Colorectal screening and cancer, rectal cancer and anal cancer Flashcards
When do you start obtaining a family history and when do you update it?
Age 20 and update every 5-10years
Who are we suspicious of for colorectal malignancy?
any patient over 40 with bowel changes and hematochezia
Who is average risk patient for colorectal screening?
asymptomatic and over 50 or over 45 if African American
When do we stop colorectal screenings?
over 85
Gold standard cancer prevention test?
colonoscopy every 10 years
Do we offer cancer prevention or cancer detection test first?
cancer prevention tests
Cancer detection tests
Annual fecal immunochemical test - don’t have to change diet, do at home and mail in
Annual fecal occult blood test- ptn can’t take aspirin or certain food; office or at home
Fecal DNA every 1-3 years- most sensitive; need to give a whole stool sample
If a cancer detection test is positive then do what?
cancer prevention test
Patient has one 1st degree relative with CRC or advanced adenoma less than 60yo
begin screening at age 40 or at an age 10 yrs younger than when person diagnosed. Get a colonoscopy every 5 yrs after.
Ex. Mother diagnosed at 45, you start getting tested at 35.
Patient has one first-degree relative with CRC or adenoma over 60 is screened how?
same as average risk person
Patient has over 2 first-degree relative with CRC or advanced adenoma of any age
begin screening at age 40 or at an age 10 yrs younger than when person diagnosed. Get a colonoscopy every 5 yrs after.
Ex. Mother diagnosed at 45, you start getting tested at 35.
Patient with lynch syndrome risk screening
Start at 20-25 or 10 yrs less than youngest affected relative and get colonoscopy every 1-2 yrs until 40, then yearly.
Genetic testing
Patient with FAP risk screening
Age 10-12 get sigmoidoscopy yearly
colonoscopy yearly after first polyp discovered
genetic testing
Patient with personal history of CRC
Total colon examination within 1 yr of resection and repeat at 3 yrs and 5 yrs if normal
Patient with personal history of adenoma
poylps removed and colonoscopy based on timeline
IBD patient
begin 8 years after onset of pancolitis
colonoscopy every 1-2 yrs
Who is most likely to get colorectal cancer?
age 50 -65; males; african americans
Where are colorectal cancers prevalent?
W. industrialized countries due to diet
Location of colorectal cancers
L. colon most common
R. colon is inherited in African Americans
Cause of CRC
genetic and molecular alterations
RF CRC
Modifiable - W. diet (red meat, fats) - obesity - smoking - alcohol - diabetes Non-modifiable - African American - Hereditary Polyposis Syndromes - FHx of colon cancer - increase in age - IBD - Childhood abdominal radiation
Modifiable prevention CRC
diet and macronutrients- veggie, fruit, less red meat, fiber
physical activity
Low dose aspirin
Clinical R. side CRC
- vague abdominal pain
- iron deficient anemia
- fatigue
- GI bleed
- weakness due to blood loss
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor
Clinical L. side CRC
- obstructive symptoms
- colicky abdominal pain
- change in bowel habits
- constipation alternating with loose stools
- stool streaked with blood
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor
Dx CRC
colonoscopy with biopsy
Labs for CRC
LFT- elevated with metastasis Carcionembryonic antigen (CEA) level- staging; drops/normalize means treatment working CT chest and abdomen
Staging CRC
T- depth of tumor penetration into the bowel wall
N- presence of lymph node involvement
M- presence/ absence of distant metastasis
Tx CRC
Surgery- resection of primary colonic or rectal cancer is tx of choice
Chemo- stage 3 and 4
Radiation and chemo- rectal cancer stage 2-4 (decrease mass and preserve sphincter)
Monoclonal antibodies that work against epidural growth factor receptor
cetuximab and panitumab; rash is good
What is patient is KRAS and NRAS wildtype?
improved tx with monoclonal antibodies
Clinical Rectal cancer
- rectal tenesmus
- urgency
- recurrent hematochezia
- narrow caliber stools
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor
What imaging can help with operative management of rectal cancer?
endorectal ultrasonography
Tx rectal cancer
- higher recurrence rate and lower long-term survival
Stage 1= surgery
Stage 2 and 3= chemoradiation and surgery
Anatomy of anal cancer
tumors arise in mucosa- glandular, transitional, squamous
Anatomy of peri-anal/anal margin cancer
arise distal to the squamous mucocutaneous junction or within the skin
Where is the cutoff line in anal cancer?
pectinate line
MC histology for anal cancer
Small cell carcinoma
Cause of anal cancer
HPV
RF anal cancer
HPV Female lifetime number of sexual partners genital warts smoking HIV receptive anal intercourse chronic immunosuppresive condition
Clinical anal cancer
- rectal bleeding
- anorectal pain
- rectal mass sensation
- rectal mass on digital rectal exam
- condylomata
- bleeding
Initial Dx anal cancer
endoscopy with biopsy
anoscopy
rigid proctosigmoidoscopy
Once dx work up of anal cancer
CT scan of abdomen/pelvis
PET
Fine needle aspirate or biopsy of node
Stages of anal cancer
Stage 0-2= node negative
Stage 3= node +
Stage 4 = metastatic disease
Tx anal cancer
Stage 0-3 - chemoradiotherapy: 5-FU + Mitomycin + radiotherapy - surgery is disease progressing Stage 4 -systemic chemo: cisplatin + 5-FU - palliative chemoradiotherapy
Post tx surveillance of anal cancer
Every 3-6 months for 5 yrs:
- DRE, anoscopy, inguinal node palpitation
CT chest, abdomen, and pelvis every 3 years
