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Clin Med 3 > E2: Colon Cancer > Flashcards

E2: Colon Cancer Flashcards

1
Q

What is it called when there is a growth on the inner surface of the colon?

A

A polyp

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2
Q

What is pedunculated polyp?

A

A polyp that is attached to the colon by a stem or stalk

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3
Q

What is a flat polyp called?

A

Sessile

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4
Q

What are the 4 types of polyps?

A
  • hyperplastic (non-neoplastic)
  • Pseudopolyps (non-neoplastic)
  • Adenomas (neoplastic)
  • Sessile serrated polyps
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5
Q

What is the most common type of polyp?

A

Adenomas (2/3s of all colon polyps)

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6
Q

What does most colorectal cancer arise from?

A

Adenomas

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7
Q

What classifies as an “advanced” Adenoma?

A
  • ≥1cm
  • villous component
  • high grade dysplasia
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8
Q

The risk of CRC increases by what 3 things?

A

The number, size, and histology of adenomas

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9
Q

What are the 3 kinds of adenoma polyps and what is the most common?

A
  • Tubular adenoma (most common)
  • Tubulovillous adenoma
  • villous adenoma
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10
Q

What is the 2nd leading cause of cancer deaths in the US?

A

Colorectal cancer

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11
Q

95% of CRC are ***.

A

Adenocarcinomas

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12
Q

Where does CRC most commonly occur?

A

-Left sided is most common, but right sided cancer rates are rising

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13
Q

What are the risk factors for CRC?

A
  • Personal or family history of CRC/adenomas, familial adenomatous polyposis, or HNPCC
  • Personal history of inflammatory bowel disease
  • age >50
  • African American
  • tobacco use
  • alcohol
  • high fat/low fiber and red meat intake
  • DM
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14
Q

What is the clinical presentation of CRC?

A
  • Patients are often asymptomatic

- Red flag symptoms: Change in bowel habits, hematochezia, IDA, anorexia, abdominal pain

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15
Q

What are the blood tests to evaluate for CRC?

A
  • CBC: evaluate for IDA
  • liver tests: alk phos may be elevated with liver Mets
  • Carcinoembryonic antigen (CEA): not used for screening, but helpful for prognostic indicator and monitoring for recurrence
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16
Q

What are the scans you can order to evaluate for CRC?

A
  • Colonoscopy: permits biopsy for pathologic confirmation

- CT chest, abdomen, and pelvis to demonstrate tumor extension, complication, regional lymphatic and distant metastases

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17
Q

What might you see on barium enema that is suggestive of CRC?

A

Apple core lesion

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18
Q

What is the management of CRC/

A
  • Partial collectors with wide margins and adjacent lymph node removal
  • chemotherapy (if Mets)
  • radiation (commonly for rectal adenocarcinoma)
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19
Q

What is used for surveillance for CRC?

A
  • Serial CEA levels
  • annual surveillance CT chest/abd/and pelvis
  • periodic colonoscopy
20
Q

What are the visualization tests you can use to screen for CRC?

A

Colonoscopy, flex sig, and CT colonography

21
Q

What are the stool based tests used to evaluate for for CRC?

A

-gFOBT, FIT, and FIT DNA

22
Q

What is the gold standard to diagnose CRC?

A

Colonoscopy

23
Q

What are the advantages of colonoscopy?

A
  • Ability to visualize the entire colon
  • able to detect and remove polyps to prevent them from turning into cancer
  • high sensitivity for CRC and advanced adenomas
  • single session
  • Long screening intervals
24
Q

What are the disadvantages of colonoscopy?

A
  • Highest cost, limited access
  • bowel prep
  • invasive
  • complications
  • sedation and chaperone
  • no infalliable
25
Q

What are the advantages of Flex sig?

A
  • limited prep
  • no sedation
  • lower cost
  • lower risk than colonoscopy for perforation
26
Q

What are the disadvantages of Flex sig?

A
  • Only reaches the distal 1/3 of the colon, deficiency in protect against proximal lesions
  • if polyps are found, need colonoscopy to r/o proximal lesions
27
Q

What is a CT colonography?

A

-A virtual colonoscopy that produces 2D/3D images of the bowel mucosa

28
Q

What are the disadvantages of a CT colonography?

A
  • can miss flat or small polyps

- unable to remove polyp, would need colonoscopy

29
Q

What is the main limitation for the stool based tests in detecting CRC?

A

Most polyps do not bleed and these tests detect blood

30
Q

What are the limitations of the gFOBT (high sensitivity hemoccult SENSA)?

A
  • Requires 3 consecutive stools
  • dietary modifications required
  • if positive result, needs COY
  • Sensitivity for one time screening is not ideal, annual use is recommended
31
Q

What are the dietary modifications that must be made prior to the gFOBT test?

A

Avoid red meat, iron supplements, Vitamin C, and NSAIDs

32
Q

How does the FIT test work?

A

Tests for the presence of human hemoglobin

33
Q

How does the FIT-DNA test work?

A

-combines FIT with testing for DNA mutation bio markers in cells shed by CRC

34
Q

What are the disadvantages of the FIT-DNA?

A
  • there are increased false positives when compared to FIT

- require entire bowel movement

35
Q

What is the preferred stool test for CRC?

A

FIT, though COY is still gold standard

36
Q

When should you start CRC screening if the patient has a single 1st degree relative with CRC or a documented adenoma diagnosed <60, or with more than two 1st degree relative diagnosed at any age?

A

Colonoscopy every 5 years beginning at age 40 or 10 years younger than the age at which the youngest 1st degree relative was diagnosed

37
Q

When should you start CRC screening in a patient who has a single 1st degree relative with CRC or documented advanced adenoma diagnosed >60?

A

Begin screening at 40 and if normal, screen as average risk individual

38
Q

What is familial adenomatous polyposis (FAP)?

A
  • An autosomal dominant APC gene mutation that results in >100 adenomatous polyps that emerge at around 16 years old
  • nearly 100% will progress to CRC by age 39 if untreated
39
Q

What is the typical recommended treatment for FAP?

A

-Prophylactic colectomy

40
Q

What are the extracolonic malignancies that people with FAP are at increased risk for?

A
  • gastric/duodenal/ampullary carcinoma
  • follicular or papillary thyroid cancer
  • hepatoblastoma
  • CNS tumors
41
Q

When should you start screening patients with FAP? How should you screen?

A
  • sigmoidoscopy/colonoscopy starting at 10-12 yo and repeating every 1-2 years
  • routine EGD recommended
  • Screen for extracolonic malignancies (thyroid US etc)
42
Q

What is hereditary Nonpolyposis colon cancer (HNPCC)?

A
  • AKA lynch syndrome
  • an autosomal dominant germline mutation in one of severeal DNA mismatch repair genes that results in increased risk for CRC, usually between ages 45-60
43
Q

What other malignancies are very common with HNPCC?

A

-Endometrial is most common, may also have ovarian, small bowel, gastric, renal/ureter/bladder, brain

44
Q

What is the criteria that is used to evaluate if a patient has lynch syndrome? What does the criteria require?

A
  • Amsterdam criteria
  • 3-2-1 rule: 3 affected family members, at least two from successive generations, and at least one diagnosed before age 50
45
Q

When should you starting screening for CRC in patient with HNPCC?

A

-Annual colonoscopy beginning between ages 20-25, or 2-5 years prior to the earliest age of CRC diagnosis in the family

Clin Med 3 (17 decks)

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