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GIHEP > L21: Tumours of the Large Bowel > Flashcards

L21: Tumours of the Large Bowel Flashcards

1
Q

Are tumours more common in the large bowel or the small bowel?

A

large bowel

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2
Q

What is a pedunculated polyp?

A

a polyp with a stalk

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3
Q

What is a sessile polyp?

A

flat polyp

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4
Q

What is a non-neoplastic polyp of the GIT?

A
  • polyps that do not progress to a carcinoma

- do not become malignant

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5
Q

List the 4 main categories of non-neoplastic polyps

A
  1. hyperplastic
  2. hamartomatous
  3. inflammatory
  4. lymphoid
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6
Q

Where are hyperplastic normally found in the GIT?

A

recto-sigmoid colon

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7
Q

What are hyperplastic polyps? Why do they occur?

A
  • non neoplastic polyps
  • typically found in recto-sigmoid colon
  • composed of non-neoplastic glands w/ goblet cell differentiation
  • no malignant potential

result from delayed shedding of epithelial cells

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8
Q

Why do hyperplastic polyps occur?

A

result from delayed shedding of epithelial cells

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9
Q

What is a hamartoma?

A

an abnormal mixture of normal tissues and cells from the area in which it grows

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10
Q

What are juvenile polyps?

A
  • non neoplastic polyps (no malignant potential)
  • hamartomatous malformations of bowel mucosa
  • children < 5 years usually
  • occur in rectum typically
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11
Q

If an adult has juvenile polyps, what are these polyps called?

A

Retention Polyps

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12
Q

What are Peutz-Jegher polyps of the GIT?

A
  • hamartomatous polyps
  • small intestine + colon
  • a/w Peutz-Jeghers Syndrome
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13
Q

Where in the GIT do Peutz-Jegher polyps occur usually?

A

small intestine + colon

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14
Q

What is Peutz-Jeghers Syndrome?

A
  • hamartomatous syndrome
  • AD
  • a) mucocutaneous pigmentation
  • b) have multiple hamartomatous polyps through GIT
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15
Q

Someone that has Peutz-Jeghers Syndrome is at an increased risk of developing what?

A

non-GI cancers (pancreas, breast, lung, ovary and uterus)

the polyps do NOT have malignant potential

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16
Q

List 3 hamartomatous syndromes of the GIT

A
  1. Peutz-Jeghers Syndrome
  2. Cowden Syndrome
  3. Cronkhite-Canada Syndrome
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17
Q

What is Cowden Syndrome?

A
  • hamartomatous syndrome
  • AD
  • a/w PTEN mutation
  • multiple hamartomatous polyps + trichoepitheliomas
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18
Q

Someone that has Cowden Syndrome is at an increased risk of developing what?

A
  • thyroid or breast cancer

the polyps do NOT have malignant potential

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19
Q

What are the 3 characteristics of Cronkhite-Canada syndrome?

A

hamartomatous syndrome

  1. hamartomatous polyps
  2. nail atrophy
  3. skin pigmentation
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20
Q

Inflammatory (Pseudo)polyps are a type of non-neoplastic polyp. What disease are they associated with?

A

Inflammatory Bowel Disease - especially Ulcerative Colitis

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21
Q

What is another name for adenomatous polyps?

A

neoplastic polyps

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22
Q

What are the 3 types of adenomatous/neoplastic polyps?

A
  1. Tubular
  2. Villous
  3. Tubulovillous
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23
Q

Is a tubular adenomatous polyp more likely to be pedunculated or sessile?

A

pedunculated

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24
Q

Is a villous adenomatous polyp more likely to be pedunculated or sessile?

A

sessile

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25
Q

What is the treatment for adenomatous polyps?

A

Complete Excision:

- should be removed as they are considered pre-malignant

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26
Q

What is Familial Adenomatous Polyposis (FAP)?

A
  • hereditary colon cancer syndrome
  • AD
  • mutation on APC gene on 5q21
  • numerous polyps that can become cancerous
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27
Q

What is the mutation associated with Familial Adenomatous Polyposis (FAP)?

A

APC gene on 5q21

28
Q

What is the treatment for Familial Adenomatous Polyposis (FAP)?

A

prophylactic total colectomy - entire colon needs to be removed

29
Q

What is Gardner’s Syndrome?

A
  • variation of FAP
  • mutations of APC gene
  • AD
  • multiple adenomas, epidermoid cyst, fibromatosis, osteomas, abnormal dentition
30
Q

Someone that has Gardner’s Syndrme is at an increased risk of developing what?

A

duodenal or thyroid cancer

31
Q

What is Turcot’s Syndrome?

A
  • variation of FAP
  • mutations of APC gene
  • AD
  • colorectal adenomatous polyps and brain tumours
32
Q

What syndrome is associated with colorectal adenomatous polyps and brain tumours?

