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Cancer > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

Arsenic is a carcinogen that increases the risk of developing which type of cancer?

A

Angiosarcoma of the liver
Squamous cell carcinoma of the skin
Lung cancer

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2
Q

Aspergillus (found on peanuts and maize) is a carcinogen that increases the risk of developing which type of cancer?

A

Hepatocellular carcinoma

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3
Q

Nitrosamines (present in smoked foods) are carcinogens that increases the risk of developing which type of cancer?

A

Stomach cancer

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4
Q

Vinyl chloride is a carcinogen that increases the risk of developing which type of cancer?

A

Angiosarcoma of the liver

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5
Q

What is alpha-fetoprotein a tumour marker for?

A

Hepatocellular carcinoma
Hepatoblastoma
Mixed germ cell tumour
Yolk sac tumour

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6
Q

Another cancer caused by APC variant of familial adenomatous polyposis coli?

A

Agressive fibromatosis

Desmoid tumours in abdominal and extrabdominal locations

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7
Q

Single gene causes of colorectal cancer?

A 
Familial adenomatous polyposis coli (FAP) - autosomal dominant
Lynch syndrome (hereditary non-polyposis colorectal cancer) - autosomal dominant
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8
Q

Risk factors for colorectal cancer?

A

Age >50
IBD
Polyposis syndromes - Peutz-Jehgers; Sessile serrated polyposis syndrome; MUTYH-associated polyposis syndrome

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9
Q

Peutz-Jehgers syndrome features:

A 
Harmatomatous polyps (esp in small bowel)
Pigmented lesions on lips, oral mucosa, face, palms and soles
GI bleeding and obstruction
Autosomal dominant, 50% of patients will have died from a different malignant cancer by the time they're 60
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10
Q

Dietary changes to decrease risk of colorectal cancer?

A

More fibre, Ca and garlic
Less red meat, animal fat and alcohol
Isothiocyanates from cruciferous vegetables increase apoptosis in neoplastic cells

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11
Q

Which oncogene allows the progression from hyper-proliferation to adenoma in CRC?

A

KRAS

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12
Q

Amsterdam II criteria for CRC:

A

3 or more relatives with histological verified CRC, endometrium, small bowel, ureter or renal pelvis cancer
Over 2 or more generations
1 has to be a 1st degree relative of another
CRC by age of 50

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13
Q

How do you diagnose Lynch syndrome?

A

Family history
Microsatellite instability (MSI) as screening for MMR genes
Mutational analysis of MMR genes

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14
Q

How do you manage confirmed Lynch syndrome?

A

Colonoscopy every 2 years from the age of 25
75mg aspirin daily as chemoprevention
Standard colonic resection +/- prophylactic resection to prevent metachronous cancer
Colonoscopy every 2 years unless panproctocolectomy and IPAA made

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15
Q

What is IPAA?

A

Ileo-pouch anal anastamosis

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16
Q

What is metachronous colon cancer?

A

A secondary CRC developing over 6 months after the index cancer - happens in 39% of cases

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17
Q

Features of FAP:

A

APC dominant gene mutation causing hundreds of CRC polyps
Malignant transformation occurs at around age 40
Congenital hypertrophy of retinal pigment epithelium (seen with ophthalmoscope)
Desmoid tumour, duodenal polyps/carcinoma
APC variant in 6% Ashkenazi Jews = x2 risk

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18
Q

FAP management:

A

Prophylactic colectomy between 16 and 20 years old
Later on proctocolectomy and IPAA
CT CAP

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19
Q

Worry with GI cancers?

A

Liver metastases through the portal vein

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20
Q

Purpose of MRI of the rectum?

A

Used to assess the necessity for pre-op chemo/RT
Need to see the status of the mesolectal fascia - if the tumour gets through this then it can access the LNs
Therefore may need to shrink the tumour away from the fascia with adjuvants before surgery

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21
Q

Symptoms of CRC?

