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Clin med GI > Colorectal/ pancreatic cancer > Flashcards

Colorectal/ pancreatic cancer Flashcards

1
Q

What is a colectomy

A

Resection/removal of any extent of the large bowel

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2
Q

What is a colonic polyp

A

mass of tissue that arises form bowel wall and protrudes into the lumen

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3
Q

What is the main concern of colonic polyps

A

Malignant transformation
*most colon cancer arise from previously benign adenomatous polyp

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4
Q

What is the treatment for polyps

A

colonoscopies removal

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5
Q

What are the two shapes of a colonic polyp

A

sessile
pedunculate

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6
Q

What may multiple polyps represent

A

familial adenomatous polyposis

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7
Q

Where are polyps most common

A

rectum and sigmoid
*decrease frequency in cecum

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8
Q

What is the polyp with the greatest concern

A

adenomatous (neoplastic) polyp

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9
Q

What are the different types of adenomas that a polyp can have

A

tubular
tubulo-villous
villous

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10
Q

How are non-adenomatous polyps classified

A

hyperplastic
hamartomas
juvenile
pseudo-polyp
leiomyomas

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11
Q

When is treatment done for non-neoplastic polyps

A

uncontrollable bleeding
intussusception

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12
Q

What is the most frequent complain with colonic polyps

A

rectal bleeding

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13
Q

What type of polyp may cause watery diarrhea and what might it cause

A

Large villous adenoma
hypokalemia

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14
Q

How are polyps diagnosed

A

Colonoscopy

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15
Q

Where is a colonoscopy done

A

complete, including the cecum

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16
Q

what helps prevent colonic polyps

A

ASA + COX2 inhibitors

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17
Q

What is familial adenomatous polyposis (FAP)

A

hereditary disorder causing numerous colonic polyps and frequently resulting in colorectal cancer by 40y/o

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18
Q

How do you treat FAP

A

Colectomy

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19
Q

When do polyps generally present with FAP

A

by age 15

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20
Q

What is indicative of classic FAP

A

100+ polyps
*surgical removal manages and reduces CRC risk

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21
Q

What is indicative of attenuated FAP

A

20-100 polyps with continued polyp development and increased CRC if not removed
*generally occurs later in life

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22
Q

What is Gardner syndrome

A

FAP variant with multiple colonic polyps and tumors outside the GI tract

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23
Q

What is Turcot syndrome

A

multiple colonic polyps and increased risk of CRC and brain tumors (glioblastoma/ medulloblastoma)

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24
Q

How do you diagnose/work up FAP

A

Colonoscopy
Genetic testing of patient & first degree relative

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25
Q

What are offspring of those with FAB screened for

A

hepatoblastoma

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26
Q

When are children screened for hepatoblastoma and How is it completed

A

From birth - 5year with annual serum alphafetoprotein and liver US

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27
Q

What is the treatment guideline for FAP

A

Endoscopic surveillance of remainder of GI tract
Annual thyroid screening w/ US
NSAIDs

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28
Q

What is hematochezia

A

blood in stool

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29
Q

What are the symptoms of CRC

A

blood in stool and change in bowel habits

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30
Q

What is the treatment for CRC

A

surgical resection with chemotherapy +/- radiotherapy

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31
Q

Where does CRC generally present in the body

A

Rectum and sigmoid
*generally adenocarcinoma

32
Q

What is the third most common cancer

A

CRC

33
Q

Where in the world does CRC have the highest incidence rate

A

Australia
New Zealand

34
Q

Where is the lowest incidence rate of CRC

A

Western Africa

35
Q

What are some predisposing factors for CRC

A

FAP
Ulcerative colitis and crohns
Diet low in fiber, high in fat, refined carbs, and animal protein (red meat specifically)

36
Q

How does CRC spread

A

Spreads by extension through bowel wall, hematogenous metastasis, regional lymph node metastasis, and perineurial spread

