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General Surgery > Colon Tumours > Flashcards

Colon Tumours Flashcards

1
Q

what is a colonic poly?

A
  • Protrusion above an epithelial surface – dysplastic epithelial lining
  • It is a tumour
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2
Q

what are the different classifications of colonic polyps?

A
  • Benign or malignant

* Epithelial or mesenchymal

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3
Q

what are the macroscopic features of colonic polyps?

A

pedunculated, sessile, flat, irregular surface, long stalk

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4
Q

what are the different types of benign epithelial polyps?

A

Neoplastic - Adenoma
Inflammatory – IBD
Hamartomatous - Juvenile polyp and Peutz-Jeghers syndrome
Metaplastic

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5
Q

what are the different types of benign mesenchymal polyps?

A 
Lipoma
Lymphangioma 
Haemangiomas
Fibromas
Leiomyoma
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6
Q

what are the different types of malignant epithelial polyps?

A

Polypoid adenocarcinomas

Carcinoid polyps

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7
Q

what are the different types of malignant mesenchymal polyps?

A

Sarcoma

Lymphomatous polyps

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8
Q

what are examples of other types of colonic polyps?

A

adenoma, serrated polyp, polypoid carcinoma, other

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9
Q

what are colonic adenoma?

A

benign tumours, not invasive, do not metastasise, are precursors to adenoma-carcinoma

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10
Q

what are the microscopic features of colonic adenomas?

A

o Microscopic: Architecture variable – tubullovillous, tubular, villous
o Are all dysplastic

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11
Q

what is the management of colonic adenomas?

A

need to be removed

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12
Q

when is segmental resection or complete colectomy considered?

A
  • Incomplete excision of malignant polyp
  • Malignant sessile polyp
  • Malignant pedunculated polyp with submucosal invasion
  • Polyps with poorly differentiated carcinoma
  • Familial polyposis coli
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13
Q

what is the definition of of low risk colonic polyps?

A

1 or 2 adenomas less than 1cm

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14
Q

what is the definition of of moderate risk colonic polyps?

A

3 or 4 small adenomas or 1 adenoma greater than 1cm

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15
Q

what is the definition of of high risk colonic polyps?

A

More than 5 small adenomas or more than 3 with 1 of them greater than 1cm

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16
Q

what is the follow-up action of low risk colonic polyps?

A

No follow up or re-colonoscopy at 5 years

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17
Q

what is the follow-up action of moderate risk colonic polyps?

A

Re-scope at 3 years

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18
Q

what is the follow-up action of high risk colonic polyps?

A

Re scope at 1 year

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19
Q

what examples if benign colon tumours?

A 
o	Adenomatous polyp
o	Papilloma
o	Lipoma
o	Neurofibroma
o	Haemangioma
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20
Q

what are the clinical features of an adenomatous polyp?

A

 Asymptomatic
 Maybe anaemia, slight rectal bleeding
 Hypokalaemia – excess mucus secretion

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21
Q

how are adenomatous polyps diagnosed?

A

screening, occasionally colonoscopy or barium enema

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22
Q

what is the management of adenomatous polyps?

A

EMR and lifelong surveillance

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23
Q

what are examples of primary malignant colon tumours?

A

 Carcinoma
 Lymphoma
 Carcinoid tumour

24
Q

what are the causes of colon tumours?

A
  • FH
  • Age
  • Diet rich in fat and meat, low in fibre
  • IBD
  • Diabetes
  • Atherosclerotic disease
25
Q

what cells does colon adenocarcinomas form from?

A

glandular cells of the mucosal lining of colon

26
Q

what are common genetic mutations associated with

A

K-Ras, C-myc, APC, DCC, MCC, C-yes, Bcl-2, P53, 5q + 18q

27
Q

what are the genetic defects that lead to tumour growth?

A

o Oncogene activation
o Loss/mutation of tumour suppressor genes
o Loss/suppression of genes involved in DNA repair pathways

28
Q

what are the macroscopic classifications of colon tumours?

A 
o	Papilliferous
o	Malignant ulcer
o	Annular
o	Diffuse infiltrating growth
o	Mucinous tumour
29
Q

where are colon tumours located?

A 
o	rectal: 40% 
o	sigmoid: 30%
o	descending colon: 5%
o	transverse colon: 10%
o	ascending colon and caecum: 15%
30
Q

what is the local spread of colon tumours?

