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GI > CRC > Flashcards

CRC Flashcards

1
Q

Most common colorectal cancer

A

95% adenocarcinoma
2/3 colon
1/3 rectal

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2
Q

How many cases of CRC are sporadic?

A

85%
10% familial risk
1% underlying IBD

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3
Q

Risk factors

A 
Age
Male 3:2 Female
Previous adenoma/CRC
Smoking
Obesity
Diabetes mellitus
Diet - decreased fibre, fruit and veg, calcium, increased red meat and alcohol
Streptococcus bovis bacteraemia
IBD - ulcerative colitis > crohns
Congenital
Genetic
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4
Q

Predisposing inheritable factors for CRC

A

HNPCC (Lynch syndrome)

FAP

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5
Q

Which structures give rise to majority of CRCs?

A

Colorectal polyps

100s-1000s by FAP

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6
Q

Classification of colorectal polyps

A

Benign or malignant

Epithelial or mesenchymal

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7
Q

Define an adenoma

A

Benign, pre-malignant growth of epithelial origin

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8
Q

3 types of adenoma and rate of occurence

A

Tubular 75%
Tubuovillous (15%)
Villous 10%

Pedunculated or sessile - stalk or no stalk

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9
Q

What characterises a high risk adenoma

A

Size
Number
Degree of dysplasia
Villous architecture

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10
Q

An adenoma can progress to …

A

An invasive carcinoma

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11
Q

Describe the evolution of an adenoma to an invasive carcinoma

A

Activation of oncogene - kras, c-myc
Loss of tumour suppressor gene - APC, p53, DCC
Defective DNA Repair Pathway genes - microsatellite instability

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12
Q

3 processes in malignancy

A

Cell growth
Proliferation
Apoptosis

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13
Q

Oncogenes involved in CRC

A

K ras, c-myc

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14
Q

TSG lost in CRC

A

APC, p53, DCC

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15
Q

6 Aspects of Presentation

A
  1. Rectal bleeding (faecal occult blood)
  2. Altered bowel opening to loose stools for more than weeks
  3. Iron deficiency Anaemia
  4. Palpable rectal or Right lower abdominal mass
  5. Acute colonic obstruction (stenotic tumour)
  6. Systemic symptoms - weight loss, fatigue, anorexia
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16
Q

Investigation of CRC

A 
Screening- faecal occult blood test
Bloods - FBC for anaemia, CEA
Colonoscopy
Barium enema - apple core sign
CT colonography
CT abdo/pelvis
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17
Q

Staging investigations

A

CT chest/abdo/pelvis
MRI for rectal tumours
PET/rectal endoscopic US

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18
Q

Staging systems

A 
TNM
Dukes
A-confined to muscularis mucosa
B- extended beyond muscularis mucosa
C- lymph nodes
D- distant metastases
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19
Q

Treatment

A

Surgery

  • Duke A and polyps - Endoscopic/ local resection
  • Laparotomy
  • Colostomy
  • Hepatectomy for metastases

Conservative - macmillan nurse and patient education

Chemotherapy

  • Dukes C and B, postive lymph node
  • Agents - oxaliplatin, 5- FU (fluorouracil)

Radiotherapy - rectal cancer only

Palliative
Chemo, colonic stenting to prevent obstruction

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20
Q

Purpose of screening

A

Detect pre-malignancies

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21
Q

Modalities of screening

A 
Faecal Occult Blood Test
Faecal immunochemical test (FIT)
Flexible sigmoidoscopy
Colonoscopy
CT colonography
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22
Q

Uses of colonoscopy

A

Biopsy

Polypectomy

23
Q

Risks associated with colonsocopy

A

Perforation and Bleeding

Sedation and bowel prep needed

24
Q

High Risk groups for CRC

A

HNPCC, FAP
IBD
Familial
Previous adenomas/CRC

25
Q

What groups are offered CRC screening?

A

Ages 50-74
2 yearly FOBT
If positive offered colonoscopy

26
Q

Which gene is mutated in Familial Adenomatous Polyposis

A

APC on chromosome 5

27
Q

What is the inheritance pattern of FAP mutations?

A

Autosomal dominant

28
Q

How does FAP present?

A

Multiple adenomas of the colon
50% by age of 15
95% by age 35

Extra-colonic manifestations
Desmoid Tumours
Congenital Retinal Hypertrophy of the Pigment Epithelia (CRHPE)

29
Q

How often should someone with FAP be screened

A

Annually from age 10-12

30
Q

Prophylaxis offered with FAP?

A

Proctocolectomy from 16-25

31
Q

Extra-colonic manifestations of FAP

A

Benign gastric fundic cystic hyperplasia
Duodenal adenomas in 90%
Periampullary cancer 5%

32
Q

Chemoprevention in FAP

A

NSAIDS
Sulindac
Reduces polyp number
Prevents recurrence of high grade adenomas in retained rectal segment

33
Q

Pattern of inheritance of Hereditary Non-Polyposis Colorectal Cancer

A

Autosomal Dominant

34
Q

What mutation occurs in HNPCC

A

DNA mismatch repair - MLH1, MSH2

Causes microsatellite instability

35
Q

Presentation of CRC in HNPCC

A

Early onset

Right sided

36
Q

Associated cancers with HNPCC

A 
Genitourinary
Endometrial
Stomach
Pancreas
CNS- glioblastoma
37
Q

Diagnostic Criteria for HNPCC

A

Amsterdam/Bethesda

Genetic testing

38
Q

Screening for HNPCC

A

From age 25

2 yearly colonoscopy

39
Q

Congenital risk factors for CRC

A

Juvenile Polyposis Syndrome - Autosomal dominant

Peutz-Jeghers - Autosomal dominant, melanosis of oral mucosa

40
Q

Complications of CRC

A

Obstruction
Intussusception
Heavy bleeding
Metastasis

41
Q

2 expressions of FAP

A

FAP coli -osteoma, epidermoid cysts, fibromas, desmoid tumours, lipomas, supernumeray teeth, periampullary cancers

Gardner Syndrome

42
Q

Most common cancer syndrome

A

HNPCC lynch

43
Q

Pathology of IBD –> CRC

A

Inflammation –> dyspasia –> carcinoma

44
Q

Common subtypes of adenocarcinoma

A

Mucinous
Signet ring
Medullary

45
Q

Site of CRC with increasing age

A

RHS
Age related change
Most present in sigmoid and rectum

46
Q

Difference between left and right tumours

A

Right tend to be larger, more aggressive, distant metastases

Left - altered bowel habit, obstruction, hematochezia (fresh bleeding in anus)

47
Q

Gold standard treatment

A

Endoscopy
Detection
Treatment of minor lesions - polypectomy, mucosal resection, submucosal dissection

48
Q

Most common sites of distant metastases

A

Liver
Lung
Bone

49
Q

What are Krukenberg’s tumours?

A

Present first as ovarian lesions

Tumours secondary to Colorectal or GI cancer

50
Q

What plexus is within the submucosa?

A

Meissner’s

51
Q

What plexus is withint the muscularis propria?

A

Auerbach’s

52
Q

Which part of the rectum are lesions most likely to spread to the peritoneum?

A

Upper rectum

Majority is extraperitoneal

53
Q

Fascia surrounding Mesorectal fascia

A

Waldeyer;s fascia- separate from sacrum posteriorly

Denonvillier’s fascia - separate from prostate anteriorly

54
Q

Mesorectal fascia extends to which set of muscle?

A

Levator ani - puborectal sling

GI (8 decks)

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