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Gen Med: GI > Colorectal Cancer/Toxic Megacolon > Flashcards

Colorectal Cancer/Toxic Megacolon Flashcards

1
Q

What are the epidemiological trends for colorectal cancer?

A
  1. 2nd leading cause of cancer death in US
    A. After lung & skin cancer
  2. Approx 90% cases occur in pts > 50 yr age
  3. Greater than 75-95% of colon CA occurs in people w/ little or no genetic risk
  4. Approximately 6% of Americans will develop colorectal cancer
    A. 40% will die from colon CA
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2
Q

What type of colorectal cancer is the most prevalent?

A
  1. Almost all colorectal cancers are adenocarcinomas
    A. Form bulky masses
  2. Majority of colorectal cancers arise from malignant transformation of adenomatous polyps
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3
Q

What are the risk factors for colorectal cancer?

A 
1. Aging
A. 90% cases > 50 yr 
2. (+) FH
A. The highest risk is in ppl with multiple first degree realtives or relatives who have developed colorectal cancer at a relatively young age
3. IBD
A. Cumulative risk 5-10% after 20 yr & 20% after 30 years
4. High fat diet
5. ETOH
A. > 1 drink/day
6. M > F
7. B > W
8. Tobacco use
9. Obesity
10. Lack of physical activity
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4
Q

What are the FH risk factors for colorectal cancer?

A
  1. Pts w/one 1st degree relative w/colorectal CA have increased risk 2x that of general population
  2. Risk is 4x greater if relative was diagnosed < 45 yr
  3. 20-30% lifetime risk if two 1st degree relatives have colon CA
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5
Q

What are the mc sxs of right sided colon cancer?

A
  1. Fatigue/weakness

2. large diameter & liquid consistency of fecal matter;

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6
Q

What are the mc sxs of left sided colon cancer?

A
  1. Fatigue/weakness
  2. Colicky abd pain
  3. Change in bowel habits
  4. Obstructing lesion
  5. smaller diameter, fecal material solid
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7
Q

What are the mc sxs of rectal cancer?

A
  1. Fatigue/weakness
  2. Tenesmus
  3. Urgency
  4. Recurrent hematochezia
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8
Q

What are the general signs of colorectal cancer?

A
  1. Physical exam may be normal
  2. (+) guaiac common
  3. Palpable mass
    A. Suggests advanced disease
  4. Hepatomegaly
    A. Suggests metastatic spread
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9
Q

What are the ddx for colorectal cancer?

A
  1. IBS
  2. Diverticular disease
  3. Ischemic colitis
  4. IBD
  5. Hemorrhoids
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10
Q

What are the dx studies for colorectal cancer?

A 
1. CBC
A. Iron Def Anemia
2. Elevated LFT’s
A. Metastatic Dz
3. Carcinoembryonic Ag (CEA)
A. Tumor marker
B. Pre-op level > 5 ng/ml poor prognosis
4. Colonoscopy
A. Diagnostic procedure of choice
B. Provides histologic Dx
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11
Q

What are the imaging studies for colorectal cancer?

A 
1. CT Chest/Abd/Pelvis
A. Demonstrates distant mets
2. Ultrasound liver
A. More accurate than CT for liver mets
3. Pelvic MRI
A. Rectal cancer 
B. Determines depth of penetration of CA through rectal wall
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12
Q

What is stage 0 colorectal cancer?

A

Polyp or lesion at innermost lining of the colon

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13
Q

What is stage I colorectal cancer?

A

Beyond innermost lining of colon to second & third layers

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14
Q

What is stage II colorectal cancer?

A

Extends thru muscular wall of colon, but not in nodes

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15
Q

What is stage III colorectal cancer?

A

Extends outside colon to ≥ lymph node

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16
Q

What is stage IV colorectal cancer?

A

Extends outside the colon to distant organs (liveror thelungs)

17
Q

What is the rx for colorectal cancer?

A
  1. Resection of tumor
  2. Regional lymph node dissection
    A. Minimum 12 nodes
    B. Determines staging & adjunctive chemoTx
18
Q

What is the rx for rectal cancer?

A

Pre-op chemo-radiation followed by surgery

19
Q

When and how should pts be followed up after colorectal cancer surgery?

A
  1. Patients should be evaluated q 3-6 months for 3-5 yrs:
    A. Hx
    B. Physical
    C. CEA: tumor marker
    D. Repeat colonoscopy 1 yr post-op; then q 3-5 yr
20
Q

What are the general recommendations for screening colonoscopies?

A

USPTF & ACS recommends start screening at age 50 yr

21
Q

What are the recommendations for screening colonoscopies for pts at high risk?

A
  1. If 1st degree relative with colon CA, begin screening at 40 yr OR at age 10 yr younger than age at which relative was Dx’d
    A. Single 1st degree relative w/ CA > 60 yrs, begin screening at age 40 & screen q 10 yr
    B. Single 1st degree relative w/CA < 60 yrs, OR 2 1st degree relatives, begin screening at 40 yr or younger; screen q 5 yr
22
Q

What are the screening methods for colorectal cancer?

A
  1. Stool Guaiac (FOBT)
  2. Flexible sigmoidoscopy
  3. Colonoscopy
  4. Barium enema
23
Q

What are the advantages/disadvantages of flexible sigmoidoscopy?

A
  1. Detects approx 65% advanced neoplasms

2. Does not examine proximal colon

24
Q

Why is colonoscopy the preferred exam of the entire colon?

A
  1. Permits exam of entire colon
    A. Preferred
    B. Allows detection and removal polyps
  2. Although most sensitive test, not infallible
25
Q

What is toxic megacolon?

A
  1. Extreme dilatation & immobility of colon

2. True emergency!!

26
Q

what is toxic megacolon in a peds pt?

A
  1. Hirschsprung’s Dz
    A. Congenital aganglionosis of colon
    B. Leads to functional obstruction in newborn
27
Q

How does toxic megacolon present in adults?

A 
1. In adults, toxic megacolon occurs as a complication of:
A. UC 
B. Crohn’s Disease 
C. Pseudomembranous colitis 
D. Infections
-Shigella, Campylobacter, C. Difficile
28
Q

What are the sxs of toxic megacolon?

A 
1. Fever
A. Hypothermia if sepsis
2. Prostration
3. Severe cramps
4. Abd distention
5. Rigid abdomen
6. Localized or diffuse rebound tenderness
7. Tachycardia
8. Dehydration
29
Q

What are the dx studies for toxic megacolon?

A 
1. CBC
A. Leukocytosis most common
B. If sepsis→ leukopenia
2. BMP
3. KUB
A. Colonic dilatation
30
Q

What are the rx goals for toxic megacolon?

A
  1. Reduce colonic distention to prevent perforation
  2. Correct fluid and electrolyte disturbances
  3. Treat toxemia & precipitating factors
31
Q

What is the non-medical treatment for toxic megacolon?

A
  1. Decompression of colon w/in 24 hrs
    A. NG tube, long intestinal tube
    B. If unable, then: subtotal colectomy w/ ileostomy
  2. Attention to fluid and electrolyte balance
    A. High risk for septic shock
  3. D/C possible triggers: narcotics, antidiarrheals, and anticholnergics
32
Q

What are the medical treatments for toxic megacolon?

A
  1. Corticosteroids if resulted from active IBD
  2. Antibiotics given to prevent sepsis
    A. Ampicillin, gentamicin, metronidazole
33
Q

What can toxic megacolon lead to?

A

Risk of death due to perforation, sepsis, and shock is high

Gen Med: GI (16 decks)

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