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Therapy Prin & Procedure > Colorectal Cancers > Flashcards

Colorectal Cancers Flashcards

1
Q

What is the age factor for colorectal cancers

A

90% are over the age of 50 so this is why screening starts at age 50

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2
Q

Cancer in the large bowel usually occurs in which part

A

Usually occurs in the distal colon and rectum (sigmoid or descending colon)

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3
Q

At what age should a person of average risk have his or her first screening colonscopy

A

50 for average risk. For high risk, it should be BEFORE 50 years old.

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4
Q

Familial adenomatous polyps is (FAP) ad hereditary non-polyposis colorectal syndrome (HNPCC) are most closely associated with what cancer

A

Colorectal cancer

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5
Q

The vermiform appendix is most closely associated with which portion of the digestive tract?

A

Cecum

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6
Q

What is the dose limiting structure of most concern for radiation treatments of colorectal cancer

A

Small bowel

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7
Q

What substance is responsible for the brown color of feces?

A

Bilirubin

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8
Q

_________ has the highest incidence of cancer related deaths in the US compared to esophageal cancers, stomach cancers, and anal cancers.

A

Colorectal cancers

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9
Q

What are the risk factors for anal cancer

A 
HPV 
Anal intercourse in those under 30 
Immunosuppression 
Genital warts 
Genital infections 
Cigarette smoking
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10
Q

There is an increased incidence of anal cancer in men under 45 and this is attributed to…

A

An increased in homosexuality and anal intercourse

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11
Q

What condition is most closely associated with adenomatous polyposis

A

Gardner syndrome

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12
Q

The most common histology of anal carcinoma

A

Squamous cell carcinoma

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13
Q

T/F

About 50 percent of patients with colorectal cancer present with positive nodes

A

True

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14
Q

Foods that patient should avoid while undergoing radiation treatments for colorectal cancer

A 
Whole grains 
Fresh fruits 
Raw veggies 
Fried, fatty foods
Milk and dairy products
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15
Q

Foods that patients are encouraged to consume while undergoing radiation treatments for colorectal cancer

A 
White bread 
Baked, broiled, or roasted meats 
Peeled apples
Banana
Macaroni, noodles 
Cooked veggies
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16
Q

What are the anti-diarrheal agents to help patients with diarrhea while undergoing colorectal radiation treatments

A

Immodium

Lomotil

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17
Q

Lymphatics of the descending colon drain following the path of the ……

A

Inferior mesenteric artery

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18
Q

What staging system is most widely used today for colorectal cancer

A

TNM

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19
Q

What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall

A

Surgery, chemo, and XRT

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20
Q

Between colon cancer and rectum cancer, which one have a higher incidence

A

Colon cancer

Rectum and colon effects men and women equally

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21
Q

It has been noted that cancers in the proximal (right) colon have increased in _______(male or female)

A

Female

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22
Q

________ is the 2nd leading cause of cancer deaths in the US

A

Colorectal cancer

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23
Q

Factors that has been linked to colorectal cancer

A

Diet (high fat low fiber, processed and red meats, low fruit/veg.
Obesity
Smoking
Excessive alcohol
Minimal physical activity
LIFESTYLE greatly affects development of colorectal cancer

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24
Q

(Colorectal cancer)

Chronic ulcerative colitis usually occurs in the __________

A

Rectum and sigmoid colon

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25
Q

Other medical factors that contributes to colorectal cancer

A

chronic ulcerative colitis
Chronic’s disease
FAP (familia adenomatous polyposis)
Hereditary non-polyposis colorectal syndrome

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26
Q

How is FAP treated

A

Complete removal of the colon and return

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27
Q

Adenomatous polyps are growths that arise in the _______ of the bowel

A

Mucosal lining and it is either villous or tubular

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28
Q

Which type of adenomatous polyps is 8 to 10 times more likely to be malignant

A

Villous adenomatous polyps

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29
Q

(Colorectal cancer)

Another factor that contributes to colorectal cancer that is similar to FAP is ______

A

Gardner’s syndrome

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30
Q

What are the 8 regions that the colon is divided into

A 
Cecum 
Ascending colon
Hepatic flexure 
Transverse colon 
Splenic flexure 
Sigmoid 
Rectum
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31
Q

Cancer of the large bowel is divided into ______ and ______ because the symptoms, diagnosis, and treatments are different based on the location of the disease

A

Colon and rectum

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32
Q

Cancer of the colon is treated with ________

A

Surgery and chemo

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33
Q

Cancer of the rectum is treated with ______

A

Surgery, chemo and XRT due to its location, it only allows for small surgical margins and adjuvant treatment is often needed

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34
Q

Which part of the large bowel is located INTRAperitoneally

A

Cecum, transverse colon, and sigmoid

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35
Q

Which portion of the large bowel is located RETRO-peritoneally

A

Ascending and descending colon,

Hepatic and splenic flexures

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36
Q

What is the difference between the organs that is located INTRAperitoneally to that is located RETROperitoneally

