colorectal cancer Flashcards

1
Q

strong RF for CRC (5)

A
  • hereditary colon cancer syndrome
  • personal hx of CRC, adenamtous polyps
  • over 50+ older
  • long standing UC or crohns)
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2
Q

5 sx of CRC

A

Occult blood in stool or bright red blood per rectum
Iron deficiency anemia
Change in caliber of stools
Constipation or diarrhea
Unexplained weight loss

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3
Q

what does CRC look like on plain film/barium enema

A

apple core lesions

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4
Q

how is CRC diagnosed?

A

CAT scan then colonoscopy

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5
Q

3 other imaging and testing you can do after diagnosing CRC

A

CT chest/abdomen/pelvis w/ IV contrast
Rectal US or pelvic MRI for rectal cancer staging
CEA level (serum tumor marker)

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6
Q

CRC Surveillance after diagnosis (3)

A
  • 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
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7
Q

who in the normal risk pop. should be screened for CRC? how?

A
  • 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
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8
Q

1 FDR w/ cancer or advanced polyp under 60 yrs at time of diagnosis OR 2 FDR @ any age

A

colonoscopy Q 5 yrs at 40 or 10 yrs before youngest affected relative

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9
Q

1 FDR over 60

A

colonoscopy Q 10 after 40, continue regular screening

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10
Q

Autosomal dominant germline mutation in DNA mismatch repair genes
microsatellite instability (MSI) in their tumors

what is this condition? when do you do colonoscopies?

A

lynch syndrome at 25
colonoscopy Q 1-3 yrs; skin exam for cancer

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11
Q

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?

A

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

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12
Q

most common neoplastic polyp that should be resected completely

A

adenomatous

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13
Q

most common non-neoplastic polyp; serrated and benign

A

hyperplastic

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14
Q

non-neoplastic stromal & epithelial components as well as inflammatory cells

what is this

A

pseudopolyps– dont need to be excised

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15
Q

surgery for colon vs rectal cancer

A
  • colon: hemicolectomy
  • rectal: low anterior resection or abdominoperineal resection
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16
Q

what stage is chemo typically added

A

stage 3

17
Q

what can be done before surgery for rectal cancer? when do you do this?

A

neoadjuvant 5-fu/leucovorin chemo, radiation if metastasized to nodes

18
Q

tx of node metastasis (colon vs rectal)

A

Colon CA: Surgery + chemotherapy
Rectal CA: neoadjuvant chemo/radiation

19
Q

which has better survival– colon or rectal

A

colon cancer

20
Q

test that looks for blood in stool, done yearly but not great for precancers since those dont bleed

pros of this test?

A

FOBT
pros: no risk to colon and no prep or sedation

21
Q

test that requires diet change to avoid things like beef blood from being picked up

A

guaiac FOBT

22
Q

reacts to globin (not heme); more specific than gFOBT and needs no dietary restrictions; done yearly

A

fecal Immunochemical Testing (FIT)

23
Q

looks for blood and DNA shed from colon polyps and cancers in stool; done every 3 yrs; very sensitiv for cancer

A

stool DNA (cologuard); same pros/cons as FOBT

24
Q

done in clinic to look for polyps and cancers; does NOT need full bowel prep or sedation; views left 1/3 of colon

A

flexible sigmoidoscopy– v small risk of bleeding & perforation

25
Q

Does not report polyps under 5 mm so return after 5 yrs if negative; takes 10 mins and does not need sedation; sees ENTIRE colon; no need to stop anticoags

A

CT colonoscopy; needs bowel prep