colorectal CA

Question 1

DDx of BRBPR (4)

Answer 1

• hemmoroids
  2. proctiis (IBD)
  3. polyps
  4. CA

Question 2

*** what is important about hemmooids

Answer 2

diagnosis of exclusion - need to rule out all others

Question 3

what is important in workup of anemia

Answer 3

scope

Question 4

what is only way to say lesion is not malig.

Answer 4

look under a microscpe

Question 5

what is part of blood supply to colon that systemic

Answer 5

middle and inferior rectal

Question 6

epi

Answer 6

3rd most common CA

• 12% of all CA in ont.
• male>female
• 1/3 local, 1/3 regional, 1/4 mets

Question 7

sporadic causes (majority

Answer 7

• AGE
• men
• env. (diet, obese, DM)
• personal Hx of CRC or polyps
• fam. Hx
• IBD

Question 8

3 known hereditary

Answer 8

1. HNPCC
2. FAP
3. MYH polyposis

Question 9

what is precursor to CA

Answer 9

adenoma that can then be removed- target for screenign

Question 10

what is tubular adenoma

Answer 10

adenomatous epi with a stalk

Question 11

what is villous adenoma

Answer 11

sessile ( no stalk) with finger-like projections

Question 12

2 features of high grade dysplasia

Answer 12

1. nuclear atypia

2. architectural complexity

Question 13

WHO definition

Answer 13

metastitis (carcinoma def.) of the colon and rectum requires invasion of the muscilaris mucosa into the submucosa

Question 14

3 variants

Answer 14

1. mucinous - > 50% of lesion has extracellula mucin epithelium
2. signet ring cell - > 50% with prominent intracytoplasmic mucin
3. other rare types

Question 15

2 grade types

Answer 15

low - 50-100% gland formation

high - 0-49% gland formation

Question 16

3 margins

Answer 16

1. proximal
   2 distal
2. radial - around fatty edge

Question 17

what is problematic margins

Answer 17

1mm is same as being at the edge

Question 18

2 types of polyps

Answer 18

neoplastic and non

Question 19

3 non-neoplastics

Answer 19

1. hyperplastic
2. inflammatory
3. juvenile

Question 20

3 neoplastic

Answer 20

1. adenomatous - all dysplastic
2. serrated
3. hamarotomatous

Question 21

3 types of adenomatous polyps

Answer 21

1. pedunclulated
2. sessile or tubular
3. villous

Question 22

epi of adenomatous polyps

Answer 22

v. common
- 1/4 will become CA
- need to be removed

Question 23

what is FAP

Answer 23

1-2% of patients with CRC

• develop in teens
• carpet of polyps
• APC gene mutation
• ALL NEED prophylactic colectomy

Question 24

what is attenuarted FAP

Answer 24

• later age
• less polyps
• may spare rectum
• same APC, but point mutation

Question 25

what is HNPCC

Answer 25

3% of all CRC
- other associated CAs
3,2,1 rule - 3 relatives, 2 gens, 1 first degree
- mismatch repair gene mutation
- 80% risk of CRC

Question 26

screening for avg.

Answer 26

• no family Hx, or over 60
  @ 50, scope q10 years
  annual FOBT

Question 27

screening for moderate risk

Answer 27

fam Hx, or 1st degree relative

Question 28

screening for FAP

Answer 28

scope annually in teens until surg

Question 29

screen for HNPCC

Answer 29

scope biannually from 20-25 and annually from 40 onward

Question 30

screen for IBD

Answer 30

scope q 1-2 years after 8 years of colitis

Question 31

5 common presentations of CRC

Answer 31

1. BRBPR
2. change in bower habits
3. abdo pain or mass
4. weight loss
5. anemia

Question 32

diagnosis

Answer 32

scope with biopsy

Question 33

***best predictor of survival

Answer 33

nodal status

Question 34

what is treatment

Answer 34

curable - surg with 5cm margins
node + - adjuvant chemo
incurable - chemo

Question 35

what is treatment for incurable

Answer 35

chemo and pallaitice surgery or stents

Question 36

what is done for survors

Answer 36

• followed 5-10 years
• scopes q 1,3,5 years
• CEA q 6 months