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GI > Colorectal Cancer and Screening > Flashcards

Colorectal Cancer and Screening Flashcards

1
Q

Is colorectal cancer a common cause of death?

A

Yeah
Second leading cause of cancer death in the western world (3rd commonest cancer overall)
Ooft

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2
Q

Risk factors for colorectal cancer?

A 
Age 
Being male
Smoking
Previous adenoma/colorectal cancer 
Genetics - about 10% have familial risk
Inflammatory Bowel Disease 
Lifestyle factors
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3
Q

Lifestyle related risks for colorectal cancer?

A 
Diet 
      - low fibre, low fruit & veg, low calcium
      - High red meat, fat and alcohol
Obesity 
lack of exercise 
Smoking 
Diabetes Mellitus
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4
Q

How do most colorectal cancers arise?

A

Majority arise from pre-existing polyps (usually adenomas)

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5
Q

What are adenomas? Types?

Describe a high risk adenoma

A

They are benign, pre-malignant epithelial growths. Three main types - tubular (75%), villous (10%) & tubulovillous

High risk lesions are large, have a high degree of dysplasia and villous architecture

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6
Q

Why do adenomas develop instead of just cancerous growths from the start?

A

Because adenomas mark stages where one or two genes regulating cell growth have been mutated, but there is still a line of control (multi-hit hypothesis)

Once all regulatory genes are mutated a carcinoma develops

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7
Q

Oncogenes and tumour suppressors regulating colorectal cancer formation?

A

Oncogenes: K-ras, c-myc

Suppressors: APC, p53, DCC

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8
Q

Presentation of colorectal cancer?

A 
Rectal bleeding (more LS)
Iron deficiency anaemia (more often right sided malignancy)
Palpable rectal/right lower abdominal mass
Colonic obstruction
Cancer symptoms (weight loss etc.)
Tenesmus (more LS)
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9
Q

First line investigation for suspected colorectal cancer?

A

Colonoscopy

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10
Q

Advantages of colonoscopy?

A

Allows biopsy to be taken

Can be therapeutic too - polypectomy (remove polyps during procedure)

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11
Q

Radiological investigations for suspected colorectal cancer?

A

CT colonography
CT abdomen/pelvis

Barium enema

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12
Q

Investigations for staging of colorectal cancer?

A

CT scan (chest/abdomen/pelvis)

MRI scan (rectal tumours)

PET scan

Rectal EUS (selected cases)

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13
Q

Treatment of colorectal cancer?

A

Surgery to remove infected part of bowel
May need to have stoma formed

Chemotherapy and radiotherapy

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14
Q

What is a stoma?

A

Opening in the abdomen that can be connected to digestive/urinary system to allow passage of waste

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15
Q

How are chemo and radiotherapy used in colorectal cancer?

A

Chemo often given adjuvantly to stop formation of secondary tumours

Both can be give neo-adjuvantly to control cancer before surgery

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16
Q

How is the prognosis for colorectal cancer greatly improved?

A

Early detection - screening

17
Q

Screening modalities available for colorectal cancer?

A

Colonoscopy
Faecal occult blood test (FOBT)
Faecal immunochemical test (FIT)

Flexible sigmoidoscopy
CT colonography

18
Q

Describe the Scottish Bowel Screening Program

A

For people age 50-74 years

  • FOBT every 2 years
  • If FOBT positive - colonoscopy

15% reduction in relative risk of colorectal cancer mortality

19
Q

Advantages of the Faecal immunochemical test?

A

Easy, automated - user friendly
Flexibility - don’t have to only have every 2 years, if predisposed can test more often - reduce interval cancer rate

Also FOBT has lower positivity in women, unlike FIT

20
Q

High risk groups for colorectal cancer?

A

Heritable conditions
- familial adenomatous polyposis (FAP)
- HNPCC (hereditary non-polyposis colorectal cancer)
IBD patients
Previous adenomas/colorectal cancer

21
Q

What is familial adenomatous polyposis (FAP)?

A

Autosomal dominant condition causing proliferation of adenomas throughout colon (95% have >100 by age 35)

High risk of malignant change
Usually give annual colonoscopy from age 10-12 years

22
Q

Management of FAP?

A

Screening for colorectal cancer

NSAIDs chemoprevention - Sulindac reduced polyp number and prevents recurrent higher grade adenomas

23
Q

What is HNPCC?

hereditary non-polyposis colorectal cancer

A

Lynch - 1 inactive MMR gene

Autosomal dominant condition, causes tumours to have microsatellite instability - frequent mutations in short repeated segments observed

Susceptible to right sided colorectal cancer (early onset - usually in 40s)

24
Q

Management of HNPCC?

A

Screening from age 25

Colonoscopy every 2 years

GI (46 decks)

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