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Y3R6: Surgery I 👨‍⚕️ > L15: Cancer Colon > Flashcards

L15: Cancer Colon Flashcards

1
Q

Arterial Supply of The Colon

A
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2
Q

Branches of SMA to The Colon

A

a) Ilio-colic
b) Right colic
c) Middle colic:

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3
Q

Level of SMA

A

L1

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4
Q

Branches of IMA to The Colon

A

a) Upper and lower left colic
b) Sigmoid arteries
c) Superior rectal artery

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5
Q

Level of IMA

A

L3

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6
Q

Arterial Supply of The Rectum

A
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7
Q

SRA

A

(hemorrhoidal) artery - branch of IMA

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8
Q

MRA

A

branch of internal iliac artery

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9
Q

IRA

A

branch of internal iliac artery

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10
Q

What are the “watershed” areas of the colon?

A
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11
Q

Venous Drainage of Colon

A
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12
Q

Venous Drainage of Rectum

A
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13
Q

Lymphatic Drainage of Colon

A
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14
Q

Lymphatic Drainage of Rectum

A
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15
Q

Histology of Colon

A
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16
Q

Mucosa of Colon

A

Columnar epithelium

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17
Q

Musclosa of Colon

A

1) Inner circular

2) Outer longitudinal (condensed into 3 bands)

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18
Q

Serosa of Colon

A

1) (Visceral peritoneum)

2) Peritoneal covering incomplete (except transverse & sigmoid)

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19
Q

Which portions of the colon are retroperitoneal?

A
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20
Q

Why Surgery of The Colon is More Hazardous Than SI?

A
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21
Q

Why is Colonic Anastomosis Leakage More Common Than SI?

A
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22
Q

Preoperative Colon Preparation for Elective Surgery to Decrease Risk of Anastomosic Leak

A
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23
Q

Incidence of Cancer Colon

A

3rd most common cancer in both male & female

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24
Q

Age of Cancer Colon

A
  • 90% of cases above 50 years
  • uncommon below 40 y unless hereditary
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25
Q

Sex in Cancer Colon

A

Equal “Maybe Males”

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26
Q

Sites of Cancer Colon

A

1/3 are in the rectum and 2/3 in the colon.

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27
Q

Synchronous & Metasynchronous Cancer Colon

A

5%

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28
Q

Why is Cancer Colon more common in Rectum & Sigmoid?

A

1) Contents are solid, stagnant.

2) It is often seat of precancerous lesions as polyps and UC

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29
Q

Categories of Cancer Colon

A
  • Sporadic colon cancer
  • Familial colon cancer
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30
Q

Percentage of Sporadic Cancer Colon

A

75%

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31
Q

Risk Factors For Sporadic Cancer Colon

A

1) Diet
2) Chronic irritation
3) Precancerous lesion

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32
Q

Predisposing factors for Sporadic Cancer Colon

A

1) Diet
2) Chronic irritation
3) Precancerous lesion

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33
Q

Diet & Sporadic Cancer Colon

A
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34
Q

Chronic Irritation & Sporadic Cancer Colon

A
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35
Q

Precancerous Lesions & Sporadic Cancer Colon

A
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36
Q

Percentage of Familial Cancer Colon

A

25%

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37
Q

Risk Factors for Familial Cancer Colon

A
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38
Q

Nature of Familial Adenomatous Polyposis (FAP)

A

Autosomal dominant

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39
Q

Gene Defect in Familial Adenomatous Polyposis (FAP)

A

Defect in (APC) gene on chromosome 5

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40
Q

Colon Cancer Risk in Familial Adenomatous Polyposis (FAP)

A

COLON CANCER: 100%

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41
Q

Age of polyps & cancer in Familial Adenomatous Polyposis (FAP)

A
  • Polyps appear by the age of 15 years
  • Cancer occurs berore age of 40 years
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42
Q

Types of Familial Adenomatous Polyposis (FAP)

A
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43
Q

Attenuated Type of Familial Adenomatous Polyposis (FAP)

A

(number of polyps is less than 100)

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43
Q

Classic Type of Familial Adenomatous Polyposis (FAP)

A

(number of polyps is more than 100)

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44
Q

Nature of Heridetery non-polyposis Colon Cancer (HNPCC)

A

Autosomal dominant

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45
Q

Gene defect in Heridetery non-polyposis Colon Cancer (HNPCC)

A

Defect in mismatch repair MMR gene (chromosome 2)

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46
Q

Risk of Cancer in Heridetery non-polyposis Colon Cancer (HNPCC)

A

COLORECTAL CANCER: 80 %

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47
Q

Age of cancer in Heridetery non-polyposis Colon Cancer (HNPCC)

A

Occurs before 45 years

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48
Q

Types of Heridetery non-polyposis Colon Cancer (HNPCC)

A
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49
Q

Lynch I

A

isolated CRC

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50
Q

Lynch II

A

CRC associated with:
* Endometrial
* Ovarian
* Prostatic
* Gastric
* Renal
* Ureteric tumors.

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51
Q

Amesterdam Criteria for HNPCC

A
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52
Q

Presentation of FAP

A
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53
Q

Colonic Manifestations of FAP

A
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54
Q

Extra-Colonic Manifestations of FAP

A
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55
Q

Investigations in FAP

A
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56
Q

Screening in FAP

A
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57
Q

TTT of FAP

A
58
Q

Asymptomatic Cancer Colon

A
59
Q

Emergency symptoms of Cancer Colon

A
60
Q

Shape of Cancer Right Colon

A

Cauliflower

61
Q

CP of Cancer Right Colon

A
  • AAA (Commonest presentation)
  • Pain
  • Mass in RIF
  • Acute presentations of cancer caecum
62
Q

Commonest Presentation of Cancer Right Colon

A

AAA (Commonest presentation)
a. Anorexia (Decrease appetite)
b. Asthenia (Unintended weight loss)
c. Anemia

63
Q

Pain in Cancer Right Colon

A
  • Type: Colicky pain
  • Cause: Hyper-peristalsis to get rid of tumor
64
Q

Mass in RIF in Cancer Right Colon

A

tumor itself, late symptom

65
Q

Acute Presentation of Cancer Caecum

A

a. Acute intestinal obstruction. (Rare)

b. Acute appendicitis: due to obstruction
to its lumen by carcinoma

c. Perforation of the caecum & peritonitis.

66
Q

Shape of Cancer left colon

A

annular

67
Q

CP of Cancer left colon

A
  • Change in the bowel habits (Commonest presentation)
  • Bleeding per rectum
  • mass in LIF
  • Intestinal obstruction (common)
68
Q

Change in the bowel habits in Cancer left colon

A

a. Progressive constipation

b. Attacks of constipation are followed by false diarrhea

c. Change in the shape of stool (narrower than normal)

69
Q

Mass in LIF in Cancer left colon

A

fecal impaction above tumor

70
Q

CP of Rectal cancer

A
71
Q

Bleeding Per Rectum in Rectal cancer

A

is the early & common symptom

72
Q

Tenesmus in Rectal cancer

A

sense of incomplete defecation

73
Q

PR Examination in Rectal cancer

A

a. Rectal tumors felt in 90% of cases
b. Mucus & blood per rectum.

74
Q

general Examination in Colon Cancer

A
75
Q

Local Examination in Colon Cancer

A
76
Q

Abdominal Mass in Colon Cancer

A
77
Q

INVx in Colon Cancer

A
  • Labs
  • Colonoscopy & biopsy: gold standard
  • Rads
  • metastatic Workup
78
Q

Labs in Colon Cancer

A
79
Q

Occult Blood in Colon Cancer

A

always positive.

80
Q

CBC in Colon Cancer

A

Anemia

81
Q

Tumor Markers in Colon Cancer

A
  • CEA (> 2.5 ng/ml): prognostic rather than diagnostic
  • CA 19-9 — more specific
82
Q

Is CEA Specific to Colon Cancer?

A
83
Q

What is The gold Standard in INVx of Colon Cancer?

A

Colonscopy + Bx

84
Q

Role of Colonoscopy & Bx in Colon Cancer

A
85
Q

NE of Colon Cancer

A
86
Q

ME of Colon Cancer

A
87
Q

Rads in Colon Cancer

A
  • Barium Enema
  • Double Contrast Barium Enema (DCBE)
  • CT Virtual Colonoscopy
88
Q

Barium Enema in Colon Cancer

A

a. Filling defects in polypoidal lesions

b. or (Apple core appearance): in annular lesions
(irregular stricture with mucosal destruction and shouldering)

89
Q

Double Contrast Barium Enema in Colon Cancer

A
90
Q

CT Virtual Colonoscopy in Colon Cancer

A
91
Q

Advantages of Colonoscopy in Colon Cancer

A
  • Evaluation of entire colon
  • Biopsy
  • Treatment of poiyps
92
Q

Disadvantages of Colonoscopy in Colon Cancer

A
  • Perforation, bleeding
  • require bowe!: preparation
93
Q

Advantages of Sigmoidscopy in Colon Cancer

A
  • Fairly quick and safe
  • Does not require full bowel preparation
94
Q

Disadvantages of Sigmoidscopy in Colon Cancer

A
  • Perforation
  • Missed lesion (40-50% of CRC and polyps)
95
Q

Advantages of CT Colonography Colon Cancer

A
  • Non-invasive
  • Detection of extracolon lesions/disease
  • Can see proximal to obstructing lesion
96
Q

Disadvantages of CT Colonography Colon Cancer

A
  • No biopsy
  • Bowel preparation
97
Q

Metastatic Work up in Colon Cancer

A
  • CT abdomen with contrast
  • Endoluminal US
  • (PET) scan
98
Q

CT Abdomen With Contarst in Colon Cancer

A
99
Q

EUS in Colon Cancer

A
100
Q

Duke’s Staging in Colon Cancer

A
101
Q

Duke’s Modified Staging in Colon Cancer

A
102
Q

TNM Staging in Colon Cancer

A
103
Q

TNM Staging in Colon Cancer

  • T
A
104
Q

TNM Staging in Colon Cancer

  • N
A
105
Q

TNM Staging in Colon Cancer

  • M
A
106
Q

What Does Grading of Colon Cancer depend on?

A
107
Q

Grades of Colon Cancer

A
108
Q

Spread of Colon Cancer

A
109
Q

Direct Spread of Colon Cancer

A
110
Q

Lymphatic Spread of Colon Cancer

A
111
Q

Blood (Distant) Spread of Colon Cancer

A
112
Q

Most Common Method of Spread of Colon Cancer?

A
113
Q

Intra-Luminal Spread of Colon Cancer

A
114
Q

Trans-Peritoneal Spread of Colon Cancer

A
115
Q

Prevention of Colon Cancer

A
116
Q

1ry Prevention of Colon Cancer

A
117
Q

2ry Prevention of Colon Cancer

A
118
Q

Screening of Colon Cancer

A
119
Q

Methods of Screening of Colon Cancer

A
120
Q

Average Risk Screening for Colon Cancer

A
121
Q

Mild Risk Screening for Colon Cancer

A
122
Q

High Risk Screening for Colon Cancer

A
123
Q

Who are at mild Risk of Colon Cancer?

A
124
Q

Who are at High Risk for Colon Cancer?

A
125
Q

Principles of Colonic Resection

A
126
Q

TTT options in Colon Cancer

A
127
Q

TTT of Localized uncomplicated Colon Cancer

A
128
Q

Neo-Adjuvant Therapy in Colon Cancer

A
128
Q

Adjuvant Therapy in Colon Cancer

A
129
Q

Pre-operative Colonic Prerparation in Colon Cancer

A
130
Q

Operation for Tumor in Hepatic Flexure

A
130
Q

Types of Operation in Colon Cancer

A
131
Q

Operation for Tumor in Caecum - ascending
colon

A
132
Q

Operation for Tumor in Transverse Colon

A
133
Q

Operation for Tumor in descending Colon

A
134
Q

Operation for Tumor in sigmoid Colon

A
135
Q

Operation for Tumor in Recto-Sigmoid Junction

A
136
Q

Operation for Tumor in low rectum

A
137
Q

Operation for Synchronous Colon Cancer

A
138
Q

managment of Metastatic Colon Cancer

A
139
Q

The most important prognostic factor in Colon Cancer

A
140
Q

5 year survival differs according to the stage

  • Explain
A
141
Q

Done

A

…

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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