General Surgery/GIT / Colorectal Cancer

Question 1

In the United States, what is the third leading cause of cancer and cancer death in men and women?

Answer 1

CRC

Question 2

What are risk factors for CRC?

Answer 2

• Age >40-50 years
• personal history of CRC
• personal history of polyps, first-degree relative diagnosed with CRC
• IBD
• cigarette smoking

Question 3

In most cases of CRC, there is a positive family history of the disease. True or false?

Answer 3

False

Question 4

What is familial adenomatous polyposis (FAP)?

Answer 4

A familial colon cancer syndrome in which a germline mutation in the adenomatous polyposis coli (APC) gene results in numerous colonic adenomas appearing during childhood

Question 5

What percent of patients with FAP develop colon cancer?

Answer 5

90% by age 45

Question 6

What is Lynch syndrome/HNPCC (hereditary nonpolyposis colorectal cancer)?

Answer 6

A familial colon cancer syndrome associated with defects in DNA mismatch repair

Question 7

What genetic disorders predispose a person to CRC?

Answer 7

• FAP
• Gardner syndrome
• HNPCC/Lynch syndrome

Question 8

What is the most common presenting symptom of CRC?

Answer 8

Abdominal pain

Question 9

What other symptoms may help localize the CRC lesion to the Right side?

Answer 9

• IDA
• weight loss
• anorexia

Question 10

What other symptoms may help localize the CRC lesion to the left side?

Answer 10

• Decreased stool caliber
• constipation
• obstipation
• diarrhoea

Question 11

What other symptoms may help localize the CRC lesion to the rectum?

Answer 11

• bright red blood per rectum
• and/or tenesmus

Question 12

What is the diagnostic test of choice for patients with symptoms suggestive of CRC?

Answer 12

Colonoscopy

Question 13

What if the colonoscope cannot reach the tumor site in a patient with CRC - what diagnositc test of choice?

Answer 13

Double-contrast barium enema

Question 14

What is the differential diagnosis of CRC?

Answer 14

• Other malignancies
  
  • lymphoma
  • carcinoid
  • Kaposi sarcoma
  • metastases
• hemorrhoids
• IBD
• diverticulitis
• infection

Question 15

What are the most common sites of metastases of CRC?

Answer 15

• Regional lymph nodes
• liver
• lungs
• peritoneum

Question 16

Can carcinoembryonic antigen (CEA) be used as a screening test for CRC?

Answer 16

No

Question 17

When do you use CEA?

Answer 17

In patients newly diagnosed with CRC for both prognosis and evaluation

Question 18

What does the metastatic workup of CRC involve?

Answer 18

• CXR
• LFTs
• abdominal CT

Question 19

What is the most important prognostic factor in CRC?

Answer 19

• Depth of bowel wall invasion

Question 20

What is the only curative modality for localized CRC?

Answer 20

Surgical resection

Question 21

For average-risk individuals, at what age should CRC screening begin?

Answer 21

50 years

Question 22

What are the different options for CRC screening?

Answer 22

• Annual fecal occult blood test (FOBT)
• flexible sigmoidoscopy alone every 5 years
• flexible sigmoidoscopy every 5 years with FOBT yearly
• colonoscopy every 10 years

Question 23

Which CRC screening option/modality has the greatest sensitivity and specificity?

Answer 23

Colonoscopy

Question 24

What are some disadvantages to colonoscopy?

Answer 24

• Risk of bleeding/perforation
• patient has to do bowel prep
• costly
• sedation leads to longer recovery time (and adds indirect costs for transportation, absenteeism, etc)

Question 25

What are some advantages to colonoscopy versus other types of screening?

Answer 25

• ability to localize lesions throughout the entire colon
• biopsy mass lesions and remove polyps

Question 26

How should you screen patients with a family history of first-degree relative with CRC?

Answer 26

• Colonoscopy every 10 years starting at age 40
• or colonoscopy 10 years prior to the age at diagnosis of the youngest family member with CRC (whichever comes first)

Question 27

When should you start screening in a patient with inflammatory bowel disease?

Answer 27

Colonoscopy every 1-2 years starting 8-10 years after diagnosis or 15 years after diagnosis, if disease is limited to the colon