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R - Alimentary System (Liam Lennox) > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

What cause of cancer death is colorectal cancer?

A

2nd leading

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2
Q

What overall cause of cancer is colorectal cancer?

A

3rd

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3
Q

What is the most common histological classification of colorectal cancer?

A

Adenocarcinoma (95%)

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4
Q

What percentage of colorectal cancer is colonic and what is rectal?

A

2/3 is colonic

1/3 is rectal

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5
Q

What genes are associated with colorectal cancer?

A

HNPCC (5%)

FAP (<1%)

Other CRP syndromes

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6
Q

What are risk factors for sporadic cases of colorectal cancer?

A

Age

Male gender

Previous adenoma

Environmental influences (diet, obesity, lack of exercise, smoking, diabetes)

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7
Q

What kind of things in your diet are risk factors for colorectal cancer?

A

Low fibre

Low fruit and veg

Low calcium

High red meat

High alcohol

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8
Q

What percentage of colorectal cancers have no genetic influence?

A

85%

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9
Q

What do majority of colorectal cancers arise from?

A

Pre-existing polyps

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10
Q

What are polyps?

A

Protuberant growths

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11
Q

What are the different kinds of polyps?

A

Epithelial or mesenchymal

Benign or malignant

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12
Q

What is an adenoma?

A

Benign tumour of glandular tissue

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13
Q

What is an adenoma in origin?

A

Epithelial

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14
Q

What are the different histological types of adenoma?

A

Tubular (75%)

Indeterminate tubulovillous (15%)

Villous (10%)

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15
Q

Explain the adenoma-carcinoma sequence?

A

Activation of oncogene, loss of tumour suppresor gene and defective DNA repair pathway genes (microsatelite instability) cause adenoma to become carcinoma by causing cell growth proliferation apoptosis

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16
Q

What are examples of oncogenes?

A

K-ras

C-myc

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17
Q

What is an oncogene?

A

A gene that has the potential to cause cancer

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18
Q

What are examples of tumour suppressor genes?

A

APC

p53

DCC

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19
Q

What are tumour suppresor genes?

A

Ones that control cell growth

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20
Q

What is the presentation of colorectal cancer?

A

Rectal bleeding (especially if mixed in with stool)

Altered bowel opening to loose stools (longer than 4 weeks)

Palpable rectal or right lower abdominal mass

Acute chronic obstruction if stenosing tumour

Weight loss

Anorexia

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21
Q

What investigations are done for colorectal cancer?

A

Colonoscopy

Radiological imaging

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22
Q

What is the investigation of choice for colorectal cancer?

A

Colonoscopy

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23
Q

What can be done with a colonoscopy?

A

Tissue biopsy

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24
Q

What does a colonoscopy require?

