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Gastroenterology > Colorectal Cancer and Polyps > Flashcards

Colorectal Cancer and Polyps Flashcards

1
Q

What is the lifetime risk of developing colorectal cancer for an average risk person?

A

5-6%

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2
Q

Colorectal Cancers are the ______ most common cancer in women and men in the US

A

Third

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3
Q

Over the past 20 years, the incidence and death rates related to colorectal cancer have _________. Why is this?

A

Fallen steadily. Due to screening and polyp removal, preventing the progression of polyps to invasive cancers, and the treatment advances overall

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4
Q

That is that the majority of colorectal cancers occur in individuals who _________ a family history of colorectal cancer.

A

Do not have!

These are Average Risk Patients

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5
Q

These types of polyps have minimal cancer potential.

A

Hyperplastic

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6
Q

These types of polyps have about 90% chance of colon or rectal cancers that arise from adenomas.

A

Adenomatous

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7
Q

Adenomas are the precursor lesions for most colon cancers, which allows us to?

A

Prevent cancer by removing these adenoma lesions in the colon!

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8
Q

There are two known pathways that create colon-rectal colonoscopy. This pathway is responsible for 80-85% of sporadic Colorectal Cancer.

A

Chromosomal Instability Pathway

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9
Q

There are two known pathways that create colon-rectal colonoscopy. This pathway is responsible for 15-20% of sporadic Colorectal Cancer.

A

Microsatellite Instability Pathway

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10
Q

Risk Factors for the development of colorectal cancer:

A
  1. 50+ yo (over 91% of cases are in this age group)
  2. Smoking
  3. Obesity
  4. Alcohol
  5. Diet high in fat and low in fiber (mixed) (High in red meats and processed meats increases the risk)
  6. Sedentary lifestyle
  7. Race/Ethnicity (AA & A.Jews&raquo_space; Hispanics)
  8. DM II
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11
Q

What are some non-modifiable risk factors for CRC?

A
  1. Personal History (IBD, Ulcerative Colitis, Crohn’s Dz, Adenomatous polyps or colorectal cancer)
  2. Family Hx (Adenomatous polyps or CRC, Familial adenomatous polyposis, hereditary non-polyposis colon cancer, Peutz-Jegher’s syndrome)
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12
Q

What are the common signs and symptoms of CRC?

A
  1. Microscopic Blood in your stool
  2. Rectal Bleeding
  3. Change in bowwl habits
  4. Abdominal Pain or Cramping
  5. Weight Loss
  6. Weakness or Fatigue
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13
Q

True/False: The majority of patients with colon polyps have no symptoms.

A

TRUE!

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14
Q

Signs and Symptoms of Colon Polyps

A
  1. No symptoms
  2. Microscopic Blood in your stool
  3. Rectal bleeding
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15
Q

Tests that detect adenomatous polyps and cancer?

A
  1. Flexible Sigmoidoscopy every 5 years
  2. Colonoscopy every 10 years
  3. Double-contrast Barium Enema every 5 years
  4. CT colonography every 5 years
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16
Q

Tests that primarily detect cancer

A
  1. Annual Guaiac-based Fecal Occult Blood Test (gFOBT)
  2. Annual Fecal Immunochemical Test (FIT)
  3. Stool DNA, interval uncertain (sDNA)
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17
Q

What is the function of FOBT (Fecal Occult Blood Test)?

A

Detects occult blood from cancers and/or large polyps

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18
Q

How do you perform the FOBT test?

A 
Test 2 samples from 3 consecutive stools. 
Add reagent (gusiac)
Add Hydrogen peroxide -- guaiaconic acid is converted to blue quinone by the pseudoperoxidase activity of heme.
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19
Q

The 13-year cumulative mortality per 1000 from CRC was ______ in the annual screening group by ____ percent.

A

Reduced by 33%.

WOWOWOW! Screening annually is important.

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20
Q

True/False: The FIT (Fecal Immunochemical Test) is specific for human hemoglobin.

A

True; though more frequently accurate after age 40.

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21
Q

This test employs antibodies to detect hemoglobin in stool. It does NOT react with ingested food, vitamins or drugs. Sample used for this test can be collected from the surface of the stool with a brush.

A

Immunochemical FOBT

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22
Q

What are some of the advantages of using Fecal Immunochemical Test?

A
  1. Increased sensitivity for cancer
  2. Specific for lower GI Bleeding
  3. Improved Compliance
  4. Easier specimen collection methods
23
Q

One study showed that the immune tested was _________ at finding adenomas and cancer than FOBT.

A

Better (2.2-2.5x)

24
Q

Why are the three tests that we use to detect cancer good?

A
  1. They all test the stool for hidden blood or other changes that could be indicative of cancer
  2. Less invasive and easy to do
  3. Less likely to find polyps
  4. Colonoscopy will be needed if these tests come back abnormal.
25
Q

What are the advantages of doing a Colonoscopy?

A
  1. Examines the entire colon
  2. High sensitivity and specificity
  3. Able to remove polyps
  4. Cost effective
  5. If normal, you can wait 10 years before the next exam.
26
Q

What is the miss rate for polyps?

A

10+ mm = 6%
6-9 mm = 13%
<5 mm = 27%

27
Q

What is the complication risks for colonoscopy?

A
  1. 2% perforation
  2. 3% bleeding
  3. 01% mortality
28
Q

What are the advantages of a CT Colonoscopy?

