Colorectal Cancer Flashcards
almost all cases of colorectal cancer involve _______
adenocarcinomas
what do adenocarcinomas originate from?
polyps
what are the risk factors for colorectal cancer? (5)
age > 45
FHx of colon cancer / adenomatous polyps
IBD
fat + red meat diet
alcohol
a patient presents with chronic blood loss, fatigue, dyspnea on exertion, and pallor. where is the lesion?
right side
a patient presents with bowel changes/obstruction + pencil stools. where is the lesion?
left side
what do rectal cancers often present with? (3)
fecal urgency
tenesmus
hematochezia
what 2 signs signify metastases?
hepatomegaly
abdominal mass
what labs will indicate metastasis to liver? (2)
elevated ALT/AST
elevated Alk Phos
what lab tracks prognosis of colorectal cancer after surgery?
CEA
what CEA level indicates a poor prognosis?
> 5
what is the diagnostic of choice for colorectal cancer?
colonoscopy
what diagnostic is used to stage colorectal cancer?
CT chest + abdomen/pelvis
what is the treatment of choice for colorectal cancer?
surgical resection
+/- chemo and radiation
what diagnostic is used to assess the depth of cancer penetration into the tissues and lymph nodes? (2)
MRI or endorectal U/S
what is the palliative care of colorectal cancer?
chemo + radiation
what is the treatment for node-negative malignancy?
resection
what is the treatment for node-positive malignancy?
resection + chemo
what is the treatment for metastatic disease?
surgical resection
what is the f/u post-resection?
labs q 3-6 months x 2 years
THEN q 6 months x 5 years
what is the CT f/u for a non-terminal patient?
CT chest, abd, pelvis annually x 5 years
what is the f/u if patient had colonoscopy prior to resection?
repeat 1 year post-op
what is the f/u if patient did not have colonoscopy prior to resection?
colonoscopy 3-6 months post-op
if the 1st colonoscopy is neg for polyps post-op, repeat q _____ years
3-5
what do new symptoms or increase in CEA require?
CT scan + colonoscopy
what is the screening for average-risk individuals 45 years or older? (6)
AT LEAST 1:
annual FOBT
annual FIT
FIT-DNA q 1-3 years
flexible sigmoidoscopy q 5 years +/- FIT
colonoscopy q 10 years
CT colonography q 5 years
what is the screening for a patient that has a single first-degree relative with colorectal cancer diagnosed at 60 years or older? (2)
begin at 40 yo
preferred colonoscopy q 10 years
what is the screening for a patient with a single first-degree relative with colorectal cancer or advanced adenoma diagnosed younger than 60, or two first-degree relatives diagnosed older than 60?
begin at 40 yo OR 10 years younger than diagnosis age of relative
colonoscopy q 5 years
what may decrease the risk of polyps in high-risk patients and those with history of polyps? (2)
NSAIDs
COX-2 inhibitors
