Colorectal and pancreatic cancers Flashcards
what is a colectomy
resection/removal of any extent of the large bowel
what is a proctocolectomy
entire large intestine and rectum is removed
what is an “anastomosis”
remaining section of intestine are connected to complete the tube; may include ileostomy or colostomy, temporary or permanent
what is the concern with colonic polyps
malignant transformation; most colon cancers arise from previously benign adenomatous polyp
how are colonic polyps diagnosed
colonoscopy
what are familial adenomatous polyposis
multiple polyps
what are the clinical presentations of colonic polyps
most asymptomatic
rectal bleeding usually occult and rarely massive, is most frequent complain
cramps, abdominal pain, or obstruction may occur with large polyps
what is the treatment of colonic polyps
complete removal during colonoscopy
follow up surgical resection
and follow up surveillance colonoscopy
what are preventative measures for colonic polyps
ASA and Cox-2 inhibitors may help prevent formation of new polyps in patients with polyps or colon cancer
What is FAP
Familial adematous polyposis
hereditary disorder (autosomal dominant) causing Numerous colonic polyps and frequently resulting in colorectal cancer, often by age 40
what are the subtypes of FAP
classic FAP
Attenuated FAP (AFAP_
Gardner syndrome
Turcot Syndrome
what are clinical presentations of FAP
most are asymptomatic
if symptomatic usu present wtih rectal bleeding, usually occult
other associated findings: Osteomas, usu of jaw, extra missing, unerupted teeth, etc
what is the treatment of FAP
yearly colonoscopy once polyps are found until a colectomy is scheduled
colectomy done as soon as possible after diagnosis made
what is hematochezia
blood in stool
what is the most common colorectal cancer
adenocarcinomas
what are predisposing factors for colorectal cancers
FAP
ulcerative colitis and Crohn’s
Diets in low fiber, high animal protein, fat and refined carbs
cacinogens in diet
what are risk factors for CRC
smoking, ETOH intake, increased body weight
T2DM
red/processed meats
when does CRC screenings start
average-risk patients: start at 45yo and continue until 75
every 10 years or annually FIT as preferred screening test
what are the screening tests for CRC
colonoscopy: every 10 years
Fecal occult blood test (FOBT): every year
flexible sigmoidoscopy: every 5 years
CT colonography; every 5 years
Fecal immunochemical test (FIT)
Fecal DNA testing
what is the treatment of CRC
surgery
neo/adjuvant therapy: chemo and radiation
Palliation
what is CEA level
serum carcinoembryonic antigen
elevated in 70% in pts with CRC
-good for surveillance
what are the types of pancreatic CA
adenocarcinoma
neuroendocrine
cystadenocarcinomas
intraductal papillary-mucinous tumor
where do most exocrine tumors develop from
ductal and acinar cells: usually adenocarcinomas
what are prominent risk factors for adenocarcinomas
smoking
hx chronic pancreatitis
obesity
male
african american
what is the clinical presentation of pancreatic CA
Early sx are non-specific: pain and weight loss
cancer can cause diabetes: glucose intolerance
exocrine insufficiency
malabsorption
what are the preferred tests for pancreatic CA
abdominal CT or MRI
followed up endoscopic ultrasound with FNA (EUS/FNA)
what type of pancreatic cancers present with jaundice
head of the pancreas CA
what are the lab tests run with Dx/workup of pancreatic CA
CBC, CMP: elevation of alk phos and bilirubin, amylase/lipase usual normal
CA 19-9
what is a pnacreaticoduodenectomy
Whipple procedure
what is the treatment of pancreatic CA
whipple +/- chemo/radiation
symptom control/palliative care
what is neuroendocrine pancreatic CA
arise from islets and gastrin-producing cells and often produce many hormones
may appear in other organs, particularly duodenum, jejunum andlung
what are the manifestations of neuroendocorine pancreatic CA
functioning: hyper-secrete specific hormone, causing various syndrome
non-functioning: may cause obstructive symptoms of biliary tract or duodenum, bleeding into Gi tract or abdominal masses
what is the tx of neuroendocrine pancreatic cancer
surgical resection
if mets preclude curative surgery, various anti-hormone tx may be tried
what is cystadenocarcinoma
RARE adenomatous pancreatic cancer that arises as malignant degeneration of a mucinous cystadenoma
manifests as upper abdominal pain, palpable abd mass
what is intraductal papillary-mucinous tumor
results in mucus hypersecretion and ductal obstruction
symtpoms: pain and recurrent pancreatitis
dx: CT/MRI
