Answer 34

nonpalpable with DRE, must be seen on Anoscopy

Question 35

how do u tx internal hemorrhoids

Answer 35

diet/hydrate, rubber band ligation, infrared coag, injected sclerotherapy

Question 36

what sx are found in external hemorrhoids

Answer 36

pain but no bleeding…

Question 37

how would u treat external hemorroids

Answer 37

hydrocortisone cream

Question 38

how are u going to treat a patient presenting with an itchy bum

Answer 38

zinc oxide (hemorrhoids don’t itch!)

Question 39

who are the most at risk for rectal prolapsse

Answer 39

elderly women

Question 40

how are u to differentiate a rectal prolapse from hemorroidal prolapse

Answer 40

rectal have circular creases vs. hemorroidal has radial creases.

Question 41

how will u tx rectal prolapse

Answer 41

rectoplexy

Question 42

how would u describe an anal fistula

Answer 42

cryptoglandular abscess, anal gland obstruction

Question 43

whats the most common cause of fecal incontinence

Answer 43

obstetric injury-prolonged labor. nml pelvis=diarrhea vs. abnml pelvic m=sphincter injuries

Question 44

how do u tx incontinent

Answer 44

bulk up stool and constipate pt

Question 45

what population is most at risk for pilonidal dz and why

Answer 45

young adults/teens men>women due to sweat in the sinus of sacrococcygeal region

Question 46

most common cause of anal condyloma

Answer 46

HPV

Question 47

which HPV is associated with malignancy

Answer 47

16 & 18

Question 48

which HPV is more likely to be benign

Answer 48

6 & 11

Question 49

what does the HPV vaccine protect against?

Answer 49

both 6 & 11 (bening) and 16/18 (malignant)