A

Sedation

Bowel preparation

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25
What are risks of a colonoscopy?
Perforation Bleeding
26
What radiological imaging is done for colorectal cancer?
CT colonography Barium enema
27
What investigations are done to stage colorectal cancer?
CT scan of chest/abdomen/pelvis MRI scan for rectal tumours PET scan/rectal endoscopic ultrasound in selected cases
28
For Duke's staging, what is T1 to T4?
T1 - confined to submucosa T2 - confined to muscularis T3 - confined to serosa T4 - breached serosa, invading other structures
29
For Duke's staging, what is N0 to N2?
N0 - no lymph node involvement N1 - seen in 3 regional lymph nodes N2 - seen in 4+ regional lymph nodes
30
For Duke's staging, what is M0 to M1?
M0 - no metastases to distinct organs M1 - metastasis to distinct organs
31
What is the treatment for colorectal cancer?
Surgery Chemotherapy Radiotherapy
32
What are the 2 surgical options for colorectal cancer?
Laparotomy vs laparosopic
33
When is radiotherapy used?
Only for rectal cancer
34
What is used for palliative care of advanced disease?
Chemotherapy Colonic stenting to prevent colonic obstruction
35
What does the prognosis of colorectal cancer depend on?
What stage it is
36
What is 5 year survival of Duke's stage A?
83%
37
What is 5 year survival of Duke's stage B?
64%
38
What is 5 year survival for Duke's stage C?
38%
39
What is 5 year survival of Duke's stage D?
3%
40
What can prognosis of colorectal cancer be improved by?
Prevention (changing lifestyle factors) Screening (high risk groups and average risk population)
41
What is the aim of population screening?
Detect pre-malignant adenomas/early cancers in the general population
42
What are some modalities of screening?
Faecal occult blood test (FOBT) Faecal immunochemical (FIT) Flexible sigmoidoscopy Colonoscopy CT colonography
43
When does the Scottish population start getting an FOBT every 2 years?
Between age 50 to 74
44
What happens if a FOBT is positive?
Colonoscopy
45
What does FOBT stand for?
Faecal occult blood test
46
Does FOBT have a greater positivity in men or woman?
Men
47
What does faecal immunochemical testing check?
Specific for human haemoglobin
48
What are examples of high risk groups for colorectal cancer that require screening?
Heritable conditions (FAP and HNPCC) Inflammatory bowel disease Familial risk Previous adenomas/colorectal cancer
49
What does FAP stand for?
Familial adenomatous polyposis
50
What does HNPCC stand for?
Hereditary non-polyposis colorectal cancer
51
What kind of genetic condition if FAP?
Autosomal dominant
52
What gene is FAP a mutation of?
ACP gene on chromosome 5
53
What do people with FAP have a high risk of?
Malignant change in early adulthood, in almost all cases by age 40 years if left untreated
54
What screening is done for people with FAP?
Annual colonoscopy from age 10-12
55
Other than screening, what else is often done for people with FAP to reduce the risk of colorectal cancer?
Prophylactic proctocolectomy usually age 16 to 25
56
What is proctocolectomy?
Surgical removal of all of the rectum and part of the colon
57
What are extracolonic manifestations of FAP?
Benign gastric fundic cystic hyperplastic Duodenal adenomas with periampullary cancer
58
What kind of chemoprevention is often given to people with FAP?
NSAIDs chemoprevention
59
What does NSAIDs chemoprevention do?
Reduces the number of polyps and prevent recurrence of higher grade adenomas in the retained rectal segment
60
What kind of genetic condition is HNPCC?
Autosomal dominant condition
61
What gene causes HNPCC?
Mutation in DNA mismatch repair (MMR) genes
62
What are examples of DNA mismatch repair genes (MMR) that cause HNPCC?
MLH1 MSH2
63
What characteristics do tumours caused by HNPCC usually have?
Microsatellite instability (MSI) which are frequent mutations in short repeated DNA sequences (microsatellites)
64
Where in the colon does HNPCC usually cause cancer?
Right sided
65
Other than the colon, what other sites can HNPCC cause cancer?
Endometrial Genitourinary Stomach Pancreas
66
How is HNPCC diagnosed?
Clinical criteria (Amsterdam/Bethesda) Genetic testing
67
What is done for people with HNPCC to reduce the change of them developing colorectal cancer?
Screening is given every 2 years as a colonoscopy
68
In terms of a family history of colorectal cancer, who is considered a high moderate risk?
Colorectal cancer in 3 first degree relatives where none \<50 or Colorectal cancer in 2 first degree relatives mean age \<60
69
What is done for people who are considered a high moderate risk with a family history of colorectal cancer?
5 yearly colonoscopy from age 50 years
70
In terms of a family history of colorectal cancer, who is considered to be low moderate risk?
Colorectal cancer in 2 first degree relatives \>60 or Colorectal cancer in 1 first degree relative \<50 years
71
What is done for people with a family history of colorectal cancer who are considered low moderate risk?
Once only colonoscopy at 55 years
72
What are people with IBD given to reduce change of getting colorectal cancer?
Index surveillance colonoscopy 10 years post diagnosis, then dependent on duration, extent and activity of inflammation and presence of dysplasia
73
What are people with previous colorectal cancer given to reduce the chance of getting it again?
5 yearly colonoscopy
74
What are people with previous adenomas given to reduce the chances of developing colorectal cancer?
Colonoscopy dependent on number of polyps, size and degree of dysplasia

R - Alimentary System (Liam Lennox) (41 decks)

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