Colorectal Cancer Flashcards
How common is colorectal cancer in the world?
1 - most common
2 - 2nd most common
3 - 3rd most common
4 - 4th most common
4 - 4th most common
- 3rd most deadly
What age is colorectal cancer rare?
1 - <50
2 - <65
3 - <70
4 - <85
1 - <50
- becomes more common in >50 y/o
What is the incidence (new cases) of colon cancer/year in the UK?
1 - 4000
2 - 40,000
3 - 400,000
4 - 4 million
2 - 40,000
- 10 year survival is 53%
Colon cancer is more likely in white than black populations, especially in the western world. What is the most likely cause of this?
1 - more pollutants
2 - westernised diet
3 - smoking
4 - obesity
2 - westernised diet
- low in dietary fibre
There are lot of risk factors for colorectal cancer, which of the following is NOT a risk factor for colorectal cancer?
1 - high BP
2 - low dietary fibre
3 - obesity/sedentary lifestyle
4 - red meat consumption
5 - smoking and alcohol
6 - genetics (Lynch, FAP)
7 - IBD
1 - high BP
- in IBD risk is increased due to chronic inflammation causing DNA damage and cancer
The colon has multiple layers. One of these is the mucosa, which itself has 3 separate layers. Which of the following is not one of the mucosa layers?
1 - epithelium
2 - muscularis mucosae
3 - serosa
4 - lamina propria
3 - serosa
Arrange the layers of the colon from the lumen outwards using the labels below:
1 - serosa (intraperitoneal) or adventia (retroperitoneal)
2 - submucosa
3 - mucosa
4 - muscularis
3 - mucosa
2 - submucosa
4 - muscularis
1 - serosa (intraperitoneal) or adventia (retroperitoneal)
There are different types of colorectal cancers. Which of the following is most common?
1 - adenocarcinomas /
adenomatuous
2 - hyperplastic polyps
3 - sessile serrated polyps
4 - non-neoplastic polyps
1 - adenocarcinomas /
adenomatuous
- tumour comes from tissue of the colon
- accounts for 70% of colon cancer
All of the following are classifications of bowel cancer based on histology. Which type accounts for >90% of colon cancer?
1 - Squamous cell
2 - Adenosquamous type
3 - Neuroendocrine
4 - Spindle cell
5 - Adenocarcinoma
5 - Adenocarcinoma
Which 2 of the following would we find sqaumous cells in the lower GI?
1 - transverse colon
2 - ascending colon
3 - anus
4 - rectum
5 - descending colon
3 - anus
4 - rectum
- this is where we could find any squamous cell carcinomas
What are adenocarcinomas?
1 - tumours formed in squamous cells
2 - tumours formed in lamina propria
3 - tumours formed in glandular tissues
4 - all of the above
3 - tumours formed in glandular tissues
- in colon glandular cells are crypts
Adenocarcinomas can be:
- well differentiated
- moderately differentiated
- poorly differentiated
Which of these resembles normal tissue and an increase in glandular tissue?
- well differentiated
- grow slowly
Adenocarcinomas can be:
- well differentiated
- moderately differentiated
- poorly differentiated
Which of these have the worst prognosis?
- poorly differentiated
Typically, what is the most common location in the colon where an adenocarcinoma would be found?
1 - transverse colon
2 - ascending colon
3 - anus
4 - sigmoid colon
5 - descending colon
4 - sigmoid colon
- caecum is the next most common site
The main types of tumours that can lead to colon cancer are:
- adenocarcinomas /
adenomatuous - hyperplastic polyps
- sessile serrated polyps
- non-neoplastic polyps
These can be grouped based on their morphology.
Which of the following is NOT an original hallmark of cancer?
1 - sustaining proliferative signalling
2 - evading growth suppressers
3 - activating invasion and metastasis
4 - enabling replicative immortality
5 - inability to induce angiogenesis
6 - resisting cell death
5 - inability to induce angiogenesis
- cancer cells are resistant to apoptosis
1 - cell growth and replication due to tyrosine kinase pathway
2 - tumour suppressor evasion
3 - activating invasion and metastasis
4 - enabling replicative immortality
5 - inability to induce angiogenesis
6 - resisting cell death
There are 6 original hallmarks of cancer, evident in the picture attached. Which of the following is NOT an emerging hallmark of cancer?
1 - avoiding immune destruction
2 - genome instability and mutation
3 - tumour promoting anti-inflammation
4 - deregulating cellular energetics
3 - tumour promoting anti-inflammation
- this is a pro-inflammatory hallmark
Adenoma-carcinoma progress in a stepwise progression from a normal bowel mucosa to an adenomatous polyp and bowel cancer. The first step of this stepwise progression is when normal bowel tissue undergoes hyperplasia and becomes an early adenoma. Which of the following occurs here?
1 - Kirsten RAt Sarcoma virus (KRAS) mutation
2 - Adenomatous polyposis coli (APC) inactivation
3 -18q loss
4 -Tumour protein 53 (TP53) mutation and/or loss
2 - Adenomatous polyposis coli (APC) inactivation
- APC gene = tumour suppressor gene
- APC gene products normally suppressor tumour growth
Adenoma-carcinoma progress in a stepwise progression from a normal bowel mucosa to an adenomatous polyp and bowel cancer. The second step is the development of an early adenoma to an intermediate adenoma due to dysplasia. Which of the following occurs to allow this?
1 - Kirsten RAt Sarcoma virus (KRAS) mutation
2 - Adenomatous polyposis coli (APC) inactivation
3 -18q loss
4 -Tumour protein 53 (TP53) mutation and/or loss
1 - Kirsten RAt Sarcoma virus (KRAS) mutation
- KRAS is a proto-oncogene involved in cell division
- mutation of proto-oncogene into an oncogene gene leads to uncontrolled cell division
Adenoma-carcinoma progress in a stepwise progression from a normal bowel mucosa to an adenomatous polyp and bowel cancer. The development from a later adenoma to a carcinoma is commonly caused by what?
1 - Kirsten RAt Sarcoma virus (KRAS) mutation
2 - Adenomatous polyposis coli (APC) inactivation
3 -18q loss
4 -Tumour protein 53 (TP53) mutation and/or loss
4 -Tumour protein 53 (TP53) mutation and/or loss
- TP53 normally acts as a tumour suppressor
Typically if a patient has a adenoma, which has the potential to become malignant, over what time period could it become malignant and progress to invasive cancer?
1 - 1-2 years
2 - 2-4 years
3 - 5 years
4 - 5-10 years
4 - 5-10 years
- early diagnosis prevents adenomas become adenocarcinomas
Which patients are monitored due to an increased risk of colorectal cancer?
1 - patients with colorectal polyps
2 - patients >65 y/o
3 - patients with previous surgery
4 - patients with >3 risk factors
1 - patients with colorectal polyps
- screened between 1-5 years to monitor polyps
- aspirin 600mg has shown some preventative effects
Why has aspirin at doses of 600mg been used in treatment for patients with colorectal cancer?
1 - inhibits tumour growth
2 - inflammatory effects
3 - induces hypoxia in tumours
4 - all of the above
2 - inflammatory effects
There is a screening programme for colorectal cancer. How do they screen patients?
1 - undertake colonoscopy
2 - laparoscopic surgery
3 - Quantitative Faecal Immunochemical Test (qFIT)
4 - change in bowel habits for >6months
3 - Quantitative Faecal Immunochemical Test (qFIT)
- measures microscopic blood in stool