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GI System > Colorectal Cancer and Screening > Flashcards

Colorectal Cancer and Screening Flashcards

1
Q

Name four heritable conditions that can increase risk of CRC

A
  • Familial risk
  • HNPCC
  • FAP
  • IBD
  • Previous adenomatous/colorectal cancer
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2
Q

What are risk factors for sporadic cases?

A 
• Age – incidence increases with age
• Male gender
• Previous adenoma/CRC
• Environmental influences:
o	Diet – decrease: fibre, fruit and veg, calcium and increase: red meat and alcohol
o	Obesity 
o	Lack of exercise 
o	Smoking
o	Diabetes mellitus
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3
Q

What are HNPCC?

A

Hereditary nonpolyposis colorectal cancer which is autosomal dominant which can cause early onset colorectal cancer right sided

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4
Q

What is FAP?

A

Familial adenomatous polyposis (FAP) is an autosomal dominant inherited condition in which numerous adenomatous polyps form mainly in the epithelium of the large intestine

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5
Q

What is the role of colorectal polyps?

A

The majority of colorectal cancers arise from pre-existing polyps (adenomas)

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6
Q

What are the three different histological types of adenomas?

A

Tubular, villous or indeterminate

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7
Q

What are the alarm symptoms of colorectal cancer?

A
  • Rectal bleeding (esp. if mixed with stool)
  • Altered bowel opening to loose stools > 4weeks
  • Iron deficiency anaemia
  • Palpable rectal or right lower abdominal mass
  • Acute colonic obstruction if stenosing tumour
  • Systemic symptoms of malignancy: weight loss, anorexia (present late)
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8
Q

What is the first investigation for suspected colorectal cancer?

A

Colonoscopy
• Can take tissue biopsies
• Therapeutic as well as diagnostic

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9
Q

What radiological imaging is used for colorectal cancers?

A
  • Barium enema

* If too unwell for colonoscopy -> CT colonography (must have bowel prep)

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10
Q

What investigations are used to stage cancer?

A
  • CT chest/abdo/pelvis
  • MRI for rectal tumour
  • PET/rectal endoscopic ultrasound
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11
Q

What criteria is used to sage colorectal cancer?

A

Duke criteria

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12
Q

Describe Duke’s Criteria

A

• A: confined to submucosa
• B: invasion through muscularis without lymph involvement
• C: invasion through muscularis with regional lymph node involvement
- C1=1-4 lymph nodes
- C2 = > 4 lymph nodes
• D: presence of distant metastases

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13
Q

What are three strategies of treatment for CRC?

A
  • Surgery
  • Chemotherapy
  • Radiotherapy
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14
Q

What does Dukes A indicate treatment wise?

A

Surgery

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15
Q

What does Dukes C indicate treatment wise?

A

Chemotherapy

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16
Q

When is radiotherapy indicated in CRC?

A
  • Rectal cancer only

* Neoadjuvant +/- chemo to control primary tumour prior to surgery

17
Q

What is used for palliative care in advanced disease?

A
  • Chemotherapy

* Colonic stenting to prevent colonic obstruction

18
Q

What is the aim of population screening?

A

Aim is to detect pre-malignant adenoma/early cancers in the general population

19
Q

What are five modalities used for screening of CRC?

A 
(• Faecal occult blood test (FOBT))
• Faecal immunochemical test (FIT)
• Flexible sigmoidoscopy 
• Colonoscopy 
• CT Colonoscopy
20
Q

What are the indications for the Scottish Bowel Screening Programme?

A
  • Age 50-74yrs
  • FIT test every 2 years
  • If FIT positive -> colonoscopy
21
Q

What is the advantage of FIT over FOBT?

A
  • Specific human Hb
  • Automate so easier to use
  • Quantitative - able to set level of sensitivity to adapt to different populations
  • Provides flexibility to alter the cut-off to accommodate risk factors including age and gender which could reduce the interval cancer rate
22
Q

What steps are taken to reduce risk of CRC in someone with FAP?

A
  • Screening - annual colonoscopy

* Prophylactic proctocolectomy

23
Q

What is microsatellite instability (MSI)?

A

HNPCC tumour have MSI characteristic with frequent mutation occurring in short repeated DNA sequences

24
Q

What other cancers can HPNCC cause other than CRC?

A
  • Endometrial
  • Genitourinary
  • Stomach
  • PANCREAS
25
Q

What steps are taken to reduce risk of CRC in someone with HNPCC?

A

Screening from 25yrs -> 2yr colonoscopy

GI System (28 decks)

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