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GI > GI Neoplasia II: Bowel Tumros > Flashcards

GI Neoplasia II: Bowel Tumros Flashcards

1
Q

what are the different formations of polyps?

A

sessile
pedunculated
papilloma

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2
Q

What are the different types of polyps?

A

adenomatous (most common type)
hyperplastic
inflammatory

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3
Q

What are the types of adenomatous polyps?

A

tubular, villous or tubulo-glandular

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4
Q

What are hyperplastic polyps?

A

diminutive, dilated glands with no malignant potential. more common in the left colon

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5
Q

What are inflammatory polyps the result of?

A

long-standing IBD, not neoplastic

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6
Q

What is the epidemiology of colorectal cancer?

A

most common GI malignancy, higher incidence in developed countries (secondary to high fat, low fiber diet)

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7
Q

what two minerals are thought to be protective from colorectal cancer?

A

calcium and folate

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8
Q

What are factors that increase your risk for CRC? Decrease?

A

Increase - lack of physical activity
consumption of red meat, obesity, cigarette smoking, alcohol abuse

Decrease - multivitamins containing folic acid
asa and nsaids
postmenopausal hormone use
calcium supplementation
selenium
consumption of fruits and veggies
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9
Q

how does CRC present when in the right colon?

A

occult bleeding, anemia

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10
Q

How does CRC present in the left colon?

A

obstructive symtpoms, overt bleeding

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11
Q

How does CRC present in the rectum?

A

tenesmus, pain bleeding, sense of incomplete vacuation

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12
Q

why does left collon have more obstructive symptoms?

A

smaller lumen

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13
Q

What is the apple core lesion?

A

Shown by barium enema, it shows the protruding cancer into the lumen, shaped like an apple core

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14
Q

What is the mainstay of colon ca tx?

A

surgery

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15
Q

When do you see a rapid drop off of prognosis in colon cancer?

A

when penetrating the muscularis or when it involveds lymph nodes

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16
Q

Explain the molecular genetic mutation pathway that leads to colon cancer

A

APC then KRAS/BRAF then p53, PIK3CA, LOSS OF 18Q, then P53

17
Q

How long does adenoma progression to cancer take typically?

A

10 yrs.

18
Q

What is FAP?

A

Familial Adenomatous Polyposis. AD, with greater than 100 adenomatous polyps starting in 2nd and 3rd decade. All will develop CRC without colectomy. May also have gastric fundic gland polyps, duodenal adenomas and cancer, periampullary adfenomas and cancer, desmoid tumors and retinal pigmented lesions

19
Q

What is the genetic etiology of FAP?

A

one allele of the apc gene inherited mutation. Then second hit occurs.

20
Q

What is HNPCC

A

hereditary non-polyposis crc, germline mutation, acounts for 5% of CRC in US. Proximal colon lesions are common. May also bea ssociated with endometrial, ovarian urinary and gastric cancers. More common than FAP. Also known as lynch syndrome

21
Q

How can you diagnose hnpcc?

A

one relative with crc less than fifty yo
crc spans 2 generations
three relatives with hnpcc tumors

22
Q

what are the three types of cancers associated with hnpcc?

A

ovarian gastric and colon

23
Q

When do you see the average age of crcs?

A

peak around 70

24
Q

when do you screen for someone with an average risk for crc?

A

start at age 50 if asx, stop at 75

25
Q

Are tubular crcs more pedunculated or sessile?

A

pedunculated

26
Q

are villous adenomas of crc more pedunculated or sessile?

A

sessile, giving them a higher risk of malignancy than tubular

27
Q

what are the malignant neoplasms of adenocarcinomas

A

polypoid (into lumen)

annular (go deeper)

28
Q

What is the characteristic description of the gross appearance of tubular adenocarcinomas?

A

test tubes in a rack

29
Q

What is the characteristic description of villous adenocarcinomas?

A

fingerlike

30
Q

what part of the colon are polypoid exophytic carcinoma?

A

greater in the right colon

31
Q

where are “napkin ring” forms of annular crc seen more often

A

in the left colon

32
Q

What are signs and symptoms of small bowel tumors?

A

vague, non-specific- delay in dx of 8-12 mos
abdom pain
weight loss
n/v
GI bleeding/anemia
jaundice with ampullary lesions
symptoms more likely with malignant lesions

33
Q

what are the two most important risk factors for crc?

A

age>50 and family hx

34
Q

what is the precursor lesion for most crc

A

adenomatous polyp

GI (40 decks)

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