Colorectal Neoplasm Flashcards
Contrast the tests that detect cancer v. the tests that are used for cancer prevention (detect cancer).
cancer detection : gFOBT, iFOBT, stool DNA
prevention: flexible sigmoidoscopy/ 5yr, colonoscopy, barium enema/ 5 yr, CT colonography/ 5yr
What are the two most common neoplastic polyps?
adenomatous polyps and serrated polyps
<5% of neoplastic polyps will become cancers
Describe the main reasoning behind CRC screening and its efficacy.
large studies have shown that reductions in colon cancer incidence with colonoscopy and polypectomy
What are risk factors for CRC?
aging is the most significant
hx of polyps, IBD, hereditary conditions, DM, diet, smoking, sedentary lifestyle, race
*family history with affected 1st degree relative before 60yo or two 1st degree relatives of any age
What is the gene mutation that occurs in HNPCC (Lynch Syndrome).
MLH1 and MSH2
> 50% risk of developing colon cancer during lifetime and a higher risk of endromet
What intervention would you consider in someone with familial adenomatous polyposis to prevent disease?
prophylactic total colectomy
List some alarm symptoms in someone you suspect could have CRC.
pain, change in stool habits, particularly caliber with a left sided lesion, hematochezia, weight loss, iron deficiency anemia, weekness, fatigue, tenesmus
symptomatic discovery, perforation or obstruction are indicators of poor prognosis
How can the pattern of spread for rectal cancer diverge from that of colon cancer.
lower and mid rectum drainage through the hypogastric vessels to the systemic circulation leads to lung metastases
What are CEA levels helpful for determining?
routine lab eval of carcinoembryonic antigen is not great for diagnosis but good to follow for disease progression
What diagnostic study is useful in staging rectal cancer?
transrectal ultrasound or MRI of the pelvis to determine how deeply a lesion has penetrated into the rectal and lymph involvement
What is the primary treatment of localized colorectal cancer?
remove the tumor with adequate margins as well as the lymphovascular drainage basin
colon: hemicolectomy
rectal: low anterior resection or abdominal perineal resection
In which patients would adjuvant chemotherapy or neoadjuvant radio/chemo therapy
in those with stage II+ disease or nodal involvement, adjuvant therapy can be useful (reduces reoccurrence by 50% in these patients)
neoadjuvant radiotherapy and chemotherapy can be really important with rectal cancer patients in which resection more limited
Describe the standard adjuvant chemotherapy regimen.
FOLFOX: 5FU, oxaliplatin and leucovorin
Describe cold induced neuropathy and hand foot syndrome, side effects of FOLFOX
hand and foot: redness, dryness and peeling of the hands and feet
cold induced neuropathy: contact with cold metal, air etc. initiates a tingling/numbness in the of whatever is in contact with cold (specifically due to the oxaplatin)
What are non-chemotherapeutic measures to decrease the risk of CRC recurrence?
aspirin exercise low glycemic index diet calcium/milk products vitamin D?
