Colorectal Cancer Flashcards by Rafael Gutierrez

Where does colorectal cancer start?

Colon or rectum

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1 in how many will develop colorectal cancer?

1 : 20

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What gender is more at risk?

Men

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Most common over what age?

Incidence rises with increasing age

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Nearly all of colorectal start of as?

Polyps

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What are polyps?

Small vascular growths on the mucous membrane (in the glandular tissue of intestinal lining)

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Where do most tumors develop ?

Sigmoid colon or rectum

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What are hyperplastic polyps?

Generally harmless, small

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What are adenomatous polyps?

Common: small tumor of epithelial tissue

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What does most colorectal cancer from from?

Adenomatous — > Adenocarcinomas

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What are polypsosis syndromes?

Hereditary conditions which cause polyps
Usually rare, occurs in young people
High chance of becoming cancerous

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What are some risk factors of colorectal cancer?

Personal or family history of colorectal cancer, polypsosis disorders, inflammatory bowel disease
Age >50
Smoking
Obesity
Alcohol
Radiation exposure
Diets high in calories, fats, and meat proteins
Presence of anaerobic gut bacteria

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What is key in prevention of colorectal cancer?

Screening

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For individuals over 50, what should they do for prevention?

Yearly fecal occult blood test
Stool DNA test
Flexible Sigmoidoscopy every 5 year
Double contrast barium enema every 5 years
Colonoscopy every 10 years
CT colonography every 5 years
*MAY reduce incidence: exercise, MVI, aspirin, NSAIDS

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What is the initial manifestation to seek care?

Rectal bleeding

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Clinical manifestations of colorectal cancer?

Changes in bowel habits 
Pain 
Anorexia/weight loss
Abdominal mass
Fatigue 
Anemia

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What are some diagnostic tools/tests used for colorectal cancer?

Endoscopy (Full colonoscopy better than sigmoidoscopy- can detect 50-65%)
Biopsy of tissue
Fecal blood tests
CBC
Carcinoembryonic Antigen (CEA)

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What can CEA be used for?

Monitor course of treatment, prognosis

*Detect possible areas of metastasis

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TNM Staging system: Colorectal Cancer

T is for what?

How far a tumor has grown into the intestinal wall and whether it has grown into nearby areas

TNM Staging system: Colorectal Cancer

N is for what?

The extent to nearby (regional) lymph nodes

TNM Staging system: Colorectal Cancer

M is for what?

Whether the cancer has spread (metasized) to other organs of the body (most common in colorectal cancer- liver and lungs)

What is a “treatment of choice” for colorectal cancer?

Surgical resection (w/ anastomosis) of tumor, adjacent colon and regional lymph node

What are some medical treatments for colorectal cancer?

Surgical resection
Excision of tumor (sometimes done during endoscopy)
Laser photocoagulation
Abdominal resection with permanent colostomy
Fulguration
Chemo and EBR (post-op typically)
Brachytherapy

What is laser photocoagulation?

Beam of light to generate heat, destroys small tumors, palliative-obstructions

In abdominal resection with permanent colostomy, what wants to be preserved and avoided?

Attempt to preserve anal sphincter and avoid colostomy

What is fulguration?

Uses electrical current to kill cancer tissue similar to cauterization

In a bowel resection, what is removed?

All or part of large intestine

For what type of patients is bowel resection used?

Patients with early stage tumors | High cure rate

Bowel resection often leads to what?

Creation of a colostomy (can be either permanent or temporary depending on factors)

What are the two types of bowel resection?

Open and laparascopic

What chemo drugs are usually used with colorectal cancer?

``` Fluorouracil (5-FU) Folonic Acid (Leucovorin) ```

How are the chemo drugs usually given?

IV | sometimes topically

What are the side effects of Flurouracil and Folonic Acid?

``` N/V Diarrhea Alopecia Photosensitivity Cardiotoxicity CNS Damage ```

Fluorouracil is usually combined with what other therapy?

Radiation

What is a sigmoid colostomy?

Most common: permanent: Cancer of the rectum

A double barrel colostomy has what kinds of stomas? | Objective?

- Distal stoma- colon is bypassed expels mucus | - Proximal stoma- functional, diverts feces to abdominal wall

Colostomy: | Transverse Loop

Emergency to relieve obstruction or address perforation: | Temporary

Colostomy: | Hartman Procedure

Temporary Distal portion left in place and oversewn for closure Follow up 3-6 months with reanastamosis Usually for trauma

What should included in the ostomy education?

- Promote quality of life "live your life" - Monitor medications (changes in bowel habits) - Well-balanced diet (avoid certain foods) - Colostomy irrigation (enema through stoma)

What should be included in ostomy care?

- Clean with soap and water, pat dry - Post-op, watch for incision - Check for leaks - Cut wafer slightly larger than stoma - Stoma paste-various products - Bag "burp" if full of gas

What should be emphasized on patient education with colorectal cancer?

Screening

What is the survival rate for people with stage 1?

5 year rate of 74-90%

How does colon cancer spread throughout?

Direct extension of the entire bowel, circumference, submucosa and outer bowel walls, neighboring structures

What is another name of Lynch syndrome?

Hereditary nonpolyposis

What is lynch syndrome?

Autosomal dominant disorder | Increase occurrence of all cancers

What is the indicator that the bag is working?

Bag "burp" if full of gas