Colorectal cancer

Question 1

List the two types of polyps with malignant potential

Answer 1

adenomatous

serrated

Question 2

Serrated polyps are more associated with mutations in ________

Answer 2

DNA mismatch repaire and BRAF

Question 3

What is the first gene mutation in the sequence from normal–> adenoma–> carcinoma

Answer 3

APC- initiating event for 80% of sporadic colorectal carcinoma

Question 4

APC protein normally binds _____ and targets it for destruction

Answer 4

B catenin

Question 5

When APC is mutated, B catenin accumulates, translocates to the nucleus, and causes ________

Answer 5

increased proliferation

Question 6

What is the key mutation in FAP?

Answer 6

APC

Question 7

List genes that are mutated later in the adenoma to carcinoma sequence?

Answer 7

KRAS, DCC, TP53

Question 8

What is the key mutation in HNPCC

Answer 8

inactivation of DNA mismatch repair genes (MLH1, MSH2) leading to microsatellite instability

Question 9

List risk factors for colorectal cancer

Answer 9

family history
IBD
diet
sedentary lifestyle
race
cigarettes/ alcohol

Question 10

List tests that detect cancer but not polyps

Answer 10

Guaiac based Fecal occult blood test (gFOBT) - yearly
Immunochemical based Fecal occult blood test (iFOBT) - yearly
Cologuard - every 3 years

Question 11

List tests that detect polyps and cancer

Answer 11

Flexible Sigmoidoscopy every 5 years
Colonoscopy every 10 years
Barium enema every 5 years
CT colonography every 5 years

Question 12

Compare the presentation of right vs left colon cancers

Answer 12

Right: occult bleeding, anemia
Left: colonic obstruction, change in bowel habits

Question 13

List presenting complaints of rectal cancer

Answer 13

bleeding
changes in stool caliber
back or sacral pain
tenesmus

Question 14

_____ is not diagnostic for colon cancer but is important for following lesions over time

Answer 14

CEA

Question 15

______ is critical for pre-operative assessment of metastatic disease

Answer 15

CT of chest, abdomen, pelvis

Question 16

______ is a mandatory part of staging of rectal cancer because it allows for assessment of tumor depth, and helps guide treatment approach

Answer 16

trans-rectal ultrasound

Question 17

Colon cancer most often metastasizes to _____

Answer 17

liver

Question 18

Rectal cancer most often metastasizes to

Answer 18

lungs or liver

Question 19

What is the surgical approach for localized colon cancer ?

Answer 19

resection (usually hemicolectomy) with removal of tumors lymphovascular drainage basin

Question 20

Most patients with stage III colon cancer are offered adjuvant chemotherapy with _____

Answer 20

FOLFOX, 5-FU, leucovorin, oxaliplatin

Question 21

There is a benefit to ___________ treatment for stage II or III rectal cancers

Answer 21

neoadjuvant chemoradiation

Question 22

List two surgical approaches to rectal cancer

Answer 22

LAR: low anterior resection, used for tumors in the upper 1/3 of the rectum. sphincter sparing

APR: abdomino-perineal resection, used for lower tumors. not sphincter sparing- permanent colostomy

Question 23

True or false: some metastatic colon cancers are curable

Answer 23

true- if single metastasis to liver that can be adequately resected

Question 24

Cetuximab and panitumumab are _____________ antibodies

Answer 24

epidermal growth factor receptor

Question 25

Bevacizumab is a ___________ antibody

Answer 25

VEG-F