colorectal cancer

Question 1

what factors increase the risk of colorectal cancer ?

Answer 1

history of polyps on prior colonoscopy
history of CRC in the family
history of receiving abdominal radiation for childhood malignancy
positive for history of familial polyposis syndrome
alcohol
obesity
smoking
IBD

Question 2

what is the age range for CRC ?

Answer 2

rare before the age of 40
the risk increases significantly between 40 and 50

Question 3

what are the variants of FAP ?

Answer 3

familial adenomatous polyposis (FAP)
|
gardner’s syndrome
turcot’s syndrome
attenuated adenomatous polyposis coli

Question 4

what is lynch syndrome ?

Answer 4

hereditary nonpolyposis colorectal cancer HNPCC
an autosomal dominant syndrome

Question 5

is FAP more common or HNPCC more common ?

Answer 5

HNPCC

Question 6

what medications are associated with a lower incidence of CRC?

Answer 6

aspirin and NSAIDs

Question 7

what are the different presentations associated with colorectal cancer ?

Answer 7

asymptomatic
bleeding
vague abdominal discomfort
intestinal obstruction

Question 8

how is a diagnosis of colorectal cancer madee ?

Answer 8

colonoscopy
lab - tumor markers, faecal occult blood test
imaging - CT colonography, barium enema

Question 9

why is aspirin and nsaids associated with a lower incidence of colorectal cancer ?

Answer 9

they inhibit APC mutation
inhibit k-ras mutation
all which may eventually lead to adenomatous carcinoma

Question 10

what are the types of colorectal polyps ?

Answer 10

sporadic adenoma
sessile serrated adenoma
inherited polyposis syndrome

Question 11

what is the characteristic appearance of sessile serrated adenoma ?

Answer 11

saw toothed appeearance

Question 12

what germline mutation is associated with FAP ?

Answer 12

APC mutation

Question 13

what cancer is highly associated with FAP ?

Answer 13

congenital hypertrophy of the retinal pigment layer

Question 14

what is the type of mutation associated with HNPCC ?

Answer 14

microsatellite instability

Question 15

what is turcot’s syndrome ?

Answer 15

FAP or lynch syndrome along with a brain tumor

Question 16

what is gardner’s syndrome ?

Answer 16

FAP along with osteoma off the skull and desmoid tumors ( soft tissue tumors )

Question 17

what are the types of familial polyposis syndromes ?

Answer 17

FAP
HNPCC (lynch syndrome)
juvenile polyposis
peutz jeghers syndrome

Question 18

what are the chances of FAP turning into CRC ?

Answer 18

100% of patients with FAP will develop CRC

Question 19

what other malignancies are highly associated with Lynch syndrome ?

Answer 19

endometrial
ovarian
gastric carcinoma

Question 20

what are the screening guidelines for CRC ?

Answer 20

screening should begin at age 40 if there is history of CRC in the family ( screen with colonoscopy)
begin screening 10 years before diagnosis of the relative and done every 10 years

Question 21

what is the difference in screening protocol if there is a first degree relative with hx of CRC before 60, or advanced adenoma in 2 or more first degree relatives ?

Answer 21

screening done every 5 years instead of 10 beginning at age 40

Question 22

what are thee stool based screening tests ?

Answer 22

guaiac based FOBT
faecal immunochemical test
FIT-DNA

Question 23

what are the methods of direct visualization in screening for CRC ?

Answer 23

colonoscopy
CT colonography
Flexible sigmoidoscopy

Question 24

how is the screening done ?

Answer 24

started with faecal occult blood test , if it is positive it is then followed by colonoscopy

Question 25

which of thee stool tests require no dietary restrictions ?

Answer 25

faecal immunochemical test

Question 26

how often and when should screening be done for average risk population ?

Answer 26

starts at 50 -74 and repeated 1 to 2 years

Question 27

what is peutz jegher syndrome ?

Answer 27

type of familial polyposis syndrome
causes small bowel and colonic carcinoma
causes bowel obstruction
brown pigmentation in the mucous membranes and in the palms of the hand