Colorectal cancer Flashcards
What features indicate patient is in the ‘low risk’ group for colorectal cancer?
No personal history of bowel cancer
No first-degree relatie with bowel cancer
or one first-degree relative with bowel cancer, diagnosed >50y
No evidence to support invasive surveillance
What features indicate the patient is in the low-moderate risk group for colorectal cancer?
One first-degree relative diagnosed with bowel cancer <50y
or two first-degree relatives diagnosed with bowel cancer >60
One-off colonoscopy at age 55
What features indicate the patient is in the high-moderate risk group for colorectal cancer?
Three or more affected first-degree relatives >50y
Two affected first-degree relatives <60y
5-yearly colonoscopy starting at age 50
What features indicate the patient is in the high risk group for colorectal cancer?
Family member with FAP or Lynch syndrome
Pedigree suggesting AD or AR colorectal cancer
Amsterdam II criteria for Lynch syndrome (3, 2, 1, 1, 1)
At least three relatives with any Lynch syndrome-associated cancer (colorectal cancer, endometrial, small bowel, urothelium)
At least two successive generations affected
One should be a first-degree relative of the other two
At least one diagnosed before age 50
Familial adenomatous polyposis excluded
Tumors verified by pathological examination
Muir-Torre syndrome
Skin manifestations of Lynch syndrome (keratocanthoma, sebaceous tumours
Especially MSH2
Extra-intestinal manifestations of Lynch syndrome (percentages)
(Large bowel 30-75%)
Endometrium 30-75% women
Stomach 5-10%
Ovary 5-10% women
Urothelium 5%
Small bowel/pancreas/brain <5%
Extra-intestinal manifestations of FAP
Ectoderm
- epidermoid cysts
- CNS tumours
- retinal hypertrophy
Mesoderm
- desmoid
- osteoma, sclerosis
- teeth things
Endoderm
- stomach, duodenum, small bowel, biliary tree, thyroid, adrenal
- fundic gland polyps
- pancreatic cancer
When to offer colectomy for FAP
- diagnosis of cancer
- severe symptoms related to neoplasia (eg bleeding)
- high grade dysplasia
- adenomas >6mm
- marked increase in polyp numbers on consecutive exams
- inability to adequately survey colon due to multiple diminutive polyps
Spigelman criteria for surveillance of duodenal disease in FAP
Number, size and histological grade of polyps, degree of dysplasia
Stage 0 - 5 years
Stage I - 5 years
Stage II - 3 years
Stage III - 1 year, consider therapeutic endoscopy
Stage IV - consider prophylactic duodenectomy
Extracolonic manifestations of MAP
Duodenal polyps (20-30%)
Possibly breast cancer
Osteoma, dental cysts
Features concerning for colorectal cancer
rectal bleeding without anal symptoms for >6 weeks
palpable right-sided mass
change of bowel habit to loose stools/increased frequency for >6 weeks
palpable rectal mass
unexplained IDA
Kikuchi risk prediction: define, quantify (3)
Subdivision of cancer invasion into thirds of submucosa to give risk of nodal metastasis
sm1: 2%
sm2: 8%
sm3: 23%
Risk of residual disease following polypectomy with <1mm margin
21-33%
Liver met is irresectable if (4)
Involvement of PV/CHA
Unfit for surgery
Extrahepatic mets on CT/PET/laparoscopy
Liver remnant too small
