Colorectal/ pancreatic cancer Flashcards
What is a colectomy
Resection/removal of any extent of the large bowel
What is a colonic polyp
mass of tissue that arises form bowel wall and protrudes into the lumen
What is the main concern of colonic polyps
Malignant transformation
*most colon cancer arise from previously benign adenomatous polyp
What is the treatment for polyps
colonoscopies removal
What are the two shapes of a colonic polyp
sessile
pedunculate
What may multiple polyps represent
familial adenomatous polyposis
Where are polyps most common
rectum and sigmoid
*decrease frequency in cecum
What is the polyp with the greatest concern
adenomatous (neoplastic) polyp
What are the different types of adenomas that a polyp can have
tubular
tubulo-villous
villous
How are non-adenomatous polyps classified
hyperplastic
hamartomas
juvenile
pseudo-polyp
leiomyomas
When is treatment done for non-neoplastic polyps
uncontrollable bleeding
intussusception
What is the most frequent complain with colonic polyps
rectal bleeding
What type of polyp may cause watery diarrhea and what might it cause
Large villous adenoma
hypokalemia
How are polyps diagnosed
Colonoscopy
Where is a colonoscopy done
complete, including the cecum
what helps prevent colonic polyps
ASA + COX2 inhibitors
What is familial adenomatous polyposis (FAP)
hereditary disorder causing numerous colonic polyps and frequently resulting in colorectal cancer by 40y/o
How do you treat FAP
Colectomy
When do polyps generally present with FAP
by age 15
What is indicative of classic FAP
100+ polyps
*surgical removal manages and reduces CRC risk
What is indicative of attenuated FAP
20-100 polyps with continued polyp development and increased CRC if not removed
*generally occurs later in life
What is Gardner syndrome
FAP variant with multiple colonic polyps and tumors outside the GI tract
What is Turcot syndrome
multiple colonic polyps and increased risk of CRC and brain tumors (glioblastoma/ medulloblastoma)
How do you diagnose/work up FAP
Colonoscopy
Genetic testing of patient & first degree relative
What are offspring of those with FAB screened for
hepatoblastoma
When are children screened for hepatoblastoma and How is it completed
From birth - 5year with annual serum alphafetoprotein and liver US
What is the treatment guideline for FAP
Endoscopic surveillance of remainder of GI tract
Annual thyroid screening w/ US
NSAIDs
What is hematochezia
blood in stool
What are the symptoms of CRC
blood in stool and change in bowel habits
What is the treatment for CRC
surgical resection with chemotherapy +/- radiotherapy
Where does CRC generally present in the body
Rectum and sigmoid
*generally adenocarcinoma
What is the third most common cancer
CRC
Where in the world does CRC have the highest incidence rate
Australia
New Zealand
Where is the lowest incidence rate of CRC
Western Africa
What are some predisposing factors for CRC
FAP
Ulcerative colitis and crohns
Diet low in fiber, high in fat, refined carbs, and animal protein (red meat specifically)
How does CRC spread
Spreads by extension through bowel wall, hematogenous metastasis, regional lymph node metastasis, and perineurial spread
How long does it generally take classic CRC to occur
10-15 years for enough mutations and epigenetic alterations to occur
When should colonoscopy be done for average risk patients
45-75
If a first degree relative has CRC, when should screening begin
40y/o OR
10 years before the age of relative at time of dx
What is a FOBT and when is it preformed
fecal occult blood test
every year
How often do first degree relatives of those with CRC need to be screened
Q 5 years
If someone has a + fecal DNA-FIT test, what is the next step in their screening
colonoscopy within 6 months
Does a - fit test r/o cancer
no
What is a blood based test for CRC screening
Septin 9 assay
*avg risk patients only and not very sensitive
What are properties of right colon cancer
large caliber/thin wall tube
contents are liquid
bleeding is usually occult
tumors grow large enough to palpate through abd wall before sx present
What are properties of left colon cancer
smaller lumen, semisolid feces
obstruction earlier than r. colon
stool streaked with blood
sx. of perf
partial obstruction with colicky abd pain
Complete obstruction generally initial manifestation
What is the initial symptoms of rectal cancer
Bleeding with defecation
What is tenesmus
sensation of incomplete evacuation
What diagnostic testing is used for CRC
colonoscopies bx
CT to evaluate tumor growth
genetic testing
How are sessile polyps removed
surgical excision
What is preformed once CRC is diagnosed
met search via CT and CXR
routine labs to evaluate anemia and overall condition
What is serum carcinoembryonic antigen (CEA) utilized for
**NOT for screening
will be low after colon tumor removal so may detect reoccurrence earlier
What does follow-up look like post CRC removal
1 yr post surgery
then 3yrs
then every 5 years
What are the different forms of pancreatic cancer
adenocarcinoma
neuroendocrine
cystadenocarcinoma
intraductal papillary-mutinous tumor
Where does most of pancreatic cancer arise from
ductal** and acinar cells
*generally adenocarcinoma
When are adenocarcinoma diagnosed
55years old
*generally in men
What are the risk factors for pancreatic cancer
smoking
chronic pancreatitis
obesity
male
African American
What are early s/sx of pancreatic cancer
pain and weight loss
*upper abd pain that radiates to back
If the cancer is in the head of the pancreas, what are the signs
obstructive jaundice
If there is cancer in the body/tail of the pancreas, what are the signs
splenomegaly, gastric/esophageal varices, GI hemorrhage
What are more severe clinical presentations of pancreatic cancer
diabetes
exocrine insufficiency
malabsorption
What imaging is done for working up pancreatic cancer
CT (pancreatic technique) or MRI followed by endoscopic US (EUS)
How is the pancreatic cancer workup when someone has obstructive jaundice
ERCP
What lab tests are done for workup of pancreatic cancer
CBC, CMP, CA 19-9
*amylase and lipase generally normal
What is the prognosis for pancreatic cancer
5 years
Who will use CA19-9 for screening
High risk individuals
BRCA2
HNPCC mutations
What is the treatment for pancreatic cancer
Whipple
+ adjunctive chemo/radiation
What is the treatment for pancreatic CA with an unresectable tumor
symptom control
-billiary stent
-duodenal stent
Is addiction a concern in regards to pain control with pancreatic cancer tx
NO
What do pancreatic neuroendocrine tumors arise from
islets and gastrin producing cells
*generally produce many hormones
What is the treatment for neuroendocrine pancreatic cancer
surgical resection
What is the presentation of a cystadenocarcinoma
upper abdominal pain with a palpable mass
*rare pancreatic cancer
What causes an intraductal papillary-mucinous tumor
mucus hyper secretion and ductal obstruction
Where are intraductal-mucinous most common
Women
tail of pancrea
*presents as chronic pancreatitis
When is pancreatic cancer typically diagnosed
Late stage
