Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

FAP

FAP definition (1)

Where else can FAP be seen? (3)

Risk of developing colorectal cancer with FAP?

A

> 100 polyps (colon)

Duodenum, pancreas and stomach

Colon ca. risk: 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

FAP :Familial adenomatous polyposis

Surveillance guideline for FAP? (3)

A
  • Yearly colonoscopy for at-risk family members from 12 years old onwards till 25-40 years old if negative
  • 5-yearly OGD for periampullary cancer (25-30 y/o)
  • Subtotal colectomy: treatment option if rectum is spared of polyps
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

FAP

What are the types of histological diagnosis polyps? (3)

Patient with Villous adenoma symptoms? (3)

A
  • Tubular
  • Tubulo-villous
  • Villous
  • secretory diarrhea –> *HypoK+
  • Mucous discharge
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

FAP

Management of FAP (3)

A

1) Colectomy with ileorectal anastomoses
2) Restorative proctocolectomy with ileal-anal pouch anastomosis (temporary stoma)
3) Total proctectomy and end ileostomy [Compromise sexual function]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

HNPCC Lynch syndrome

What type of inheritance? (1)

Increases the risk of Colon ca. and other cancers which are? (4)

What is the lifetime risk of developing CRC? (1)

How to diagnose HNPCC?

A

Autosomal dominant

-Endometrial cancer
- Ovarian cancer
- Stomach cancer
- Small bowel cancer

80%

Genetic testing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the Modified Amsterdam criteria? (5)

What is the Bethesda criteria? (5)

A

At least 3 relatives with HNPCC-associated cancer (colon, endometrium, small bowel, ureter, renal pelvis) and ALL of the following:

  • One affected person is a first-degree relative of the other two affected persons
  • 2 successive generations affected
  • At least one case of cancer diagnosed before age 50 years
  • FAP excluded

The Amsterdam criteria or one of the following:
- 2 cases of HNPCC-associated cancer in one patient
- Colon cancer and a first degree relative with HNPCC- associated cancer and/or colonic adenoma (cancer before 45 y/o, adenoma before 40 y/o)
- Colon or endometrial cancer diagnosed before 45 years
- Right-sided colon cancer that has an undifferentiated pattern or signet-cell HPE (<45 y/o)
- Adenomas diagnosed <40 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the Differential diagnosis of colonic masses?

Benign (11)

Malignant lesions (5)

A

Benign:

  • Crohn colitis
  • Diverticulitis
  • Endometriosis
  • Solitary rectal ulcer
  • Lipoma
  • Tuberculosis
  • Amebiasis
  • CMV
  • Fungal infection
  • Nematode infection
  • Extrinsic lesion

Malignant:
- Adenocarcinoma
- Lymphoma
- Carcinoid tumor
- Kaposi sarcoma (AIDS)
- Prostate cancer (rare: Dr Ahmad)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Colon carcinoma

What are the four common macroscopic varieties of colon ca? (4)

A

1) Annular
2) Tubular
3) Ulcer
4) Cauliflower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the 5 Polyposis syndromes?

A

FAP
HNPCC
MYH associated polyposis
Peutx-Jeghers syndrome
Cowden disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the genetic defect in:

1) FAP?
2) HNPCC?

A

1) APC gene
2) Germline mutations of DNA mismatch repair genes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the sequence of adenomatous polyps to colorectal cancer? (3)

A
  • APC gene mutation (in 2/3 of cases)
    KRAS mutation
    -p53 mutation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors of colorectal cancer?

What is the protective factor against CRC?

A

Intake of red meat and processed meat products
Advanced age
Family history or CRC
History of Polyposis syndromes (FAP, HNPCC)

Dietary fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Most common site for CRC?

A
  • Left colon more affected than the right
    Rectosigmoid in 50% of cases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 4 metastatic spread of CRC?

A

1) Local invasion
Longitudinal and radical
Radical: Ureter. duodenum, Retroperitoneal structures

2) LN

3) haematogenous spread: Liver mets, Lung (2nd common), Others; ovary, brain and kidney

4) Transcoelemic: Peritoneum, Ovary, omentum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is transcoelomic spread?

A

Transcoelomic spread refers to a route of tumor metastasis across a body cavity, such as the peritoneal cavity.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common presenting complaint of CRC?

A

Altered bowel habit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Rectal cancer (lower rectum) most commonly mets to lungs.

