Colorectal Cancers Flashcards
What is the age factor for colorectal cancers
90% are over the age of 50 so this is why screening starts at age 50
Cancer in the large bowel usually occurs in which part
Usually occurs in the distal colon and rectum (sigmoid or descending colon)
At what age should a person of average risk have his or her first screening colonscopy
50 for average risk. For high risk, it should be BEFORE 50 years old.
Familial adenomatous polyps is (FAP) ad hereditary non-polyposis colorectal syndrome (HNPCC) are most closely associated with what cancer
Colorectal cancer
The vermiform appendix is most closely associated with which portion of the digestive tract?
Cecum
What is the dose limiting structure of most concern for radiation treatments of colorectal cancer
Small bowel
What substance is responsible for the brown color of feces?
Bilirubin
_________ has the highest incidence of cancer related deaths in the US compared to esophageal cancers, stomach cancers, and anal cancers.
Colorectal cancers
What are the risk factors for anal cancer
HPV Anal intercourse in those under 30 Immunosuppression Genital warts Genital infections Cigarette smoking
There is an increased incidence of anal cancer in men under 45 and this is attributed to…
An increased in homosexuality and anal intercourse
What condition is most closely associated with adenomatous polyposis
Gardner syndrome
The most common histology of anal carcinoma
Squamous cell carcinoma
T/F
About 50 percent of patients with colorectal cancer present with positive nodes
True
Foods that patient should avoid while undergoing radiation treatments for colorectal cancer
Whole grains Fresh fruits Raw veggies Fried, fatty foods Milk and dairy products
Foods that patients are encouraged to consume while undergoing radiation treatments for colorectal cancer
White bread Baked, broiled, or roasted meats Peeled apples Banana Macaroni, noodles Cooked veggies
What are the anti-diarrheal agents to help patients with diarrhea while undergoing colorectal radiation treatments
Immodium
Lomotil
Lymphatics of the descending colon drain following the path of the ……
Inferior mesenteric artery
What staging system is most widely used today for colorectal cancer
TNM
What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall
Surgery, chemo, and XRT
Between colon cancer and rectum cancer, which one have a higher incidence
Colon cancer
Rectum and colon effects men and women equally
It has been noted that cancers in the proximal (right) colon have increased in _______(male or female)
Female
________ is the 2nd leading cause of cancer deaths in the US
Colorectal cancer
Factors that has been linked to colorectal cancer
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
(Colorectal cancer)
Chronic ulcerative colitis usually occurs in the __________
Rectum and sigmoid colon
Other medical factors that contributes to colorectal cancer
chronic ulcerative colitis
Chronic’s disease
FAP (familia adenomatous polyposis)
Hereditary non-polyposis colorectal syndrome
How is FAP treated
Complete removal of the colon and return
Adenomatous polyps are growths that arise in the _______ of the bowel
Mucosal lining and it is either villous or tubular
Which type of adenomatous polyps is 8 to 10 times more likely to be malignant
Villous adenomatous polyps
(Colorectal cancer)
Another factor that contributes to colorectal cancer that is similar to FAP is ______
Gardner’s syndrome
What are the 8 regions that the colon is divided into
Cecum Ascending colon Hepatic flexure Transverse colon Splenic flexure Sigmoid Rectum
Cancer of the large bowel is divided into ______ and ______ because the symptoms, diagnosis, and treatments are different based on the location of the disease
Colon and rectum
Cancer of the colon is treated with ________
Surgery and chemo
Cancer of the rectum is treated with ______
Surgery, chemo and XRT due to its location, it only allows for small surgical margins and adjuvant treatment is often needed
Which part of the large bowel is located INTRAperitoneally
Cecum, transverse colon, and sigmoid
Which portion of the large bowel is located RETRO-peritoneally
Ascending and descending colon,
Hepatic and splenic flexures
What is the difference between the organs that is located INTRAperitoneally to that is located RETROperitoneally
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
The rectum is continuous of the ______
Sigmoid
The rectum begins at the level of the ______
3rd sacral vertebrae
Just like the sigmoid, the upper rectum is covered by _____ on the anterior and lateral surfaces
Peritoneal
The lower half to 2/3 of the rectum is located
RETROperitoneally
What are the 3 valves that the rectum is divided into
Superior, middle and inferior
The rectum acts as ___________
Acts as a holding station for fecal matter before it is ready to be excreted out of the body
Because the rectum is located RETROperioneally, tumors can invade structures such as….
Prostate, bladder, vagina, and sacrum
What are the 4 layers of the bowel
Mucosa- lumen of bowel
Submucosa- rich in lymphatics an blood vessels
Muscularis propria- muscle layer responsible for peristalsis
Serosa- layer of fat
The right colon follows the _______
Superior mesenteric vessel
The left colon follows the …..
Inferior mesenteric vessels and includes regional nodes
The sigmoid drains into the ….
Inferior mesenteric vessels and also include nodes along the superior rectal, sigmoidal and the sigmoidal mesenteric vessels
The rectal node drainage all depends on how high or low. So the upper rectum follows the
Superior rectal vessel and terminates in the inferior mesenteric nodes
The middle and lower rectum drain to the ….