37
Q

How long does it generally take classic CRC to occur

A

10-15 years for enough mutations and epigenetic alterations to occur

38
Q

When should colonoscopy be done for average risk patients

A

45-75

39
Q

If a first degree relative has CRC, when should screening begin

A

40y/o OR
10 years before the age of relative at time of dx

40
Q

What is a FOBT and when is it preformed

A

fecal occult blood test
every year

41
Q

How often do first degree relatives of those with CRC need to be screened

A

Q 5 years

42
Q

If someone has a + fecal DNA-FIT test, what is the next step in their screening

A

colonoscopy within 6 months

43
Q

Does a - fit test r/o cancer

A

no

44
Q

What is a blood based test for CRC screening

A

Septin 9 assay
*avg risk patients only and not very sensitive

45
Q

What are properties of right colon cancer

A

large caliber/thin wall tube
contents are liquid
bleeding is usually occult

tumors grow large enough to palpate through abd wall before sx present

46
Q

What are properties of left colon cancer

A

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

47
Q

What is the initial symptoms of rectal cancer

A

Bleeding with defecation

48
Q

What is tenesmus

A

sensation of incomplete evacuation

49
Q

What diagnostic testing is used for CRC

A

colonoscopies bx
CT to evaluate tumor growth
genetic testing

50
Q

How are sessile polyps removed

A

surgical excision

51
Q

What is preformed once CRC is diagnosed

A

met search via CT and CXR
routine labs to evaluate anemia and overall condition

52
Q

What is serum carcinoembryonic antigen (CEA) utilized for

A

**NOT for screening

will be low after colon tumor removal so may detect reoccurrence earlier

53
Q

What does follow-up look like post CRC removal

A

1 yr post surgery
then 3yrs
then every 5 years

54
Q

What are the different forms of pancreatic cancer

A

adenocarcinoma
neuroendocrine
cystadenocarcinoma
intraductal papillary-mutinous tumor

55
Q

Where does most of pancreatic cancer arise from

A

ductal** and acinar cells
*generally adenocarcinoma

56
Q

When are adenocarcinoma diagnosed

A

55years old
*generally in men

57
Q

What are the risk factors for pancreatic cancer

A

smoking
chronic pancreatitis
obesity
male
African American

58
Q

What are early s/sx of pancreatic cancer

A

pain and weight loss
*upper abd pain that radiates to back

59
Q

If the cancer is in the head of the pancreas, what are the signs

A

obstructive jaundice

60
Q

If there is cancer in the body/tail of the pancreas, what are the signs

A

splenomegaly, gastric/esophageal varices, GI hemorrhage

61
Q

What are more severe clinical presentations of pancreatic cancer

A

diabetes
exocrine insufficiency
malabsorption

62
Q

What imaging is done for working up pancreatic cancer

A

CT (pancreatic technique) or MRI followed by endoscopic US (EUS)

63
Q

How is the pancreatic cancer workup when someone has obstructive jaundice

A

ERCP

64
Q

What lab tests are done for workup of pancreatic cancer

A

CBC, CMP, CA 19-9
*amylase and lipase generally normal

65
Q

What is the prognosis for pancreatic cancer

A

5 years

66
Q

Who will use CA19-9 for screening

A

High risk individuals
BRCA2
HNPCC mutations

67
Q

What is the treatment for pancreatic cancer

A

Whipple
+ adjunctive chemo/radiation

68
Q

What is the treatment for pancreatic CA with an unresectable tumor

A

symptom control
-billiary stent
-duodenal stent

69
Q

Is addiction a concern in regards to pain control with pancreatic cancer tx

A

NO

70
Q

What do pancreatic neuroendocrine tumors arise from

A

islets and gastrin producing cells
*generally produce many hormones

71
Q

What is the treatment for neuroendocrine pancreatic cancer

A

surgical resection

72
Q

What is the presentation of a cystadenocarcinoma

A

upper abdominal pain with a palpable mass
*rare pancreatic cancer

73
Q

What causes an intraductal papillary-mucinous tumor

A

mucus hyper secretion and ductal obstruction

74
Q

Where are intraductal-mucinous most common

A

Women
tail of pancrea
*presents as chronic pancreatitis

75
Q

When is pancreatic cancer typically diagnosed

A

Late stage

Clin med GI (9 decks)

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