Colorectal Cancer, Merter

Question 1

What are the symptoms of colorectal cancer/

Answer 1

BAP, SSAID
Bleeding
Anorectal pain
Pelvic pain/Pain
,
Swelling
Stomach ache
Anal discharge
Incontinence
Defecation change=constipation/dirrhea

Question 2

In which side of the colon is the perforation more likely to occur?

Answer 2

Left colon, bcz it is much smaller than the right

Question 3

Obstruction in the right /left colon will lead to what?

Answer 3

*perforation

Question 4

Having a tumor in which side of the colon will cause bleeding and Anemia

Answer 4

Right colon

Question 5

Clinical evaluation of colorectal cancer?

Answer 5

Family history
CT
MRI
Colonoscopy
PET-CT

Question 6

Colectomy:
Colostomy:

Answer 6

Colectomy: removal of colon/section of colon
Colostomy: forming a an exterior stoma for the colon to excrete the feces

Question 7

Which type of polyp has 100% colorectal cancer risk?

Answer 7

FAP; familial adenomatous polyposis

Question 8

Any polyp that is …….. has a high risk of being cancerous?

Answer 8

Adenomatous

Question 9

What are the etiologies of CRC?

Answer 9

-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

Question 10

In which patients does the risk of CRC increases 3.5-6.5 times?

Answer 10

1)adenomatous* polyp larger than 1cm*
2)villous or tubulovillose polyp
3)high grade dysplasia*

Question 11

What are other etiological factors for CRC?

Answer 11

-Acromegaly
-Diabetes milletus
-obesity
-insulin resistance

Question 12

What are the lifestyle risks that inc the chances of having CRC?

Answer 12

-Red/processed meat
-smoking
-alcohol
-androgen therapy (fertility-related )

Question 13

Which type of polyp provides a risk for CRC?

Answer 13

Neoplastic (adenomatous) polyps has high risk for cancer dev.

Question 14

Which type of the Neoplastic (adenomatous) polyps has the highest risk of CRC?

Answer 14

1-Villous adenoma type 40%

(2-tubular adenoma5% & 3-Tubulovillous adenoma 22%)

Question 15

What are the polyp size classifications according to their level of risk for cancer?

Answer 15

<1cm=<1% ca
1cm=10%risk ca
2cm=15% risk ca

Question 16

Describe the treatment for each cancer case?

1-In-situ cancer:
2-Invasive ca; in-pedunculated polyp :
3-Invasive ca; sessile polyp:

Answer 16

1-polypectomy(removal of polyps in the colon)
2-polypectomy
3-colon resection

Question 17

APC gene mutation is positive in which diseases related to CRC?

Answer 17

FAP (familial adenomatous polyposis) ;APC 75% +ve
&
Attenuated form of FAP; APC 60% +ve and needs screening at the age of 15 plus colonoscopy

Question 18

What is the Amsterdam criteria for HNPCC (hereditary non-polyposis colorectal cancer)/Lynch Syndrome diagnosis?

Answer 18

-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

Question 19

What is the pathway of carcinoma development in Lynch syndrom (HNPCC)?

Answer 19

RER pathway, DNA mismatch repair gene defect (hMLH1, hMSH2)

Question 20

What is the pathway of carcinoma development in FAP?

Answer 20

APC gene mutation

Question 21

What are the Bethesda criteria?

Answer 21

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

Question 22

What is the most imp sign for poor prognosis in CRC?

Answer 22

Lymph node metastasis (BY TNM staging)

Question 23

Know TNM staging for malignant metastasis;

Answer 23

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

Question 24

what is a specific finding in FAP?

Answer 24

retinal pigment epithelial hypertrophy

Question 25

describe stage 1 CRC

Answer 25

T1-2,N0,M0

Question 26

describe stage 2 CRC

Answer 26

T3-4,N0,M0

Question 27

describe stage 3 CRC

Answer 27

Tany,N1-3,M0

Question 28

describe stage 4 CRC

Answer 28

Tany,Nany,M1

Question 29

what is the surgical treatment for FAP?

Answer 29

restorative proctocolectomy (procto=rectum), J-pouch ileoanal anastomosis

Question 30

what are the diagnostic tests required for FAP?

Answer 30

colonoscopy and endoscopy (since periampullary tumors and GIS polyps dev)

Question 31

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

Answer 31

peutz -jegher syndrome

Question 32

describe the 3 types of polyps and which surgery they require ?

Answer 32

sessile polyp; colon resection
in situ ca; polypectomy
in-pedunculated ; polypectomy

Question 33

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%

Answer 33

FAP

Question 34

which CRC risky diseases occur in children b/w 10-12 yrs

Answer 34

FAP

Question 35

which CRC risky diseases occur in patients b/w 20-25 yrs

Answer 35

HNPCC

Question 36

which diagnostic staging method is used to diagnose CRC?

Answer 36

TNM staging