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Gastrointestinal System > EXAM #3: COLORECTAL CANCER > Flashcards

EXAM #3: COLORECTAL CANCER Flashcards

1
Q

What are the landmarks for the colon?

A

1) Tenia coli

2) Transition from colon to rectum where the Tenia coli “splay”

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2
Q

What are the major arteries that branch from the SMA to the colon?

A

SMA supplies proximal 2/3 of the colon–branches include:

1) Ileocolic
2) Right colic
3) Middle colic

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3
Q

What are the major arteries that branch from the IMA to the colon?

A

IMA supplies the distal 1/3 of the colin–branches include:

1) Left colic
2) Sigmoidal branches
3) Superior rectal

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4
Q

What arteries supply the rectum? Where do these arteries branch from?

A

1) Superior rectal from the IMA

2) Middle and inferior rectal from the internal iliac arteries

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5
Q

Review the layers of the GI mucosa.

A

1) Mucosa
- Epithelium
- Lamina propria
- Musclaris mucosa
2) Submucosa
3) Muscularis Propria
4) Serosa

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6
Q

How prevalent is colon cancer?

A

3rd most common cancer

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7
Q

List the risk factors for colon cancer.

A

1) Family history
2) IBD
3) Smoking
4) Alcohol
5) Obesity
6) Inactivity
7) Diet rich in red meat and animal fat

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8
Q

What factors are protective against colon cancer?

A

1) Hormone Replacement Therapy
2) NSAIDs
3) Diet rich in fiber, fruits, and veggies

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9
Q

Outline the Adenoma-Carcinoma Sequence.

A

1) APC= early adenoma
2) K-RAS= intermediate adenoma
3) DCC= late adenoma
4) p53= carcinoma

*Note that this normally takes roughly 10 years.

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10
Q

How can adenomatous polyps be removed via colonoscopy?

A

Snare excision

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11
Q

What are the four most common etiologies of colon cancer?

A

1) Sporadic
2) Non-syndromic familial colorectal cancer
3) FAP
4) HNPCC or Lynch Syndrome

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12
Q

What mutation is associated with FAP?

A

Autosomal dominant APC mutation

Chromosome 5

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13
Q

What is the clinical manifestation of FAP?

A

1,000 of adenomatous polyps

  • Early onset
  • WILL get colon cancer
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14
Q

What is the treatment for FAP?

A

Total colectomy

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15
Q

What genetic defect is seen in HNPCC?

A

Defects in DNA mismatch repair genes

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16
Q

What are the clinical manifestations of HNPCC?

A
  • 100s of polyps
  • Accelerated progression to colon cancer

*Not a 100% progression to cancer like APC.

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17
Q

What cancers are associated with HNPCC in addition to colon cancer?

A

Endometrial

Ovarian

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18
Q

What is the treatment for HNPCC?

A

Colectomy

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19
Q

What sign is associated with advanced polyps?

A

Fecal occult blood test

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20
Q

What are the three major screening modalities for colorectal cancer?

A

1) Colonoscopy*
2) Flexilble sigoidoscopy
3) FOBT (Fecal Occult Blood Test)

*Gold standard

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21
Q

What imaging modalities are used to screen for colorectal cancer?

A

1) Double contrast barium enema

2) CT Colongraphy

22
Q

What is the difference between colonscopy and flexible sigmoidoscopy?

A

Flexible sigmoidoscopy isn’t as long (will only reach the splenic flexure)

*Note that you develop more polyps in the distal colon/rectum, which is why this is used as a good alternative to colonoscopy

23
Q

What is the drawback to the fecal occult blood tests?

A

Detects more ADVANCED polyps or cancer

24
Q

What are the drawbacks to double contrast barium enemas?

A

1) Still requires bowel prep
2) Give rectal air and contrast
3) Only detects advanced polyps

Plus, if its positive, you still have to get a colonoscopy.

25
Q

What are the drawbacks to CT Colonography?

A

Same as barium enema.

