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Clinical Med III > Exam 2 - Colon Cancer > Flashcards

Exam 2 - Colon Cancer Flashcards

1
Q

Compare a pedunculated and a sessile colon polyp.

A

Pedunculated - attached by stem/stalk

Sessile - Flat

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2
Q

What is the most common adenoma classification of colon polyps?

A

Tubular adenoma

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3
Q

What is an emerging type of pre-cancerous polyp?

A

Sessile serrated polyp

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4
Q

What is the most common origin site of CRC?

A

Left-sided colon

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5
Q

What is the most common clinical presentation associated with CRC?

A

Asymptomatic

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6
Q

What are some red flag symptoms associated with the clinical presentation of CRC?

A
  • Change in bowel habits
  • Hematochezia or occult blood in stool
  • Iron Deficiency Anemia
  • Anorexia/Weight loss
  • Abdominal pain
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7
Q

What is a classic finding on imaging to support colon cancer?

A

“Apple core” lesion

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8
Q

What does the TNM system stand for?

A

Tumor
Node
Metastasis

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9
Q

What are some hereditary risk factors associated with CRC?

A
  • Adenomas or colon cancer
  • FAP (Familial adenomatous polyposis)
  • HNPCC (Hereditary nonpolyposis colon cancer)
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10
Q

What is the management of CRC?

A
  • Partial colectomy
  • Chemotherapy (if metastasis present)
  • Radiation (commonly used for rectal adenocarcinoma)
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11
Q

What is included in surveillance of CRC?

A
  • Serial CEA levels
  • Annual CT chest/abd/pelvis
  • Periodic colonoscopy
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12
Q

What types of visualization tests are recommended for the screening of CRC?

A
  • Colonoscopy
  • Flex Sigmoidoscopy
  • CT Colonography
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13
Q

What types of stool-based tests are recommended for the screening of CRC?

A
  • gFOBT
  • FIT
  • FIT-DNA
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14
Q

What is the gold standard diagnostic screening test for CRC?

A

Colonoscopy

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15
Q

What is a major advantage of a colonoscopy in regards to CRC screening?

A
  • Able to both detect and remove polyps to prevent them from turning into cancer
  • Only screening test that is preventative
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16
Q

What is a major disadvantage of a Flex Sigmoidoscopy in regards to CRC screening?

A

Deficiency in protection against proximal lesions (only goes through distal 1/3 of colon)

17
Q

What is a major disadvantage of a CT Colonoscopy in regards to CRC screening?

A

Can miss flat or small polyps (<10 mm - 1 cm)

18
Q

What is a major disadvantage of using both the gFOBT and FIT stool tests in regards to CRC screening?

A

Sensitivity for one-time screening is not ideal, annual use recommended

19
Q

What is the preferred CRC detection test if patient refuses a scope?

A

FIT (stool-based)

20
Q

What is a disadvantage of all stool-based CRC screening tests?

A
  • Positive results require follow-up colonoscopy

- Adenomatous polyps usually do not bleed, thus can be missed by tests that assess for hemoglobin in stool

21
Q

At what age should screening for CRC generally begin in a patient with no risk factors?

22
Q

When should you start CRC screening for those with increased risk related to family history or IBD?

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 (whichever comes first)

Single 1st degree relative w/ CRC or advanced adenoma dx > 60 y/o
- Being screening at age 40 and if normal, screen as a average risk individual

IBD:
- Screening begins 8-10 years after onset of symptoms

23
Q

Discuss some etiology behind FAP?

A
  • > 100 adenomatous polyps
  • Polyp emergence begins at around 16 years of age
  • Nearly 100% will develop CRC by around 39 years of age if left untreated
  • Increased risk of extracolonic malignancies
24
Q

What is typically recommended with FAP?

A

Prophylactic colectomy

25
Q

What is the screening protocol for FAP?

A
  • Sigmoidoscopy/Colonoscopy starting at age 10-12 and repeating every 1-2 years
  • Routine EGD
  • Screen for extracolonic malignancies (thyroid ultrasound, etc.)
26
Q

Discuss some etiology behind HNPCC?

A
  • Usually right-sided CRC; aged 45-60 years of age
  • Multiple family members affected
  • Increased risk of multiple cancers (endometrial most common)
27
Q

What is the Amsterdam Criteria associated with the diagnosis of HNPCC?

A

“3-2-1 rule” (3 affected family members, 2 generations, 1 under age 50)

28
Q

What screening is recommended with HNPCC?

A
  • Annual colonoscopy beginning between the ages of 20-25 or 2-5 years prior to th earliest age of CRC diagnosis in the family (whichever comes first)
  • Screen for other extracolonic malignancies (pelvic exam with endometrial biopsy and transvaginal US, EGD)
29
Q

When should you consider Hereditary Colon Cancer Syndromes?

A
  • Family hx of CRC in > 1 family member
  • Personal or FH of CRC at early age (< 50 years)
  • Personal or FH of multiple adenomas (> 10-20)
  • Personal or FH of multiple extracolonic malignancies

Clinical Med III (12 decks)

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