Colorectal and Anal Cancer

Question 1

Discrete mass lesions that protrude into the intestinal lumen

Refers to a benign or not-yet malignant lesion

Answer 1

Polyps

Question 2

What are the types of polyps?

Answer 2

Adenomatous
Serrated
Non-neoplastic
Submucosal Lesions

Question 3

This type of polyp is a major precursor to cancer development

Answer 3

Adenomatous Polyps

Question 4

Majority of polyps are which type?

Answer 4

Adenomatous Polyps

Question 5

Larger polyps and those with more villous characteristics are more likely to contain what?

Answer 5

dysplasia

Question 6

The only way to distinguish adenomatous from non-adenomatous polyps

Answer 6

Through a biopsy

Question 7

List some risk factors for the development of polyps

Answer 7

Age
High fat diet
Low fiber diet
Cigarette smoking
obesity

Question 8

List some conditions with a high risk of developing colon cancer

Answer 8

Familial Adenomatous Polyposis (FAP)
Hereditary Nonpolyposis CR Cancer (HNPCC)
Peutz-Jeghers Syndrome

Question 9

Rare

Autosomal dominant

Associated with APC gene (90%) and MYH gene (8%) mutation 🡪 can
screen for this

Childhood onset

Entire length of colon and rectum

100% risk of colorectal cancer by age 50

Answer 9

Familial Adenomatous Polyposis

Question 10

What is the treatment for patients with familial adenomatous polyposis?

Answer 10

Colectomy can be performed in teens if they have mutated gene

Bottom line: A total colectomy is performed (the only intervention) and upper endoscopy done every 1-3 years to look for adenomas or carcinoma

Question 11

Hereditary Nonpolyposis Colorectal Carcinoma has associations with which cancer(s)?

Answer 11

Associations with:

Colorectal cancer
Endometrial cancer
Ovarian cancer

Question 12

Mucocutaneous pigmentation of lips, buccal mucosa, and skin

Hamartomatous polyps of GI tract (mainly small bowel)

Associated with increased risk of colorectal cancer

Autosomal dominant

Answer 12

Peutz-Jeghers Syndrome

Question 13

Peutz-Jeghers Syndrome is on which chromosome?

Answer 13

Mapped to chromosome 19

Question 14

Second most common cause of cancer death

Answer 14

Colorectal Cancer

Question 15

90% of cancers occur in those >50 years old, Highest rate in N. America and Europe

Answer 15

Colorectal Cancer

Question 16

Almost all cases of colorectal cancer are what type?

Answer 16

adenocarcinoma

Question 17

Risk of colon cancer begins to rise about how many years after disease
onset in patients with UC or Crohns?

Answer 17

7-10 years

Question 18

What are some risk factors for the development of colorectal cancer?

Answer 18

Age over 50
Adenomatous polyps/Adenomas
Fhx: first degree relative with colorectal cancer
Familial Adenomatous Polyposis (FAP)
Hereditary Nonpolyposis CR Cancer (HNPCC)
Peutz-Jeghers syndrome
Inflammatory bowel disease
Higher incidence in African Americans

Question 19

What are some signs/symptoms to watch out for that you may see in colorectal cancer?

Answer 19

Change in bowel pattern or habit, especially in those >50 years old (Ask about “pencil-thin” stool)
+ fecal occult blood (FOBT)
Iron deficiency anemia
Colon obstruction
Rectal bleeding
Unintentional weight loss
Fatigue/malaise

Question 20

Any unexplained what in any adult MANDATES a thorough endoscopic or radiographic visualization of the entire bowel?

Answer 20

iron deficiency anemia

Question 21

What is the test of choice for evaluating and diagnosing colorectal cancer?

Answer 21

Colonoscopy

Question 22

If you see “apple core” lesions on a barium enema, what should you suspect/rule out?

Answer 22

Colorectal cancer

Question 23

In colorectal cancer, what is one of the most important determinants of
survival?

Answer 23

The stage of the disease at presentation

Question 24

2.5% of GI malignancies (7210 new cases a year)

Why we do rectal exams!

Evidence shows linking incidence with HPV

Adenocarcinoma or squamous cell carcinoma

Answer 24

Anal Carcinoma

Question 25

What are some risk factors for anal carcinoma?

Answer 25

Anoreceptive intercourse
Anogenital warts
Immunosuppression
Smoking

Question 26

What are some signs/symptoms of anal carcinoma?

Answer 26

Mass
Pain
Bleeding
Discharge
Tenesmus
Pruritis
Lesion that “won’t heal”