colorectal cancer Flashcards
strong RF for CRC (5)
- hereditary colon cancer syndrome
- personal hx of CRC, adenamtous polyps
- over 50+ older
- long standing UC or crohns)
5 sx of CRC
Occult blood in stool or bright red blood per rectum
Iron deficiency anemia
Change in caliber of stools
Constipation or diarrhea
Unexplained weight loss
what does CRC look like on plain film/barium enema
apple core lesions
how is CRC diagnosed?
CAT scan then colonoscopy
3 other imaging and testing you can do after diagnosing CRC
CT chest/abdomen/pelvis w/ IV contrast
Rectal US or pelvic MRI for rectal cancer staging
CEA level (serum tumor marker)
CRC Surveillance after diagnosis (3)
- CEA levels q 3-6 months x 5 years
- CT yearly x 5 years
- colonoscopies before tx, 1 yr after tx. if normal then repeat in 3 yrs. if normal then q 5 yrs
who in the normal risk pop. should be screened for CRC? how?
- all adults 45-75 should be screened, after that decide w/ provider
- annual guaiac-based FOBT or immunochemical FOBT (FIT) or colonscopy q 10 years
1 FDR w/ cancer or advanced polyp under 60 yrs at time of diagnosis OR 2 FDR @ any age
colonoscopy Q 5 yrs at 40 or 10 yrs before youngest affected relative
1 FDR over 60
colonoscopy Q 10 after 40, continue regular screening
Autosomal dominant germline mutation in DNA mismatch repair genes
microsatellite instability (MSI) in their tumors
what is this condition? when do you do colonoscopies?
lynch syndrome at 25
colonoscopy Q 1-3 yrs; skin exam for cancer
Autosomal dominant germline mutation in APC gene; Also at risk for duodenal and gastric polyps
what is this condition? when do you screen & how? treatment?
familial adenomatous polyposis
initial screen at age 10-12 w/ flexible sigmoidoscopy yearly
Prophylactic total colectomy often performed (will get CRC by age of 45 if they don’t) & refer to gastroent. for continued surveillance
most common neoplastic polyp that should be resected completely
adenomatous
most common non-neoplastic polyp; serrated and benign
hyperplastic
non-neoplastic stromal & epithelial components as well as inflammatory cells
what is this
pseudopolyps– dont need to be excised
surgery for colon vs rectal cancer
- colon: hemicolectomy
- rectal: low anterior resection or abdominoperineal resection