26
Q

What are the screening recommendations for colorectal cancer?

A

1) Colonoscopy every 10 years
2) Flexible sigmoidoscopy every 5 years AND FOBT every 3 years
3) FOBT every year

27
Q

When do you start screening?

A

If AVERAGE risk, start at 50 y/o

*Average= no family history or personal history of polyps/cancer

28
Q

What gives a patient a positive family history of colon cancer?

A

1) First degree relative with hx at less than 60
2) 2x first degree at ANY age
3) Second degree relative less than 50

29
Q

When do you start screening for patients with a family history of colon cancer?

A

40 y/o AND repeat every 5 years

30
Q

What are the screening recommendations for colon cancer in patients with IBD?

A

1) Start colonoscopy 8-10 years after onset of sx.
2) Collect 4x random biopsies every 10cm (total of 30+)

*Repeat every 1-2 years

31
Q

When do you start screening for colon cancer in HNPCC?

A

Age 20-25 y/o

*Repeat every 1-2 years

32
Q

What are the screening recommendations for FAP?

A

Age 10-12 y/o

*Repeat every 1-2 years

33
Q

What is the most common cause of colon obstruction in adults?

A

Colorectal cancer

34
Q

What symptoms are associated with colorectal cancer?

A
  • Vague abdominal pain
  • Change in bowel habits e.g. pencil-thin stool
  • GI Bleeding
35
Q

For a person that presents with symptoms suggestive of colon cancer, what imaging should be ordered?

A

1) KUB
2) CT abdomen and pelvis with IV and enteral contrast
3) Colonoscopy or Proctoscopy
- TATTOO the lesion!

36
Q

What is the serum tumor marker for colon cancer? How is this used?

A

CEA= carcinoembryonic antigen

*Clinically this is used for surveillance s/p resection

37
Q

What is the TNM classification system?

A

T= invasion depth of Tumor

N= extent of regional lymph Node involvement

M= Metastasis

38
Q

Outline the different T-stages of tumors.

A 
Tis= intraepithelial 
T1= Submucosa 
T2= Muscularis propria
T3= Pericolorectal tissue
T4a= Penetrates peritoneum 
T4b= invading adjacent organs
39
Q

Outline the N-stages.

A 
N0= no nodes 
N1= 1-3 regional nodes 
N2= 4+ nodes
40
Q

How many nodes need to be examined for adequate staging?

A

At least 15 nodes

41
Q

Outline the M-stages.

A 
M0= no mets
M1= distant mets
42
Q

What resection margins do you need to have in the treatment of colon cancer?

A

5cm

1-2cm in the rectum

43
Q

What determines your resection margin in the treatment of colon cancer?

A

The resected artery

*All bowel associated with artery needs to be removed

44
Q

What is a Low Anterior Resection (LAR)?

A

Rectosigmoid resection below the peritoneal reflection

*This procedure preserves the anal sphincter and opening

45
Q

What is an Abdominal Perineal Resection (APR)?

A

Rectosigmoid resection including:

  • Anal sphincters
  • Anal opening
46
Q

When does colon cancer require the addition of chemotherapy to surgical resection?

A

1) Any nodal disease

2) Some T3 and any T4+ disease

47
Q

What colon cancer mets are treated with resection?

A

Liver and lung metastases

48
Q

What colon cancers are treated primary with chemotherapy and secondarily with palliative resection?

A

1) Bleeding
2) Obstruction
3) Perforation

49
Q

What is the treatment for Tis and T1 rectal cancer?

A

Transanal excision

50
Q

What is the treatment for T2 rectal cancer?

A

Surgical resection

51
Q

What is the treatment for T3, T4, or N+ rectal cancer?

A

1) Neoadjuvant (i.e. begin with) chemoradiation

2) Surgical resection

52
Q

After surgical resection, what are the recommendations for surveillance?

A

1) H and P every 3-6 months for 5 years
2) CEA same
3) CT annually for 5 years

Gastrointestinal System (42 decks)

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