A

encircling the wall of the bowel and invading the coast of the colon, eventually involving adjacent viscera (small intestine, stomach, duodenum, ureter, bladder, uterus, abdominal wall etc)

31
Q

what is the lymphatic spread of colon tumours?

A

to the regional lymphnodes, eventually spreading via the thoracic duct, and may involve supraclavicular nodes in late cases

32
Q

what is the blood spread of colon tumours?

A

to the liver via the portal vein, and thence to the lung

33
Q

what are the local effects of colon tumours?

A

o Change in bowel habit
o Intestinal obstruction due to a constricting neoplasm, commonly left descending
o Perforation of the tumour, either into the general peritoneal cavity or locally with the formation of a pericolic abscess, or occasionally by fistulation into adjuvant viscera
o Left sided lesions are usually constricting, right sided proliferative

34
Q

what are the clinical features of colon tumours

A

Iron Deficiency Anaemia, Weight loss, Malaise, Vague abdominal pain, Faecal occult blood loss, Palpable mass, Obstruction, Altered bowel habit, Tenesmus, Rectal bleeding, Anal and perianal pain, Faecal incontinence, Recurrent UTI, Sister Mary Joseph Nodule, Ascites

35
Q

what are red flag symptoms relating to colon tumours?

A
  • Palpable rectal mass (any age)
  • Iron deficiency anaemia in men of any age
  • Iron deficiency anaemia in non-menstruating women of any age
  • Rectal bleeding and change of bowel habit for more than six weeks in patients over 40
  • Rectal bleeding for 6 weeks or more in anybody over 50
  • Anybody with a palpable rectal mass
36
Q

what is the gold standard imaging method for colon tumours?

A

colonoscopy?

37
Q

what imaging is used for colon tumours?

A 
Colonoscopy
Sigmoidoscopy
Double-contrast barium enema 
CT colonography
Carcinoembryonic antigen (CEA) levels
38
Q

what staging methods are used for colon tumours?

A

Dukes Scale, TMN

39
Q

what is the definition of Stage A colon tumours?

A

the tumour is confined to the mucosa

40
Q

what is the definition of Stage B colon tumours?

A

the tumour has spread through all the layers of the mucosa to the serosa. There are no lymph nodes metastasis

41
Q

what is the definition of Stage C colon tumours?

A

the same as stage B, but there is lymph node involvement

42
Q

what are the different types of stage C tumours?

A

C1 there is local lymph node involvement

C2 there is distant lymph node involvement

43
Q

what is the definition of Stage D colon tumours?

A

disease with wide spread metastatic involvement.

44
Q

what is the management of colonic tumours?

A

Surgical Resection

Radiotherapy, chemotherapy

45
Q

what stages of colon tumours is surgery appropriate?

A

A-C

46
Q

what are the features of surgery for colon tumour management?

A

o You should remove 2cm either side of the tumour (5cm in all directions in the rectum)
o Can be a laparotomy or laparoscopy
o Anastomosis is usually, although not always made afterwards

47
Q

when is radiotherapy and chemotherapy used as adjuvants in colon tumour management?

A

B-C

48
Q

when is radiotherapy and chemotherapy used as palliation in colon tumour management?

A

D

49
Q

what are the genetic classifications of colon tumour?

A

sporadic (95%)
Hereditary, non-polyposis colorectal carcinoma (HNPCC)
Familial adenomatous polyposis (FAP<1%)

50
Q

what is the genetic cause of sporadic colon tumours?

A

Loss of APC gene

51
Q

what is the diagnostic criteria for HNPCC?

A

Occurrence of colon cancer in at least three family members spanning two generations with one before the age of 50

52
Q

what is the genetic cause of HNPCC?

A

o MSH2
o MLH1
o Dominantly inherited

53
Q

what are the features of HNPCC?

A

o Tumours arise in right colon before age of 50

o Associated with tumours of ovary, uterus and stomach

54
Q

what is the genetic cause of FAP?

A

o Adenomatous polyposis coli gene (APC) on chromosome 5

o Autosomal dominant inheritance

55
Q

what are the features of FAP?

A

o Polyps appear in adolescence, symptoms of bleeding and diarrhoea start 21, malignant change occurs 20-40

56
Q

how is FAP diagnosed?

A

o Hypertrophy of the retinal pigment layer is a useful screening test
o Gardner’s Syndrome - Colonic polyps associated with desmoid tumours and osteromas of the mandible and skill

57
Q

what is the management of FAP?

A

total colectomy

General Surgery (14 decks)

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