A
  1. Safe
  2. Examines BOTH sides of bowel folds
  3. Precisely localizes lesions
  4. Can examine proximal colon if obstructed
29
Q

What are disadvtanges of CT Colonoscopy?

A
  1. Bowel Prep
  2. Gas Distention
  3. Radiation
  4. Diagnostic ONLY
30
Q

Why are CRC prevention tests not commonly completed?

A

Patient Preference!

  1. Many don’t want invasive tests or to do the bowel prep
  2. Some prefer to have screening in the privacy of their home (random)
  3. Some may not have access to invasive tests due to the lack of coverage or local resources.
31
Q

If you have a family hx (single direct relative) of CRC or advanced adenoma, what would the precautions be (as opposed to average risk)?

A

Colonoscopy every 5 years starting at age 40 OR 10 years younger than the age of dx for the relative.

32
Q

If you have a history of IBD for greater than 7-10 years, what should you do?

A

Colonoscopy every 1-2 years

33
Q

If you are at average risk (aka no risk factors and no symptoms), you want to start screening as this age. How options do you have?

A

Age 50+ yo

Stool Tests, Endoscopy, Radiologic Tests, Colonoscopy

34
Q

If you are at high risk (aka familial syndrome and/or IBV for 8+years), you want to start screening as this age. How options do you have?

A

ANY AGE! You want to refer them to a speciality so they can get a colonoscopy done asap and possible a genetic test.

35
Q

If you are at increased risk (aka CRC/Adenoma in a direct relative), you want to start screening as this age. How options do you have?

A

Age 40+ OR 10 years prior to the earliest dx in the relative.

36
Q

True/False: The histology at dx is the most important determinant of the likelihood of survival.

A

Falseeeee. CRC is fatal when it metastasizes to the other organs (most commonly liver and lungs)

37
Q

I’m a localized adenoma on the endothelium. Stage me.

A

Stage 0

38
Q

I’m a tumor of the colon and I have pierced through the entire wall of the colon and have spread to other organs. Stage me!

A

Stage 4

39
Q

I am a tumor who has grown slightly and pierced through the endothelial layer but hasn’t gone very far.

A

Stage 1

40
Q

I’m a tumor who has pierced through all layers but hasn’t spread to other organs yet

A

Stage 3

41
Q

I’m a tumor that is still piercing through the layers of the colon, but have not gotten all the way through.

A

Stage 2

42
Q

The biggest benefit of screening is ______.

A

Finding the cancer earlier! When it’s localized, theres a 90% survival rate in 5 years, whereas distant has only a 12% and regional is 70%.

43
Q

What are two types of hereditary colon cancer syndromes?

A
  1. Familial Adenomatous Polyposis (FAP)

2. Hereditary Non-Polyposis Colon Cancer (HNPCC)

44
Q

When does Familial Adenomatous Polyposis (FAP) start showing polyps?

A

Early age – usually teens

45
Q

What is characteristic of tis condition?

A

Hundreds to thousands of polyps. They tend to be small and sessile (immobile).

46
Q

True/False: Familial Adenomatous Polyposis (FAP) is a colon disease exclusively.

A

False.

Found in:

  1. Duodenum (clustered around the papilla and common in 33-92% of pts)
  2. Gastric Adenomas (as well as gastric fundic plyps)
  3. Small bowel
  4. Pancreas
  5. Papillary Thyroid
  6. Hepatoblastoma
47
Q

Are all of the findings in a patient with FAP cancerous or malignant?

A

Nope, the following are benign.

  1. Desmoids (usually in mesentery, abdominal wall, extremities, occurs in 10% of FAP pts)
  2. Osteomas (usually in mandible)
  3. Epidermoid Cysts
  4. Fibromas
  5. CHRPE (retinal lesions)
48
Q

FAP is an ________________ genetic disorder.

A

Autosomal Dominant. There’s a lot of more details about the genetic factors, but I’m choosing to ignore it.

49
Q

What’s the difference between attenuated FAP and FAP?

A

Onset is later with less polyps (20-100).

50
Q

How do we treat/manage FAP?

A
  1. Annual sigmoidoscopy or colonoscopy starting around 10-12 yo
  2. Prophylactic colectomy following polyp detection with continue surveillance of rectum, ileal pouch.
  3. Esophagogastroduodenoscopy (EGD) at age 25, repeat every 1-3 years
  4. Endoscopies for polyps
  5. Resection of large lesions or cancers
51
Q

Genetic Testing for FAP is important, you will want to:

A

Test other members just in case. And there are lots of words on this slide that don’t seem super important.

52
Q

This is an autosomal dominant genetic disorder that leads to multiple primary cancers (such as colon and endometrial cancer). Cancer usually appears at a young age.

A

Hereditary NonPolyposis Colorectal Cancer (HNPCC)

53
Q

Hallmark Sign of Hereditary NonPolyposis Colorectal Cancer (HNPCC)

A

Microsatellite Instability.

54
Q

Management for Hereditary NonPolyposis Colorectal Cancer (HNPCC).

A
  1. Screening colonoscopy initiated by 20-25 years of age and repeated every 1-2 years
  2. Subtotal colectomy with ileorectal anastomosis is advised with the appearance of cancer.
  3. Annual rectal surveillance thereafter
  4. Prophylactic hysterectomy and b/l salpingo-oophorectomy for women after completion of childbearing
  5. Screening for endometrial cancer during childbearing years starting age 30

Gastroenterology (12 decks)

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