Colorectal Cancer Flashcards
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
64 cases per 100,000
- 10 year survival is 53%
What age is colorectal cancer rare?
1 - <50
2 - <65
3 - <70
4 - <85
1 - <50
- becomes more common in >50 y/o
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 (specifically Ulcerative colitis)
8 - T2DM
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)
Colorectal cancers can occur anywhere in the GIT, including all of the following. But which is most common?
1 - rectal
2 - sigmoid
3 - descending colon
4 - transverse colon
5 - ascending colon and caecum
1 - rectal
Accounts for 40%, closely followed by the sigmoid and then the caecum
Colon cancer can be sporadic or hereditary. Which is most common?
1 - sporadic
Accounts for 95% of colon cancers
- hereditary non-polyposis colorectal carcinoma (HNPCC, 5%)
- familial adenomatous polyposis (FAP, <1%)
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
adeno” meaning ‘pertaining to a gland’ and “carcinoma” meaning cancer.
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
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 normally suppressor tumour growth
- abnormal APC gene means adenocarcinoma can begin to develop
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
- Loss of the tumour supressor leads to adenocarcinoma growth
Adenoma have 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 - faecal immunochemical test (FIT)
4 - change in bowel habits for >6months
3 - Faecal Immunochemical Test (FIT)
qFIT may be used to quantify the amount of blood rather than just the presence of blood
- measures microscopic blood in stool
Patients who are eligible will have a qFIT every 2 years. What is the current screening age?
1 - 30-40 y/o
2 - 40-60 y/o
3 - 54-74 y/o
4 - >65 y/o
3 - 54-74 y/o
- likely to be reduced to 50 y/o
Which of the following conditions increases the risk of colorectal cancer?
1 - IBS
2 - coeliac disease
3 - IBD
4 - diverticulosis
3 - IBD
- both crohns and ulcerative colitis
A small proportion of colorectal carcinomas can be due to familial inheritance. Polyposis syndromes is where patients develop a large number of polyps early in life, that can then become malignant. Which of the following is the most important?
1 - Familial adenomatous polyposis
2 - MUTYH-associated polyposis
3 - Serrated polyposis syndrome
4 - Peutz-Jeghers syndrome
1 - Familial adenomatous polyposis
- inevitable that patients will develop colon cancer if untreated by 40 y/o
- 100-1000s of polyps form in teens
- subtotal colectomy and/or rectum removal with ileostomy is curative
Autosomal dominant genetic condition, meaning only 1 copy of mutated gene is required
A small proportion of colorectal carcinomas can be due to familial inheritance. Polyposis syndromes is where patients develop a large number of polyps early in life, that can then become malignant. One of these is peutz-jeghers syndrome. Which of the following is NOT a common effect of this syndrome?
1 - polyps in just the colon
2 - freckles around the mouth
3 - freckles on hands, feet and genitls
4 - hyperpigmented macules on the lips
1 - polyps in just the colon
Polyps can form anywhere in the GIT
Peutz Jeghers syndrome (PJS) is an autosomal dominant genetic condition, meaning only 1 copy of mutated gene is required
A small proportion of colorectal carcinomas can be due to familial inheritance. Polyposis syndromes is where patients develop a large number of polyps early in life, that can then become malignant. One of these is hereditary nonpolyposis colorectal cancer (HNPCC) syndrome, also known as Lynch syndrome. Which of the following is NOT true about this syndrome?
1 - defect in mismatch repair gene
2 - 70-80% lifetime risk of colorectal cancer
3 - most common cause of hereditary colorectal (colon) cancer
4 - tumours form anywhere in the GIT
5 - median age is 44-61 y/o
4 - tumours form anywhere in the GIT
- typically occur on the right side of the colon
- if confirmed with HNPCC syndrome then need screening every 2 years after >25y/o
Autosomal dominant genetic condition, meaning only 1 copy of mutated gene is required