Colorectal Cancer

Question 1

what is the screening test for colon cancer

Answer 1

qFIT

Question 2

how does the qFIT test work

Answer 2

it detects hidden/occult blood in stool by using antibodies that test specifically for haemoglobin

Question 3

a positive qFIT triggers a

Answer 3

urgent colonoscopy

Question 4

describe the appearance of a polyp

Answer 4

on a stalk
projects into lumen
smooth surface
well defined
no obvious ulceration or haemorrhage

Question 5

why might colon abnormality be recognised by someone started on aspirin

Answer 5

the aspiring thins their blood
more likely to bleed
so might bleed from colon when wouldn’t have otherwise

Question 6

what are the cytological features of malignancy

Answer 6

high nucleus:cytoplasm ratio
hyperchromasia - darker nuclei in histology
pleomorphism

Question 7

feature of an adenocarcinoma that makes it different to adenoma

Answer 7

it has invaded the base of the polyp and has less defined borders

Question 8

common sites of metastasis in colon cancer

Answer 8

liver and lungs

Question 9

what should be done after an adenocarcinoma is found on biopsy

Answer 9

CT scan or MRI to stage it
MDT meeting to determine next steps
consider surgery

Question 10

what type of polyp has the most potential to progress to an adenocarcinoma

Answer 10

adenoma

Question 11

what type of polyps don’t have malignant potential

Answer 11

hyperplastic
(except serrated polyp)

Question 12

what type of polyp is very flat

Answer 12

serrated polyp

Question 13

how are oncogenes expressed in tumour cells

Answer 13

either mutated to escape surveillance of body
or at high levels

Question 14

is p53 a tumour suppressor gene or oncogene

Answer 14

tumour suppressor gene

Question 15

what is the APC gene and what is it’s role in cancer

Answer 15

it encodes for the APC protein which is a tumour suppressor
APC protein regulates other things which are involved in cell adhesion
deletion of the APC gene predisposes to cancer

Question 16

how long does it take to progress from a late adenoma to cancer

Answer 16

2-10 years

Question 17

red flags for colon cancer

Answer 17

rectal bleeding
frequent nocturnal symptoms
weight loss
persistent diarrhoea
anaemia
thrombocytosis
new onset over 50
family history
PMHx IBD

Question 18

is weight loss an early or late stage symptom

Answer 18

late stage

Question 19

differential diagnosis for colon cancer

Answer 19

IBD
colon polyps
haemorrhoids

Question 20

what group are more likely to have IBD than colon cancer

Answer 20

younger people

Question 21

what is cancer grade

Answer 21

indication of invasiveness
based on how the patterns of cancer cells look under the microscope
degree of abnormality

Question 22

what is cancer staging

Answer 22

describes how far the cancer has spread

Question 23

what does TNM stand for

Answer 23

tumour - how far the primary tumour has grown into the wall of the organ and nearby organs
nodes - how many nearby lymph nodes the cancer has spread to
metastasis

Question 24

alternative staging process to TNM

Answer 24

Duke’s

Question 25

risk factors for colon cancer

Answer 25

high red meat and processed intake
cooking meats at very high temperatures (frying, grilling)
low fibre diet
age
male
smoking
alcohol excess
obesity
physical inactivity
history of IBD
family history of colorectal polyps or cancer

Question 26

most common sites of colorectal cancer

Answer 26

sigmoid colon and rectum - 50%
caecum and ascending colon - 20-30%

Question 27

who is screened for colon cancer

Answer 27

over 50s

Question 28

is removal of adenomas curative

Answer 28

yes