How does this occur? (explain venous drainage)

A

Venous drainage of lower* rectum is through the hemorrhoidal veins to the vena cava, bypassing the liver.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Red flags of CRC signs and symptoms? (4)

A

Abdominal pain
Per rectal bleeding
Diarrhea
Iron deficiency anemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Right colon symptoms:
- Obstruction is a late event (T/F)
- Bleeding is occult (T/F)
- Anemic symptoms (T/F) Fatigue and weakness
- No abdominal mass (T/F)

A

True
True
True (others: palpitations, syncope, dizziness, reduced effort tolerance, paler than usual)
False. Abdominal mass in the form of a tumor growing large may be palpable in the right colon

20
Q

Left Colon Symptoms:

  • Obstruction is an early event. (T/F)
  • Partial obstruction with colicky abdominal pain or complete obstruction may be the initial manifestation. (T/F)
  • Stool streaked or mixed with blood. (T/F)
  • Perforation (Walled off) (T/F)
A

True
True
True
True. perforation is focal pain and tenderness as a S/S

21
Q

Rectal Ca symptoms:

Bleeding with defecation (T/F)
Can occur in the presence of:
Hemorrhoids (T/F)
Diverticular disease (T/F)
Tenesmus (T/F)
May have:
rectovaginal fistula (T/F)
Rectovesicle fistula (T/F)

A

True
True
True
True
True
True

22
Q

What are the diagnostic and investigations for colorectal cancer? (3)

A

Colonoscopic biopsy to visualize the colon for lesions and synchronous lesions (<6 months) and to biopsy the lesion for HPE

  • CT TAP to evaluate the extent of tumour growth and spread (locally advanced)
  • Genetic testing (<45 years old case): APC, HNPCC (Lynch syndrome)
23
Q

Tumor markers used in CRC

A

CEA (used to detect recurrence)
CA 19-9
CA 125

24
Q

T staging of CRC (4)

A

T1: into submucosa
T2: Muscularis propria
T3: pericolic fat
T4: Breaks serosa

25
Q

N staging of CRC (3)

A

N0: No nodes
N1: 1-3 nodes
N2: >= 4 nodes

26
Q

Metastases (M)

A

M0= No mets
M1= Mets

27
Q

Surgical methods for colorectal cancer (4)

A

Right hemicolectomy–> Extended Right hemicolectomy

Left hemicolectomy

Laparoscopic surgery

Emergency surgery

28
Q

Emergency surgery of CRC (3)

A

R sided lesion: R hemicolectomy & anastomosis

Perforation with substantial contamination: ileocolostomy

L sided lesion: Hartmann’s OR resection and anastomosis

29
Q

Complications of postoperative period for CRC

A

Wound infection (10%)

Anastomotic leak (4-8%)

30
Q

Management of metastatic disease (3)

A

Liver mets can be resected
Do not biopsy resectable Hepatic mets –> seeding
Palliation: Palliative chemotherapy

31
Q

Vessels in colorectal surgery

Arteries removed in R hemicolectomy (3)

A

ileocolic
right colic
right branch of middle colic vessels

32
Q

Vessels in colorectal surgery

Vessels removed in L hemicolectomy (3)

A

left branch of the middle colic vessels
Inferior mesenteric vein
Left colic vessels

33
Q

Vessels in colorectal surgery

Vessels in sigmoidocolectomy. (1)

A

IMA is fully dissected out

34
Q

Anterior resection

More than or less than 5 cm from anus?

A

More than 5 cm

35
Q

APR

More than or less than 5 cm from anus?

A

Less than 5cm

36
Q

When is Hartmann’s procedure used?
What are the two indications?
Describe Hartmann’s procedure (3)

A
  • Emergency bowel surgery
  • Bowel obstruction or perforation
  • complete resection of the recto-sigmoid colon
  • End colostomy
  • Closure of rectal stump
37
Q

Chemotherapy indication?

A
  • Locally advanced disease
  • If high-risk stage 2
  • Node positive patients (stage 3 )
38
Q

Chemotherapy ALONE only used of colon cancer.

What are the two regimens and their content? (3 each)

A

FOLFOX regimen
Folinic acid, Fluorouracil, oxaliplatin

FOLFIRI regimen
Folinic acid, Fluorouracil, irinotecan

39
Q

When is radiotherapy used in Colorectal cancer?

A

ONLY in rectal cancer
And is used in conjunction with Chemotherapy
known as
CCRT: concurrent chemoradiotherapy

40
Q

How many cm is the anal canal? (range)

A

2-4 cm

41
Q

The surgical option based on the location of the rectal cancer in relation to the dentate line:
- within 3 cm?
- greater than 3 cm?

A
  • Abdominoperineal resection (APR)
  • Low anterior resection
42
Q

High risk features of stage II colon ca? (7)

A
  • Obstruction
  • Perforation
  • T4 disease
  • Poorly differentiated tumor
  • Lymphovascular invasion
  • Perinueral invasion
  • Inadequate LN samping (<12))
  • Young age
43
Q

Surveillance modalities for CRC? (3)

A
  • CEA
  • Colonscopy
  • CECT TAP (stage 2 high risk and stage 3 only)
44
Q

CEA surveillance timeline

A

CEA
Every 3 months for the first 2 years
Every 6 months for the following 3 years
Every year for the next 5 years

45
Q

Colonoscopy surveillance timeline

A

1 year post-op
3rd year
5th year

If initial colonoscopy workup cannot visualize whole colon due to obstruction, repeat within 6 months to detect synchronous lesion (<6 months)

Surgery (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions