Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Gen Surgery > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Describe the adenoma- carcinoma sequence

A

Sequence of changes from normal mucosa to hyper- proliferative mucosa to adenoma and eventually to carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Incidence of adenomatous polyps and colorectal cancer in the general population

A

Polyps: 20 % in post mortem studies

Colorectal cancer: 5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which polyps are high risk

A
  • Large polyps > 1 cm
  • villous lesions
  • sessile lesions
  • high grade dysplasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most common region for polyps

A

Recto sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What parameters are used for the aetiology of colorectal cancer

A
  • dietary parameters
  • physical parameters
  • inflammatory bowel disease
  • familial risks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What diets are associated with increased risk of colorectal cancer

A
  • high amounts of animal fat and meat
  • substitution of fish and poultry is thought to reduce risk
  • high intake of dietary fiber has been associated with a reduction in risk of colorectal cancer, maximum benefit is from wheat bran and cellulose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Physical parameters increasing the risk of colorectal cancer

A
  • obesity –> increased insulin and insulin growth factor –> adenoma formation
  • exercise is thought to be protective
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which are the hereditary cancers

A
  • familial adenomatous polyposis
  • attenuated FAP
  • Lynch syndrome
  • MUYTH associated polyposis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

FAP is an autosomal dominant condition, where is the genetic defect

A
  • chromosome 5 (APC gene)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When do patients with FAP manifest with disease

A
  • manifest with polyps on teenage years

- Onset of cancer in fourth decade

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Gardener’s syndrome (FAP)

A

Patients afflicted with colonic polyposis and extra intestinal manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is turcot’s syndrome

A
  • polyposis in combination with brain tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When do patients with attenuated FAP present

A
  • most patients present with polyps in the 4th to 5th decade
  • cancer diagnosed after 6th decade
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the lifetime risk of colorectal cancer in a patient with Lynch syndrome? What criteria are used to identify those at risk

A
  • 80%

- Amsterdam criteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Is MUYTH associated polyposis autosomal dominant or recessive

A

Recessive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the risk of colorectal cancer in a patient with IBD before and after 20 years duration of the condition

A
  • less than 20: 5 %

- at 20 years: 10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are additional risk factors for colorectal cancer in patients with IBD

A
  • greater extent of the disease
  • evidence of mucosal dysplasia
  • sclerosing cholangitis family history of cancer
  • early onset IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If blood in the stool is found what is usually the next investigation

A

Colonoscopy

19
Q

When should first degree relatives of cancer patients have a colonoscopy

A

10 years prior to the age of onset of disease in the affected relative

20
Q

What percentage of colorectal cancers are recto sigmoid tumours

A

50-60%

21
Q

Presentation of rectal tumour?

A
  • bloody or mucoid discharge from the anus, alteration in bowel habit with/out tenesmus
  • if presentation was delayed: features of obstructive symptoms and perianal pain
  • discrete mass palpable on digital rectal exam
22
Q

How do left sided colonic tumours present

A
  • Intermittent constipation or diarrhea or both
  • passage of blood per rectum may be reported
  • weight loss
  • delayed presentation: palpable mass or symptoms and signs of large bowel obstruction
23
Q

How do right sided colonic tumours present

A
  • unexplained anaemia and/or weight loss
  • occult faecal blood
  • advanced: abdominal mass
  • non specific pain
24
Q

What is the gold standard test for diagnosing colorectal carcinoma

A

Colonoscopy

25
Q

What information can a barium enema give when investigating colon cancer

A
  • characterize tumour somewhat

- rule out synchronous lesions

26
Q

Which is the most frequently involved organ in metastatic colon cancer

A

Liver

27
Q

What is the gold standard investigation for staging of colorectal cancers

A

CT scan (chest, abdomen and pelvis)

28
Q

What local features is one looking for on CT scan

A
  • size and location of primary tumour and depth of invasion
  • involvement of any adjacent organs or structures
  • presence of any surrounding lymph nodes
29
Q

Metastatic features on CT scan

A
  • Opacities in liver, lung or bone
  • ascites
  • pleural effusion
30
Q

Which cancer is MRI scan reserved for

A

Assessment of rectal tumours

31
Q

If CT scans are inconclusive which investigation should be done to look for metastases

A

PET scanning

32
Q

What is the management of metastatic disease

A

Chemotherapeutic and or radiotherapy with surgery being reserved for emergency situations (impending or established obstruction, perforation)

33
Q

Management of tumour that is locally advanced and not amenable to curative resection

A

Neoadjuvant chemotherapy and or radiotherapy can be considered to help downstage the tumour rendering it resectable

34
Q

Post resection what factors need to be assessed

A
  • completeness of surgical excision
  • adequateness of resection: lymph node yield
  • features of advanced disease/ spread
  • tumour characteristics
  • depth of invasion
35
Q

What are surgical options for colorectal cancer

A
  • right hemi colectomy
  • left Hemi colectomy
  • sigmoid colectomy
  • anterior resection and abdomino- perineal resection
36
Q

What is removed in a right hemicolectomy

A
  • removal of the caecum, ascending colon, proximal transverse colon and includes the iliocaecal valve with short segment of terminal ileum
  • extent of resection is determined by blood supply of the right colic artery
37
Q

What is removed in a left hemi- colectomy

A
  • removal of distal transverse colon down to the end of the descending colon
  • extent determined by blood supply of left colic artery
38
Q

Alternative ls to anastomosis in left hemi colectomy

A
  • end to end anastomosis with a diverting atoms proximal to anastomostic site
  • Hartmanns colostomy: proximal stoma –> end stoma
39
Q

What is an anterior resection

A

Removal of upper part of the rectum for tumours involving the upper and middle thirds of the rectum. Preservation of the anal sphincter complex

40
Q

What is stage one colorectal disease

A
  • tumours classified as T1 or T2 with no evidence of lymph node involvement
41
Q

What is stage two colorectal cancer

A

Correlates with T3 or T4 with no lymph node involvement

42
Q

What is stage 3 colorectal cancer

A

Highlights involvement of lymph nodes

43
Q

Factors which confer a poorer prognosis to patients post surgery for colorectal cancer

A
  • tumor present at surgical margins
  • obstructed tumor at presentation
  • poorly differentiated tumour
  • inadequate lymph node yield
  • perineural invasion
  • peritoneal deposits/ micrometastases
44
Q

What investigation is done for surveillance/ follow up of patients after treatment of colorectal cancer

A
  • Serial carcino embryonic antigen measurements

- colonoscopy at 6m, 1 yr, 3 yrs and 5 yrs following surgery and at 5 - 10 year intervals thereafter

Gen Surgery (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions