GI Neoplasia II: CRC (Nichols/Jackson)

Question 1

Defn of polyp

Answer 1

Bump or nodule in the mucosa

Question 2

result of KRAS mutation without APC mutation

Answer 2

Hyperplastic polyp

Question 3

mass of mature, but disorganized tissue indigenous to site

Answer 3

Hamartoma

Question 4

Is a papilloma a polyp?

Answer 4

Yes

Question 5

What are the types of polyps with malignant potential?

Answer 5

Adenomatous

Question 6

What are the types of polyps that do not have malignant potential

Answer 6

Hyperplastic and inflammatory

Question 7

Inflammatory polyps-occur in long-standing ____

Answer 7

IBD

Question 8

Is CRC more common in developed or underdeveloped counties

Answer 8

developed

Question 9

What components in diet may be protective against CRC

Answer 9

Ca++ and folate

Question 10

Increases risk for CRC

Answer 10

Age and FH
IBD colitits  
Lack of exercise
Consumption of red meat
Obesity 
Smoking 
ETOH use

Question 11

Decreases risk for CRC

Answer 11

Multivitamins containing folic acid 
Aspirin and NSAIDs
HRT (post menopausal)
Ca++ supplement 
Selenium 
Inc fiber in diet (veggies and fruit)

Question 12

How does CRC present in the right vs left colon

Answer 12

Left = obstructive symptoms and overt bleeding

Right: occult bleeding and anemia

Question 13

Apple core lesion

Answer 13

Barium enema shows this in the diagnosis of CRC

Question 14

Goals of colonoscopy

Answer 14

Locates lesions, removes polyps, and biopsies lesions

Question 15

What determines the prognosis of CRC

Answer 15

Extent of invasion (how deep it goes)

Question 16

Is chemo used to treat CRC?

Answer 16

Yes, but as an adjuvant in pts with + nodes

Surgery is the mainstay

Question 17

What is the molecular/mutatio pathogenesis in CRC

Answer 17

Loss of APC → KRAS mut → loss of p53

• *AK-53**
• This is from First aid, ppt has more confusing/detailed pictures of this

Question 18

Defn Tumor suppressor gene vs oncogene

Answer 18

Genes that function normally in inhibition of cell growth
Vs
Activation results in uncontrolled cellular proliferation

Question 19

Tumor suppressor gene or oncogene is normally inherited

Answer 19

Tumorsuppressor gene mutation

Question 20

Mutation in Familial Adenomatous Polyposis

Answer 20

Autosomal dominat mutation in APC gene on chromosome 5q (2 hit hypothesis)

Question 21

How does FAP present

Answer 21

> 100 adenomatous polyps starting in 2md to 3rd decade

Pancolonic and always involves rectum (according to First Aid)

Question 22

Mutation in hereditary non-polyposis CRC

Answer 22

Germline mutation of DNA repair genes

Question 23

What part of the colon does HNPCC affect? FAP?

Answer 23

HNPCC: more commonly proximal
FAP: pancolonic

Question 24

How is HNPCC diagnosed?

Answer 24

1. 1 releative with CRc < 50 yo
2. CRC spans 2 generations
3. 3 relatives eith HNPCC (2 must be 1st degree relatives of the first)

Question 25

What are the goals of screening for CRC?

Answer 25

Decrease mortality from CRC and prevent CRC by removing polyps

Question 26

How is fecal occult blood used to diagnose CRC

Answer 26

Put poop on card …. WIKI THIS

Question 27

What are the limitations to fecal immunochemical test?

Answer 27

Does not detect upper GU bleeding More expensive that poop card May require 2 stool samples

Question 28

What are the advantages to fecal immunochemical test?

Answer 28

Responds only to human Hgb More sensitive and specific than Guiac tests Not a colonoscopy—people don’t have to take off work and, ya know, get probed

Question 29

Helical CT reconstructed into 3D images. Studies on sensitivity and specificity have been variable. Requires bowel prep

Answer 29

Virtual colonoscopy

Question 30

What are the barriers to colon screening?

Answer 30

1. limited acess to medical care in general 2. bowel prep and time off work 3. risk and expense of tests

Question 31

Major complication seen with colonoscopy

Answer 31

Perforation

Question 32

What are the types of benign adenoma polyps

Answer 32

Tubular and villous adenomas

Question 33

Diff between tubular and villous adenomas

Answer 33

Tubular are more pedunculated and villous are more sessile and have a higher risk of malignancy

Question 34

What are the types of malignant colon adenocarcinomas

Answer 34

Polypoid and annular

Question 35

Poly Exophytic Carcinoma is more common in left or right side of colon?

Answer 35

Right

Question 36

Annular “napkin ring” form is more common on left or right side of colon?

Answer 36

Left colon

Question 37

What are the signs and syptoms of small bowel tumors

Answer 37

Non-specific: crampy, weight loss, nausea/vomiting, GI bleeding/anemia, Jaundice with ampullary lesions

Question 38

Colon cancer is the (1st, 2nd, 3rd, 4th, 5th, 6th, or 7th) leading cause of cancer death

Answer 38

2nd

Question 39

Most important risk factors for CRC

Answer 39

Age > 50 and FH

Question 40

Precursor lesion to most CRC

Answer 40

Adenomatous polyp

Question 41

The goal of screening for CRC is to

Answer 41

decrease mortality from colon cancer or to prevent colon cancer by removing adenomatous polyps