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GI > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Colorectal Neoplasia Naming

A 
Benign = Adenoma 
Malignant = Adenocarcinoma
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2
Q

Types of Colorectal Polyps

A

Inflammatory
Hamartomatous
Metaplastic
Neoplastic (adenoma)

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3
Q

Adenoma - Carcinoma Sequence

A

The bigger the adenoma, the greater the risk of it developing cancer
APC is generally the first mutation (found in nearly all colorectal cancers)
Generally, then Kras, p53 and 18q

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4
Q

Genes Associated with Cancer

A

Oncogenes = Mutation causes gain of function. Excess cell growth and division
Tumour Supressor Genes = Mutation causes loss of function. Does not suppress cell growth and division

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5
Q

Pathology - Macroscopic Appearance

A

Polypoidal
Ulcerative
Annular

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6
Q

Common Sites of Colorectal Cancer

A 
Commonly Rectum 
Sigmoid Colon 
Caecum 
Transverse Colon 
Rarely Descending Colon
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7
Q

Histology - Adenomas

A 
Tubular = Predominantly tubular are unlikely to be malignant 
Villous = Predominantly violas are more likely to be malignant
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8
Q

Histology - Adenocarcinoma

A

Well differentiated = Lots of intracellular mucus
Moderately differentiated = Virtually lost all intracellular mucus
Poorly differentiated = Strands of highly undifferentiated cells

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9
Q

Dukes Staging

A 
A = Cancer has not invaded through the muscle layer 
B = Cancer has invaded all the way through the muscle layer 
C = Lymph node invasion 
D = Distant metastases
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10
Q

Spread of Colorectal Cancer

A 
Local = Adjacent structures
Lymphatic = Pericolic or perivascular nodes 
Blood = Liver or lungs (MOST COMMON SITES)
Transcoleomic = Peritoneal cavity
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11
Q

Lifestyle Factors

A

Protective =
EXERCISE
Vegetables
Fibre

Causative = 
OBESITY 
Red and processed meat 
Smoking 
Alcohol
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12
Q

Autosomal Dominant Inheritance

A

FAP =
Mutation in APC gene
Many many many adenomas

HNPCC =
Mutation in DNA mismatch repair

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13
Q

Predisposing Conditions

A

Adenomatous polyps
Ulcerative Colitis
Crohn’s Disease

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14
Q

Symptoms

A

Dependent on site
Generally larger tumours are more symptomatic

Rectal =
PR bleeding
Tenesmus

Sigmoid =
Pain
Change of bowel habit
PR bleeding

Caecum =
Anaemia

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15
Q

Clinical Findings

A

General =
Anaemia
Cachexia
Lymphadenopathy

Abdomen =
Mass
Hepatomegaly
Distension

Rectum =
Mass
Blood

NOTE = In most patients, you will not find any of these signs. If you do, they probably have advanced disease

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16
Q

Diagnosis of Primary Disease

A

Barium enema = sometimes isn’t very effective and shows very little
CT colography = gives much better definition
Sigmoidoscopy or Colonoscopy = GOLD STANDARD. Can see and biopsy the tumour

17
Q

Faecal Occult Blood Testing

A

Guaiac = Turns blue in presence of blood

Immunochemical = Tests for presence and quantity of blood

Used in screening at lower sensitivity

18
Q

Colorectal Cancer Screening

A

Participation = 30% reduction in death

No blood = negligible chance of colorectal cancer

19
Q

Staging Investigations

A

CT - Lungs and Liver

MRI - Primary rectal cancer

20
Q

Emergency Presentation

A

Obstruction = distension, constipation, pain, vomiting
Bleeding
Perforation

21
Q

Treatment of Obstruction

A

Colostomy
Resection + colostomy
Resection + anastomosis
Stenting

22
Q

Treatment

A

Surgery
Radiotherapy
Chemotherapy

23
Q

Surgery for Colonic Cancer

A

Take out the affected part
E.g. right hemicolectomy, transverse colectomy, subtotal colectomy etc.
You must also removed all the draining lymph nodes

24
Q

Surgery for Rectal Cancer

A

Abdomino-perineal excision = Leaves part of the rectum

Anterior resection = Rectum is removed and an ileostomy required

25
Q

Radiotherapy for Rectal Cancer

A

Adjuvant =
Pre or post operative
Reduced local recurrence after rectal excision

Palliative =
Inoperable primary rectal cancer
Recurrent rectal cancer

26
Q

Chemotherapy for Colorectal Cancer

A

Adjuvant for Stage C

For advanced disease

27
Q

Keys to Improved Survival

A 
Prevention = diet and lifestyle
Early detection = heightened awareness and screening 
High quality surgery 
Appropriate use of RT and chemo 
New agents for advanced disease

GI (24 decks)

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