Internal iliac and pre-sacral nodes
The lower rectum lesions that spread into the anal canal may end up in the …
Inguinal nodes
As you get further down the anus, you have more concerns with the ________ nodes then you would if you were more superior
Inguinal nodes
What are the clinical presentation of colorectal cancer
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
T/F
Colonscopy should always follow any positive test result for colorectal cancer
True
What are the tests ACS recommends for avg people risk less than 50 o face for colorectal cancer
Annual fecal occult blood test
Sigmoidoscopy or double contract BA every 5 yrs or colonoscopy every 10 yrs, CT colonoscopy every 5 yrs
What are the ACS recommendations for high risk colorectal
Colonoscopy before 50
History and physical
Digital rectal exam
(Colorectal cancer)
Which is better, the lesion to grow inward or outward
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
_________ is the most common malignancy of the large bowel (90-95 percent of all tumors)
Adenocarcinomas
What is the 5 yr survival rate of G1-G2 of colon Adenocarcinoma
55 percent
What is the 5 yr survival rate for G3-G4 of colon Adenocarcinoma
30 percent
What are the 2 most important prognostic indicator for colorectal cancer
The number of positive nodes and the depth of penetration through the bowel wall
Colorectal cancer usually spread through
Direct extension
Lymphatics
Hematogenous - distant mets
The initial nodes involved for rectal cancer are the
Perirectal nodes
T/F
About 50 percent of all patients have positive nodes at diagnosis for rectal cancer
True
(Colon cancer)
_______ is the treatment of choice
Surgery (colon tumor surgery= right or left hemicolectomy is common)
(LAR) low anterior resection is done for
Colon cancer and some rectal cancer and DOES NOT REQUIRE COLOSTOMY
(APR) Abdominal peritoneal resection is done for
Done for distal rectal cancer and some anal cancer and REQUIRES COLOSTOMY
___________ is the goal in conjunction with LAR
Sphincter preservation
Disadvantage of pre-op treatment is
Lack of pathological staging
Advantage of pre-op treatment is
The clinical down staging of the tumor and prevention of possible seeding that might be caused by surgery
Why are patients set up on prone board for colorectal treatment
Bowel is a crital structure so the prone belly boards move the bowel out of the way
(Rectum)
What is the field design
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)
Rectal cancer recurrences most often occur in the
Posterior aspect of the pelvis- pre sacral and internal iliacs
Portal design for rectal cancer
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)
The most common histology for colorectal cancer
Adenocarcinoma
The most common histology for anal cancer
Squamous cell carcinoma
What are the staging systems used for colorectal cancer
TNM
Dukes
Astler-Coller
What is the treatment of choice for colorectal cancer
Surgery
What is the most common symptom at presentation for anal cancer
Bleeding
What is the most common site for distant metastasis for colorectal cancer
Lungs
Describe the setup/most commonly used for colorectal cancer and the significance of the position
Prone on belly board with arms up. This position aides with the removal of the bowel out of the way
Lymphatics from the right colon follows what drainage
SUPERIOR mesenteric vessels
What is the dose limit for small bowel
4500cGy (45Gy)
What is the most common histology for anal cancer
Squamous cell carcinoma
To which nodal group would you expect DISTAL anal tumors to spread to
Inguinal nodes
What 2 side effects most always occur to people receiving radiation for anal cancer
Erythema
Desquamation
What is not a significant risk factor for anal cancer
Drinking and dieting
T/F
A patient receiving radiation for rectal cancer should consume raw vegetables
False!
Should NOT consume raw vegetables
When would a 4 field technique be used for the treatment of racial cancer instead of a 3 field technique
When there’s invasion/involvement of the prostate, rectum, bladder or vagina
What is the major dose limiting structure when treating a patient for rectal cancer
Small bowel
Which patient would be most likely to experience leukopenia while being radiated for rectal cancer
Patient receiving 3 field prone 3DCRT
After an abdominal perineal resection APR, the inferior border for a rectal treatment field will change how
The inferior border will become MORE INFERIOR
What is the standard treatment for most anal cancer
Radiation and chemo
What is the standard of treatment for most colon cancer
Surgery and chemo
What is the standard of treatment for most rectal cancer
Surgery, chemo and XRT
At what dose should a large rectal field be boosted to include only the tumor bed
5500cGy (55Gy)
At what age should a person of average risk have his or her screening colonscopy
50yrs old
Familial adenomatous polyposis (FAP) and hereditary no polyposis colorectal syndrome (HNPCC) are most closely associated with which types if cancer
Colorectal cancer
The vermiform appendix is most closely associated with its which potion of the disgestive tract
Cecum
What is the dose limiting structure of most concern for radiation treatment of colorectal cancer
Small bowel
Displacing the small bowel out of the field during treatment with radiation is more easily achievable with…
With pre-op
Because once surgery is done, certain anatomy and organs is removed so other organs will drop down, becoming more inferior
What substance is responsible for the brown color of feces
Bilirubin
What is NOT a risk factor for Anal cancer
Diet
What are the risk factors for anal cancer
HPV
Immunosuppression
Anal intercourse
When treating anal cancer with just XRT, what total dose is given
Just XRT, total dose is 60-65Gy
Larger field is 60-65Gy
Smaller field is 55-60Gy
IORT typically utilizes
Electrons
What is the most common site for distant spread from colorectal cancer
Liver
What condition is closely associated with adenomatous polyposis
Gardner syndrome
What’s the most common histology for anal cancer
Squamous cell carcinoma
T/F
About 50% of patients with colorectal cancer present with positive nodes
TRUE
What are the foods patients that undergo radiation for colorectal should AVOID
Whole grains
Fresh veggies
Dairy products
Raw veggies
What cancer would radiation treatment to likely include the inguinal lymph nodes
Anal cancer
Lymphatics of the DESCENDiNG colon drain follows the….
INFERIOR mesenteric artery
What is the inner most lining of the bowel
Mucosa
The staging system most commonly used for colorectal cancer
TNM
What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall
Surgery, chemo and XRT
Neoadjuvant chemoradiation is given…
To shrink tumor BEFORE surgery
When NOT counting prostate and breast cancer, colorectal cancer is the _______ leading cause of cancer death
Second leading cause of cancer death
What is the most common presenting symptom for colorectal cancer
Hematochezia ( blood found in stool)
