colorectal cancer Flashcards

1
Q

what is the most common malignancy in the gastrointestinal tract ?

A

colorectal cancer

third most common cancer of all

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2
Q

when is the peak incidence of CRC?

A

70 years

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3
Q

what are the types colorectal carcinomas ?

A

adenocarcinoma - 95 recent

carcinoid tumors - specialised hormone producing cells in intestine

GIST - intestinal cells of CAJAL
GIST are most usually in the colon

lymphomas

sarcoma - muscle and connective tissue of the wall of colon and rectum
very rare

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4
Q

what is the etiology of CRC ?

A

exogenous
smoking
obesity
red meat and animal fat

ulcerative colitis (sometime chrons disease)

colorectal adenoma

familial adenomatous polyposisi - by 20 age almost all have colorectal cancer

peutz jeghers syndrome

heridtory non polposi colon cancer / lynch syndrome (short interval to malignancy 2 years where normal 10-15 years)

hamartomatous syndromes

endocarditis and bacteria related to streptocoss gallolyticus

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5
Q

where is most colorectal carcinoma found ?

A

in rectum and sigmoid colon followed by colon ascended

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6
Q

what is the pathophysiology of colorectal adenocarcinoma ?

A

arises for adenomatous polyps

mutation in oncogenes and tumor suppressor genes - result to carcinoma

COX-2 over expression - related to colorectal carcinoma - that’s why PRVENTIVE MEASURES IF ASPIRIN AND NSAIDS

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7
Q

what are the types of non neoplastic colorectal polyps ?

A
types of polyps :
adenomas -  malignancy potential 
tubular
tubulovillous
villous

hyperplastic (highest occurrence and located in colorectal )

inflammatory

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8
Q

what are the prognostic malignant factors of polyps ?

A

size of polyp - more than 2 cm

type of polyp
tubular- most of the time
tubovillous
villous even lower - highest change of malignant (can cause hypkalemia and profusemucus discharge , serrated )

sessile (villous) or pedunulated

numer of polyps - more than 3

poor differentiation

site of polyp

vascular and lymphatic invasion

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9
Q

what is the prophylaxis of colorectal carcinoma >

A

screening
polyps takes 10-15 years for malignancy - colonoscopy at the age of 50 - negative then every 10 years
in higher risk = no later than 40
double contrast barium enema = good at fining cancer and polyps

adenomas removed with wire lopp or hot forceps

stool dna test
GUIAC fetal occult blood test fecal immunochemical test
COLOGUARD - sTOOL DNA TEST

blood tumor markers - ca 19-9

epiprocolon - blood based colorectal test

MICROSATELITE INSTABILITY TESTING

CALCIUM AND FOLATE AND FIBRE

aspirin and NSAIDs

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10
Q

what are the clinical signs and symptoms for CRC ?

A

usually asymptomatic until late stage

b symptoms - weigh loss , fever , night sweats

fatigue due t blood loss

severe diarrhea - in large villous adenomas in distal colrectum

palpable abdominal mss

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11
Q

symptoms can vary according to where the tumor is located what are the symptoms if located right side ?

A

cecum and ascending colon
melena - iron def anemia
diarrhea

cecum - dyspepsia and appendicitis

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12
Q

symptoms can vary according to where the tumor is located what are the symptoms if located left side

A

TRANSVERSE AND DESCEDING COLON

progressive constipation or change in bowel habits
blood streaked stools
colic like abdominal pain due to obstruction

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13
Q

symptoms can vary according to where the tumor is located what are the symptoms if located at rectum or sigmoid ?

A
Hematochezia- bright red stools
rectal pain 
tenesmus
flatulance 
involuntary stool loss 

rectum - bladder symptoms

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14
Q

what are the metastatic signs and symptoms ?

A

if liver : abdominal distension , hepatomegaly , ascots

lung - dyspnea , cough , hemoptysisi , pleural effusion

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15
Q

what’s the diagnosis fo CRC ?

A

complete colonoscopy with biopsy - golden standard
if incomplete - double contrast barium enema

capsule endoscopy

staging
CT
endorectal ultrasound

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16
Q

what is the tnm staging of colorectal cancer ?

A

Tis - tumor confined to the mucosa - limited to muscular mucosa

T 1
TUMOR CONFINED TO THE SUBMUCOSA

T2
tumor confined musclaris propria

T 3 -tumor has gone into the serosa - but has not gone through them

T4 a - has gone through the serososa (visceral peritoneum)

4b - cancer invades nearby tissue and organs - metastasis

17
Q

what is the modified duke classification ?

A

DUKE CLASSIFICATION - 5 year survival percentage

A - confined to the mucosa
=90

B1 - confined tot he musclaris propria
=80

B2 - confined into the serosa
=60

C1
tumor spread to 1-4 regional lymph nodes
C2 - more than 4 regonal lymph nodes
=30 percent

D
distant metastasis
<1 percent

18
Q

how many grades are there are the colorectal cancer

A

4 grades

19
Q

what is the treatment of colorectal cancer ?

A

if polyps - snare polepectomy

Tis t1a - endoscopic submucosal dissection

tumor resection - colectomy(coplete in hereditary cases)
regional lymph node dissection
resection of resectoble metatasis the in liver or lung
adjuvant chemotherapy

palliative chemotherapy and
ileocolonic anastomosis
colonic stenting

20
Q

what is a complication of polyps ?

A

obstruction
diarrhea
bleeding

21
Q

dd of polyps ?

A

post inflammatory - pseudopolyps - IBD

22
Q

what is the endoscopic paris classification

A

paris classification

protruding lesion :
pedunculate
semi pedunculate
sessile

flat elevated lesions :
flat elevation of mucosa
flat elevation with central depression

flat lesions
flat mucosal change
mucosal depression
mucosal depression with raised edges