Colorectal Cancer, Merter Flashcards
What are the symptoms of colorectal cancer/
BAP, SSAID
Bleeding
Anorectal pain
Pelvic pain/Pain
,
Swelling
Stomach ache
Anal discharge
Incontinence
Defecation change=constipation/dirrhea
In which side of the colon is the perforation more likely to occur?
Left colon, bcz it is much smaller than the right
Obstruction in the right /left colon will lead to what?
*perforation
Having a tumor in which side of the colon will cause bleeding and Anemia
Right colon
Clinical evaluation of colorectal cancer?
Family history
CT
MRI
Colonoscopy
PET-CT
Colectomy:
Colostomy:
Colectomy: removal of colon/section of colon
Colostomy: forming a an exterior stoma for the colon to excrete the feces
Which type of polyp has 100% colorectal cancer risk?
FAP; familial adenomatous polyposis
Any polyp that is …….. has a high risk of being cancerous?
Adenomatous
What are the etiologies of CRC?
-Age 40-50>
-Gender;25% more in males
-Having the APC gene affected by FAP disease
-BRCA gene mutation
-5% Hereditary CRC’s
-80% HNPCC (hereditary nonpolyposis CRC)
-Having Crohn’s or ulcerative colitis
In which patients does the risk of CRC increases 3.5-6.5 times?
1)adenomatous* polyp larger than 1cm*
2)villous or tubulovillose polyp
3)high grade dysplasia*
What are other etiological factors for CRC?
-Acromegaly
-Diabetes milletus
-obesity
-insulin resistance
What are the lifestyle risks that inc the chances of having CRC?
-Red/processed meat
-smoking
-alcohol
-androgen therapy (fertility-related )
Which type of polyp provides a risk for CRC?
Neoplastic (adenomatous) polyps has high risk for cancer dev.
Which type of the Neoplastic (adenomatous) polyps has the highest risk of CRC?
1-Villous adenoma type 40%
(2-tubular adenoma5% & 3-Tubulovillous adenoma 22%)
What are the polyp size classifications according to their level of risk for cancer?
<1cm=<1% ca
1cm=10%risk ca
2cm=15% risk ca
Describe the treatment for each cancer case?
1-In-situ cancer:
2-Invasive ca; in-pedunculated polyp :
3-Invasive ca; sessile polyp:
1-polypectomy(removal of polyps in the colon)
2-polypectomy
3-colon resection
APC gene mutation is positive in which diseases related to CRC?
FAP (familial adenomatous polyposis) ;APC 75% +ve
&
Attenuated form of FAP; APC 60% +ve and needs screening at the age of 15 plus colonoscopy
What is the Amsterdam criteria for HNPCC (hereditary non-polyposis colorectal cancer)/Lynch Syndrome diagnosis?
-3 relatives with colorectal cancer, where one of them is 1st degree.
- 2 generations of colorectal cancer
- 1 colorectal cancer before age of 50
- FAP is excluded
What is the pathway of carcinoma development in Lynch syndrom (HNPCC)?
RER pathway, DNA mismatch repair gene defect (hMLH1, hMSH2)
What is the pathway of carcinoma development in FAP?
APC gene mutation
What are the Bethesda criteria?
1-Amsterdam criteria is met
2- 2 or more HNPCC related malignancies in one patient.
3-1st degree relative with CRC or HNPCC; one of the cancers diagnosed <45 yr
4-colon or endometrial ca diagnosed <45 yrs
5-diagnosed w/ adenoma before the age of 40
6-signet ring cell or undifferentiated right colon ca <45 yrs
What is the most imp sign for poor prognosis in CRC?
Lymph node metastasis (BY TNM staging)
Know TNM staging for malignant metastasis;
Tis; tm in mucosa
T1; tm in submucosa
T2;tm in muscularis propria
T3; tm in serosa
T4; tm spread into visceral peritoneum
N1;1-3 lymph node in pericolic and perirectal involved
N2; 4> LN pericolic or perirectal involved
N3; vascular pedicle(cardiac) LN involvement
M0;no metastasis
M1; metastasis
what is a specific finding in FAP?
retinal pigment epithelial hypertrophy
describe stage 1 CRC
T1-2,N0,M0
describe stage 2 CRC
T3-4,N0,M0
describe stage 3 CRC
Tany,N1-3,M0
describe stage 4 CRC
Tany,Nany,M1
what is the surgical treatment for FAP?
restorative proctocolectomy (procto=rectum), J-pouch ileoanal anastomosis
what are the diagnostic tests required for FAP?
colonoscopy and endoscopy (since periampullary tumors and GIS polyps dev)
which disease is characterized by being autosomal dom with Hyperpigmentation and hamartomatous(benign) polyps found in the small intestines plus in the rectum and colon
peutz -jegher syndrome
describe the 3 types of polyps and which surgery they require ?
sessile polyp; colon resection
in situ ca; polypectomy
in-pedunculated ; polypectomy
which disease is symptomatic at 16yrs with many adenomatous polyps which if left untreated before 45yrs, 90% can dev into CRC and lifetime risk of 100%
FAP
which CRC risky diseases occur in children b/w 10-12 yrs
FAP
which CRC risky diseases occur in patients b/w 20-25 yrs
HNPCC
which diagnostic staging method is used to diagnose CRC?
TNM staging
