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Bloc E - GI & Metabolism > Feb27 M1-Colorectal Cancer Screening > Flashcards

Feb27 M1-Colorectal Cancer Screening Flashcards

1
Q

dx test vs screen

A

screen = just to check

dx test = suspect disease

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2
Q

signs and symptoms in colorectal cancer

A
  • bowel habit changes
  • bleeding (BRBPR)
  • abd pain, bloating
  • incomplete evacuation
  • weight loss (cancer cachexia)
  • fatigue (anemia, liver metastases)
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3
Q

(IMPORTANT) big 3 cancers in adults

A

lung, breast, colorectal

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4
Q

(IMPORTANT) how cancer incidence differs in age groups

A

adults 30+: the big 3

youth: different cancers have the higher incidences (CNS AND LEUKEMIA in youth)

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5
Q

how incidence and prevalence of CRC (colorectal cancer) changing

A

worlwide: increasing incidence
Canada: decreasing incidence
Increasing prevalence

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6
Q

normal seq of CRC dev

A

normal - proliferative epithelium - adenoma - carcinoma

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7
Q

how CRC develops

A

series of genetic alterations over 7-10 yrs: FIRST HEAT IS APC (adenomatous polyposis coli gene)

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8
Q

order of genetic hits in CRC

A

APC (get proliferative epithelium), 18q deletion, TP53 = CA

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9
Q

2 hereditary CRC

A 
FAP (familial. no APC). 
Lynch syndrome (germline mutation in mismatch repair genes)
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10
Q

2 pathways to CRC

A
  • chromosomal instability (sporadic)

- microsatellite unstability (mismatch repair genes)

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11
Q

MMR genes problems (micro sat unstability): CRC is where + often related to what

A
  • right side CRC

- linked with hereditary non polyposis colon cancer (HNPCC)

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12
Q

non modif risk factors in CRC

A

age, ethnic background (ashkenazi jews and african americans), genetics (heredity)

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13
Q

modif risk factors in CRC

A
  • diet
  • phys activity
  • meds
  • other conditions (diabetes, obesity)
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14
Q

what age CRC risk rises a lot and consequence

A

50 yrs old. so gvt screening starts at 50

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15
Q

diet factors in CRC

A
  • red meat (iron, N-nitroso compounds, polycyclic aromatic hydrocarbons, heterocyclic amines, heme)
  • fruits may help (antioxidants: indoles, carotene)
  • dietary fiber: less ADENOMA (should help for less CA in theory)
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16
Q

micronutrients in CRC

A

Ca, vit D and dairy helps

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17
Q

diet types in CRC

A
  • alcohol bad
  • medit diet good
  • prudent diet good (poultry, fish, fruits)
18
Q

meds in CRC

A

aspirin and NSAIDS reduce CRC risk

19
Q

obesity, exercise in CRC

A
  • obesity = higher risk
  • exercise = less risk
  • estrogens (women) decrease risk
20
Q

fecal occult blood test (FOBT) at home (3x over 7 days): benefit

A

15-33% reduction in CRC mortality

21
Q

overt vs obscure vs occult bleeding

A 
overt = see blood
obscure = see blod but don't know where it's from
occult = only seen on test (not with eyes)
22
Q

importnt thing in FOBT

A

helps even more to reduce mortality if done every year instead of every 2 years (age 50 to 74)

23
Q

(IMPORTANT) DX TEST done if FOBT is positive

A

FULL OPTICAL COLONOSCOPY

24
Q

how FOBT helps

A

indirectly leads us to go and find the polyp and remove it

25
Q

better version of FOBT

A

fetal IHC test (FIT test): more SENSITIVE. no diet restriction.
DISTAL GI blood

26
Q

(IMPORTANT) DX test if FIT test is positive

A

FULL OPTICAL COLONOSCOPY

27
Q

NNT of FIT test

A
  1. is a good number
28
Q

to remember in FIT test and FOBT

A

bleeding may have other cause than CRC (polyp)

29
Q

radiological tests for CRC screening + in who

A
  1. barium enema (double contrast): look for apple core lesion
  2. virtual colonography: CT scan reconstruct inside of colon
    FOR NORMAL ASYMPTOMATIC person
30
Q

(IMPORTANT) DX test if radiological screening for CRC is positive

A

FULL OPTICAL COLONOSCOPY

31
Q

barium enema problems

A

not best test for sensitivity + not proven to help for CRC mortality

32
Q

virtual colonoscopy problem

A

need bowel prep + insufflate air with no sedation, very uncomfortable for pt

33
Q

optical tests for CRC + important principle

A

-flexible sigmoidoscopy
-colonoscopy
REDUCE MORTALITY 50%

34
Q

(EXAM) 6 screening recommendations)

A
  1. high sens FOBT or FIT ANNUALLY
  2. flexible sigmoidoscopy every 5 years + FOBT or FIT annually
  3. double contrast barium enema every 5 years
  4. CT colonography every 5 years (air thing)
  5. colonoscopy every 10 yrs
  6. fecal DNA testing
35
Q

(EXAM) preferred strategy for screening

A

colonoscopy every 10 years

36
Q

(EXAM) screening for CRC in Quebec

A

annual FIT

37
Q

(EXAM) BLOOD in stool or Lynch patients: screening recommendations

A

annual colonoscopy

38
Q

(EXAM) why annual FIT test if choose flexible sigmoidoscopy every 5 years

A

to not miss right sided cancers and polyps. (sigmoidoscopy covers left side, sigmoid and rectum)

39
Q

(EXAM) where most CRC cancers occur

A

left side, sigmoid colon and rectum

40
Q

(EXAM) normal mucosa to cancer time

A

7-10 years

Bloc E - GI & Metabolism (58 decks)

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