A

the INTRAperiotneal have a complete mesenteric and serosa and are FREE mobile while the RETROperitoneal does NOT. However, seeding is common in the INTRA peritoneal

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37
Q

The rectum is continuous of the ______

A

Sigmoid

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38
Q

The rectum begins at the level of the ______

A

3rd sacral vertebrae

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39
Q

Just like the sigmoid, the upper rectum is covered by _____ on the anterior and lateral surfaces

A

Peritoneal

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40
Q

The lower half to 2/3 of the rectum is located

A

RETROperitoneally

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41
Q

What are the 3 valves that the rectum is divided into

A

Superior, middle and inferior

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42
Q

The rectum acts as ___________

A

Acts as a holding station for fecal matter before it is ready to be excreted out of the body

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43
Q

Because the rectum is located RETROperioneally, tumors can invade structures such as….

A

Prostate, bladder, vagina, and sacrum

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44
Q

What are the 4 layers of the bowel

A

Mucosa- lumen of bowel
Submucosa- rich in lymphatics an blood vessels
Muscularis propria- muscle layer responsible for peristalsis
Serosa- layer of fat

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45
Q

The right colon follows the _______

A

Superior mesenteric vessel

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46
Q

The left colon follows the …..

A

Inferior mesenteric vessels and includes regional nodes

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47
Q

The sigmoid drains into the ….

A

Inferior mesenteric vessels and also include nodes along the superior rectal, sigmoidal and the sigmoidal mesenteric vessels

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48
Q

The rectal node drainage all depends on how high or low. So the upper rectum follows the

A

Superior rectal vessel and terminates in the inferior mesenteric nodes

49
Q

The middle and lower rectum drain to the ….

A

Internal iliac and pre-sacral nodes

50
Q

The lower rectum lesions that spread into the anal canal may end up in the …

A

Inguinal nodes

51
Q

As you get further down the anus, you have more concerns with the ________ nodes then you would if you were more superior

A

Inguinal nodes

52
Q

What are the clinical presentation of colorectal cancer

A

Rectal bleeding
Bright red on paper or in stool (hematochezia)
Change in bowel habitus (diarrhea or constipation)
Change in stool form (pencil thin indicates rectal valve blockage)
Tumor extension can cause buttock pain

53
Q

T/F

Colonscopy should always follow any positive test result for colorectal cancer

A

True

54
Q

What are the tests ACS recommends for avg people risk less than 50 o face for colorectal cancer

A

Annual fecal occult blood test

Sigmoidoscopy or double contract BA every 5 yrs or colonoscopy every 10 yrs, CT colonoscopy every 5 yrs

55
Q

What are the ACS recommendations for high risk colorectal

A

Colonoscopy before 50
History and physical
Digital rectal exam

56
Q

(Colorectal cancer)

Which is better, the lesion to grow inward or outward

A

You want the lesion to grow outward into the lumen of the bowel because then it is not affecting anything. Lesions that grow inward into the muscle have a much worst prognosis

57
Q

_________ is the most common malignancy of the large bowel (90-95 percent of all tumors)

A

Adenocarcinomas

58
Q

What is the 5 yr survival rate of G1-G2 of colon Adenocarcinoma

A

55 percent

59
Q

What is the 5 yr survival rate for G3-G4 of colon Adenocarcinoma

A

30 percent

60
Q

What are the 2 most important prognostic indicator for colorectal cancer

A

The number of positive nodes and the depth of penetration through the bowel wall

61
Q

Colorectal cancer usually spread through

A

Direct extension
Lymphatics
Hematogenous - distant mets

62
Q

The initial nodes involved for rectal cancer are the

A

Perirectal nodes

63
Q

T/F

About 50 percent of all patients have positive nodes at diagnosis for rectal cancer

A

True

64
Q

(Colon cancer)

_______ is the treatment of choice

A

Surgery (colon tumor surgery= right or left hemicolectomy is common)

65
Q

(LAR) low anterior resection is done for

A

Colon cancer and some rectal cancer and DOES NOT REQUIRE COLOSTOMY

66
Q

(APR) Abdominal peritoneal resection is done for

A

Done for distal rectal cancer and some anal cancer and REQUIRES COLOSTOMY

67
Q

___________ is the goal in conjunction with LAR

A

Sphincter preservation

68
Q

Disadvantage of pre-op treatment is

A

Lack of pathological staging

69
Q

Advantage of pre-op treatment is

A

The clinical down staging of the tumor and prevention of possible seeding that might be caused by surgery

70
Q

Why are patients set up on prone board for colorectal treatment

A

Bowel is a crital structure so the prone belly boards move the bowel out of the way

71
Q

(Rectum)

What is the field design

A

Encompass primary tumor plus 2-5cm margins and any pelvic lymph nodes (pre sacral and internal iliac S included because this is whee we see a lot of reoccurrence)