A

Change in bowel habit - constipation/diarrhoea/straining/frequency
Abd. mass/pain from bowel obstruction
Rectal bleeding
Tiredness from anaemia
Weight loss
Obstructed ureters/fistula formation into stomach/bladder

22
Q

Signs of left sided CRC?

A 
Change in bowel habit
Colicky abdominal pain
Blood coating of the stool
Straining
Mucus PR
23
Q

Signs of right sided CRC?

A 
Less obstruction (more liquid and wider)
Typically present with an iron deficiency anaemia - in this case the patient must have an upper and lower GI endoscopy to exclude gastric and colon cancer
24
Q

What blood tests are ordered for suspected CRC?

A

FBC
U+E
LFTs - check for liver metastases
CEA - carcinoma-embryonic antigen

25
Q

CRC T staging:

A 
T1 = Submucosa
T2 = Muscle layer
T3 = Serosa
T4 = Through serosa
26
Q

CRC N staging:

A 
N0 = No lymph nodes involved
N1 = Involvement of 1-3 lymph nodes close to the bowel
N2 = Involvement of 4 or more nearby lymph nodes
27
Q

CRC M staging:

A 
M0 = No spread to other organs
M1 = Spread to other organs
28
Q

Staging CRC: inner lining/muscle wall

A

Stage 1

29
Q

Staging CRC: T1/2, N0, M0

A

Stage 1

30
Q

Staging CRC: no lymph node involvement

A

Stage 1 or 2

31
Q

Staging CRC: T1-3, N0, M0

A

Stage 2a

32
Q

Staging CRC: T4, N0, M0

A

Stage 2b

33
Q

Staging CRC: T1/2, N1, M0

A

Stage 3a

34
Q

Staging CRC: T3/4, N1, M0

A

Stage 3b

35
Q

Staging CRC: T1-4, N2, M0

A

Stage 3c

36
Q

Staging CRC: T1-4, N1-2, M1

A

Stage 4

37
Q

Duke’ stage A CRC:

A

Submucosa/slightly into the muscle layer

38
Q

Duke’s stage B CRC:

A

Growth into the muscle layer

39
Q

Duke’s stage C CRC:

A

Spread to at least 1 lymph node

40
Q

Duke’s stage D CRC:

A

Distant metastasis e.g. liver/lungs

41
Q

Management of high-risk locally advanced?

A

Pre-operative chemotherapy 6 weeks before

Stage 2 gets adjuvant therapy

42
Q

Management of stage 3 (Duke’s C)?

A

Capecitabine as mono therapy

Oxaliplatin in combination with 5-fluorouracil and folinic acid

43
Q

Which CRCs get adjuvant chemo?

A

All high-risk stage 2s and all stage 3 rectal cancers

44
Q

Chemo therapy for advanced metastatic CRC:

A

FOLFOX then imnotecan
FOLFOX then FOLFIRI
XELOX then FOLFIRI

45
Q

Which mutations are present in 35-40% of patients in colorectal carcinogenesis?

A

KRAS mutations

46
Q

Monoclonal Abs to EGFR in CRC?

A

Cetuximab
Panitumumab
(they prevent signal transduction involving RAS, PI3K-AKT and SRC kinase)

47
Q

Risk of chemotherapy?

A

Infection

Neutropenic sepsis

48
Q

Post resection management?

A

First 2 years regular surveillance - minimum 2 CT scans CAP

Serum CEA 6 monthly

49
Q

Screening programme for CRC:

A

FIT screening for men and women aged 60-74

Flexible sigmoidoscopy for people aged 55

50
Q

Diagnosis of CRC:

A

Colonoscopy is gold standard
Double contrast barium enema
CT colonography

51
Q

What is Gardner syndrome?

A

FAP with demoed tumours and osteomas

52
Q

What is MYH associated polyposis?

A

Autosomal recessive condition with polyps in GI track with somatic KRAS mutations

Cancer (10 decks)

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