Colorectal Cancer

Question 1

almost all cases of colorectal cancer involve _______

Answer 1

adenocarcinomas

Question 2

what do adenocarcinomas originate from?

Answer 2

polyps

Question 3

what are the risk factors for colorectal cancer? (5)

Answer 3

age > 45
FHx of colon cancer / adenomatous polyps
IBD
fat + red meat diet
alcohol

Question 4

a patient presents with chronic blood loss, fatigue, dyspnea on exertion, and pallor. where is the lesion?

Answer 4

right side

Question 5

a patient presents with bowel changes/obstruction + pencil stools. where is the lesion?

Answer 5

left side

Question 6

what do rectal cancers often present with? (3)

Answer 6

fecal urgency
tenesmus
hematochezia

Question 7

what 2 signs signify metastases?

Answer 7

hepatomegaly
abdominal mass

Question 8

what labs will indicate metastasis to liver? (2)

Answer 8

elevated ALT/AST
elevated Alk Phos

Question 9

what lab tracks prognosis of colorectal cancer after surgery?

Answer 9

CEA

Question 10

what CEA level indicates a poor prognosis?

Answer 10

> 5

Question 11

what is the diagnostic of choice for colorectal cancer?

Answer 11

colonoscopy

Question 12

what diagnostic is used to stage colorectal cancer?

Answer 12

CT chest + abdomen/pelvis

Question 13

what is the treatment of choice for colorectal cancer?

Answer 13

surgical resection

+/- chemo and radiation

Question 13

what diagnostic is used to assess the depth of cancer penetration into the tissues and lymph nodes? (2)

Answer 13

MRI or endorectal U/S

Question 14

what is the palliative care of colorectal cancer?

Answer 14

chemo + radiation

Question 15

what is the treatment for node-negative malignancy?

Answer 15

resection

Question 16

what is the treatment for node-positive malignancy?

Answer 16

resection + chemo

Question 17

what is the treatment for metastatic disease?

Answer 17

surgical resection

Question 18

what is the f/u post-resection?

Answer 18

labs q 3-6 months x 2 years
THEN q 6 months x 5 years

Question 19

what is the CT f/u for a non-terminal patient?

Answer 19

CT chest, abd, pelvis annually x 5 years

Question 20

what is the f/u if patient had colonoscopy prior to resection?

Answer 20

repeat 1 year post-op

Question 21

what is the f/u if patient did not have colonoscopy prior to resection?

Answer 21

colonoscopy 3-6 months post-op

Question 22

if the 1st colonoscopy is neg for polyps post-op, repeat q _____ years

Answer 22

3-5

Question 23

what do new symptoms or increase in CEA require?

Answer 23

CT scan + colonoscopy

Question 24

what is the screening for average-risk individuals 45 years or older? (6)

Answer 24

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

Question 25

what is the screening for a patient that has a single first-degree relative with colorectal cancer diagnosed at 60 years or older? (2)

Answer 25

begin at 40 yo
preferred colonoscopy q 10 years

Question 26

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?

Answer 26

begin at 40 yo OR 10 years younger than diagnosis age of relative

colonoscopy q 5 years

Question 27

what may decrease the risk of polyps in high-risk patients and those with history of polyps? (2)

Answer 27

NSAIDs
COX-2 inhibitors