72
Q

Rectal cancer recurrences most often occur in the

A

Posterior aspect of the pelvis- pre sacral and internal iliacs

73
Q

Portal design for rectal cancer

A

Presacral and internal iliacs nodes included
3 or 4 field treatments usually used
PA and POF laterals
AP/PA and POF for anterior involvements (like prostate)

74
Q

The most common histology for colorectal cancer

A

Adenocarcinoma

75
Q

The most common histology for anal cancer

A

Squamous cell carcinoma

76
Q

What are the staging systems used for colorectal cancer

A

TNM
Dukes
Astler-Coller

77
Q

What is the treatment of choice for colorectal cancer

A

Surgery

78
Q

What is the most common symptom at presentation for anal cancer

A

Bleeding

79
Q

What is the most common site for distant metastasis for colorectal cancer

A

Lungs

80
Q

Describe the setup/most commonly used for colorectal cancer and the significance of the position

A

Prone on belly board with arms up. This position aides with the removal of the bowel out of the way

81
Q

Lymphatics from the right colon follows what drainage

A

SUPERIOR mesenteric vessels

82
Q

What is the dose limit for small bowel

A

4500cGy (45Gy)

83
Q

What is the most common histology for anal cancer

A

Squamous cell carcinoma

84
Q

To which nodal group would you expect DISTAL anal tumors to spread to

A

Inguinal nodes

85
Q

What 2 side effects most always occur to people receiving radiation for anal cancer

A

Erythema

Desquamation

86
Q

What is not a significant risk factor for anal cancer

A

Drinking and dieting

87
Q

T/F

A patient receiving radiation for rectal cancer should consume raw vegetables

A

False!

Should NOT consume raw vegetables

88
Q

When would a 4 field technique be used for the treatment of racial cancer instead of a 3 field technique

A

When there’s invasion/involvement of the prostate, rectum, bladder or vagina

89
Q

What is the major dose limiting structure when treating a patient for rectal cancer

A

Small bowel

90
Q

Which patient would be most likely to experience leukopenia while being radiated for rectal cancer

A

Patient receiving 3 field prone 3DCRT

91
Q

After an abdominal perineal resection APR, the inferior border for a rectal treatment field will change how

A

The inferior border will become MORE INFERIOR

92
Q

What is the standard treatment for most anal cancer

A

Radiation and chemo

93
Q

What is the standard of treatment for most colon cancer

A

Surgery and chemo

94
Q

What is the standard of treatment for most rectal cancer

A

Surgery, chemo and XRT

95
Q

At what dose should a large rectal field be boosted to include only the tumor bed

A

5500cGy (55Gy)

96
Q

At what age should a person of average risk have his or her screening colonscopy

A

50yrs old

97
Q

Familial adenomatous polyposis (FAP) and hereditary no polyposis colorectal syndrome (HNPCC) are most closely associated with which types if cancer

A

Colorectal cancer

98
Q

The vermiform appendix is most closely associated with its which potion of the disgestive tract

A

Cecum

99
Q

What is the dose limiting structure of most concern for radiation treatment of colorectal cancer

A

Small bowel

100
Q

Displacing the small bowel out of the field during treatment with radiation is more easily achievable with…

A

With pre-op

Because once surgery is done, certain anatomy and organs is removed so other organs will drop down, becoming more inferior

101
Q

What substance is responsible for the brown color of feces

A

Bilirubin

102
Q

What is NOT a risk factor for Anal cancer

A

Diet

103
Q

What are the risk factors for anal cancer

A

HPV
Immunosuppression
Anal intercourse

104
Q

When treating anal cancer with just XRT, what total dose is given

A

Just XRT, total dose is 60-65Gy

Larger field is 60-65Gy
Smaller field is 55-60Gy

105
Q

IORT typically utilizes

A

Electrons

106
Q

What is the most common site for distant spread from colorectal cancer

A

Liver

107
Q

What condition is closely associated with adenomatous polyposis

A

Gardner syndrome

108
Q

What’s the most common histology for anal cancer

A

Squamous cell carcinoma

109
Q

T/F

About 50% of patients with colorectal cancer present with positive nodes

A

TRUE

110
Q

What are the foods patients that undergo radiation for colorectal should AVOID

A

Whole grains
Fresh veggies
Dairy products
Raw veggies

111
Q

What cancer would radiation treatment to likely include the inguinal lymph nodes

A

Anal cancer

112
Q

Lymphatics of the DESCENDiNG colon drain follows the….

A

INFERIOR mesenteric artery

113
Q

What is the inner most lining of the bowel

A

Mucosa

114
Q

The staging system most commonly used for colorectal cancer

A

TNM

115
Q

What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall

A

Surgery, chemo and XRT

116
Q

Neoadjuvant chemoradiation is given…

A

To shrink tumor BEFORE surgery

117
Q

When NOT counting prostate and breast cancer, colorectal cancer is the _______ leading cause of cancer death

A

Second leading cause of cancer death

118
Q

What is the most common presenting symptom for colorectal cancer

A

Hematochezia ( blood found in stool)

Therapy Prin & Procedure (17 decks)

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