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Year 2- GIT > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

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1
Q

What are the risk factors of bowel cancer?

A

-Most are sporadic with no clear influence
-Some are caused by familial risk
-Some caused by genetic conditions
-Underlying IBD

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2
Q

List some of the risk factors for sporadic cases of colorectal cancer.

A

Age
Male
Previous adenocarcinoma
Environmental: diet, obesity, diabetes, smoking, lack of exercise

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3
Q

What do the majority of colorectal cancers arise from?

A

Pre-existing polyps

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4
Q

What are some indications of a high risk polpy?

A

Size
Number of polyps
Degree of dysplasia (abnormal development).
Villous architecture

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5
Q

Describe how adenocarcinomas can develop from epithelium.

A

Activation of oncogenes
Loss of tumour suppressor genes
Defective DNA pathway repair genes

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6
Q

What is the presentation of colorectal cancer?

A

Rectal bleeding- especially mixed in stool
Iron deficiency anaemia
Palpable mass
Weight loss
Altered bowel opening to loose stools >4week

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7
Q

Where would a palpable mass usually be found in those with colorectal cancer?

A

Rectal or right abominable mass

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8
Q

What is the investigation of choice for colorectal cancer?

A

Colonoscopy as allows imaging and biopsies to be taken simultaneously

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9
Q

What are patients often given before colonscopy?

A

Sedation and analgesia as uncomfortable procedure

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10
Q

Which radiological imaging can be used for the investigation of colorectal cancer?

A

Barium enema
CT colonography- imaging of choice

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11
Q

What are some of the disadvantages of radiological imagining in terms of colorectal cancer?

A

Ionising radiation
Bowel preparation
No histology

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12
Q

What are the disadvantages of colonoscopy?

A

Sedation required
Risk of perforation
Bowel preparation

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13
Q

Which imaging technique would be used to help determine staging of cancer in the chest/abdomen/pelvis?

A

CT

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14
Q

Which imaging technique would be used to help determine staging of cancer in the rectum?

A

MRI

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15
Q

What is the main treatment for colorectal cancer?

A

Surgery

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16
Q

What is the management if the cancer has metastases to the liver?

A

Partial hepatectomy

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17
Q

Discuss the chemo/radiotherapy for patients with rectal cancers.

A

Radiotherapy combined with chemo before patient undergoes surgery

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18
Q

In terms of palliative care, what might be given?

A

Chemotherapy
Colonic stenting

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19
Q

Why might colonic stenting be given as a palliative measure?

A

Relieves chronic obstruction

20
Q

How is colorectal cancer getting controlled on a population level?

A

Screening of high risk groups and average high risk population

21
Q

What is the first part of screening for colorectal cancer?

A

Faecal tests- either FIT or FOBT

22
Q

What might happen is someone has signs of colorectal cancer in their screening faecal test?

A

Will undergo colonoscopy

23
Q

Which age group get screened for bowel cancer in Scotland?

A

50-74

24
Q

Which heritable conditions put individuals at higher risk of developing colorectal cancer?

A

FAP (familial adenomatous polyposis)
MAP (MUTYH-associated polyposis)
HNPCC (hereditary nonpolyposis colorectal cancer)

25
Q

Which other groups are considered to have a higher risk and are screened for colorectal cancer?

A

Individuals with IBD
Familiar risk
Previous adenocarcinomas/ colorectal cancer

26
Q

Is FAP autosomal dominant or recessive?

A

Autosomal dominant

27
Q

What happens in FAP?

A

Multiple adenomas develop throughout colon usually in childhood, high risk of malignant changes in 20s

28
Q

How often do those with FAP get screened for colorectal cancer?

A

Every year from the age of approx. 10-12 via colonoscopy

29
Q

There are some extracolonic manifestations of FAP. List some.

A

Benign hyperplastic polyps in stomach.
Duodenal adenocarcinomas.

30
Q

Which tumours may those with FPA also develop?

A

Desmoid tumours

Non-cancerous growths in connective tissue

31
Q

Is MAP autosomal dominant or recessive?

A

Autosomal recessive

32
Q

How is MAP similar to FAP?

A

Polyps develop but tend to be in early adulthood rather than childhood.

33
Q

How often do those with MAP get screened for colorectal cancer?

A

Every year from the ages of 18-20.
Upper GI surveillance may occur from 35yrs.

34
Q

Why may upper GI surveillance occur in those with MAP from 35yrs?

A

Higher risk of duodenal carcinomas

35
Q

Is HNPCC autosomal dominant or recessive?

A

Autosomal dominant

36
Q

What causes HNPCC?

A

Mutation in DNA mismatch repair genes

37
Q

Those with HNPCC also display a condition called microsatellite instability. What does this mean?

A

Frequent mutations in short repeated DNA sequences.

38
Q

How often do those with HNPCC get screened for colorectal cancer?

A

Screening from 25yrs, every 2 years

39
Q

At which other sites could you get cancer relating to HPNCC?

A

Stomach
Pancreas
Endometrium
Genitoruinary

40
Q

How often are those with a family history of colorectal cancer offered screening?

A

High risk- colonoscopy every 5yrs from age of 50

Low risk- one colonoscopy at 55yrs

41
Q

How often are those with a IBD offered screening?

A

10 years after diagnosis, then depends on duration and extend of inflammation.

42
Q

How often are those with a history of colorectal cancer offered screening?

A

Colonoscopy one year after surgery and then every three years

43
Q

How often are those with previous adenocarcinomas offered screening?

A

Depends on number of polyps, size and degree of dysplasia

44
Q

Undetectable levels of what could be a good rule out test for significant bowel disease?

A

Undetectable levels of faecal haemoglobin

45
Q
A

Year 2- GIT (37 decks)

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