A

Turcot’s Syndrome

33
Q

List 2 syndromes that are variations of FAP

A
  1. Gardner’s Syndrome

2. Turcot’s Syndrome

34
Q

In the adenoma-carcinoma sequence what is typically the first mutation present?

A

APC mutation

35
Q

The Faecal Immunochemical Test (FIT) is used to screen for colon cancer by looking for…

A

testing faeces for occult blood

36
Q

List some of the risk factors for colon adenocarcinoma

A
  • increasing age
  • adenomatous polyps
  • hereditary syndromes
  • IBD (especially ulcerative colitis)
  • diet
  • obesity
  • physical inactivity
37
Q

What is another term for Hereditary Non-Polyposis Colorectal Cancer (HNPCC)?

A

Lynch Syndrome

38
Q

Why does Lynch Syndrome occur?

A
  • due to microsatellite instability

- mutations in mismatch DNA repair genes

39
Q

What mutations are present in Lynch Syndrome? [4]

A

mutations in mismatch DNA repair genes

  • hMSH2
  • hMLH1
  • hPMS1
  • hMPS2
40
Q

What is Lynch Syndrome?

A
  • AD familial
  • colonic cancer - typically right sided
  • there are 2 types
41
Q

What is Lynch Syndrome 1?

A

a/w increased risk of colon cancer

42
Q

What is Lynch Syndrome 2?

A

a/w increased risk of colon cancer and non-GI cancers (endometrial, ovarian)

43
Q

Where does colon cancer arising from Lynch Syndrome normally occur?

A

right sided

44
Q

How does right-sided colorectal carcinoma typically present?

A
  • polypoid “cauliflower” lesions
  • may ulcerate –> occult bleeding
  • iron deficiency anaemia
45
Q

How does left-sided colorectal carcinoma typically present?

A
  • annular, encircling lesions
  • constriction
  • symptoms of obstruction
  • rectal bleeding + changing bowel habits
46
Q

Give 2 reasons why tumours of the left side present with obstruction

A
  1. lumen is narrower on left side

2. solid faecal material present

47
Q

What are some of the symptoms of colorectal cancer?

A
  • change in bowel habits
  • blood in stool
  • iron deficiency anaemia
48
Q

Colonic carcinoma is a/w increased risk of endocarditis by what organism?

A

Streptococcus bovis

49
Q

Where does colorectal carcinoma typically metastasize to first?

A

liver, lungs (think of blood circulation)

50
Q

Do right-sided or left-sided lesions have a poorer prognosis?

A

left-sided lesions

51
Q

What is the most common staging system used for colorectal adenocarcinomas?

A

Dukes’ Staging

52
Q

What are the different stages of Dukes’ Staging of colorectal adenocarcinomas?

A

Dukes’ A = confined to the wall

Dukes’ B = invades through muscularis propria

Dukes’ C = nodal involvement

Dukes’ D = distant mets

53
Q

What chemopreventive drug may be given to treat colon cancer?

A

COX Inhibitors (NSAIDs, aspirin…)

54
Q

Why are COX inhibitors given when treating colorectal cancer?

A

because COX-2 has tumourigenesis effects (helps tumour propagation)

55
Q

What is the MOA of Erbitux and Vectibix in treating colorectal cancer? (i.e. Cetuximab and Panitumumab respectively)

A

block the EGFR signalling pathway

56
Q

What is the MOA of Avastin in treating colorectal cancer?

A

blocks the growth of blood vessels

57
Q

How do carcinoid tumours of the GIT present?

A
  • solitary, firm, yellow nodules
  • form islands, glands or sheets
  • monotonous
  • speckled nuclei
  • abundant pink cytoplasm
58
Q

What 2 immunohistochemical stains can be used for carcinoid tumours?

A
  1. Synaptophysin

2. Chromogranin

59
Q

What is Zollinger-Ellison Syndrome?

A

tumors cause the stomach to produce too much acid, resulting in peptic ulcers
– e.g. carcinoid tumour produces too much gastrin

60
Q

What is Carcinoid Syndrome?

A

overproduction of serotonin by a carcinoid tumour

61
Q

What is the clinical presentation of Carcinoid Syndrome?

A
  • skin flushing
  • diarrhea/cramps
  • wheezing, cough
  • hepatomegaly (from mets to liver usually)
62
Q

What are Gastrointestinal Stromal Tumours (GISTs)?

A
  • mesenchymal neoplasms of GIT

- arise from the pacemaker cells of GIT (Interstitial Cells of Cajal)

63
Q

Which cells do GISTs arise from?

A

Interstitial Cells of Cajal - pacemaker cells of the GIT

64
Q

What 2 mutations are associated with GISTs?

A

C-Kit (CD117)

PDGFRA

65
Q

What medication/drug can be used for GISTs?

A

Gleevec (Imatinib) - tyrosine kinase inhibitors

66
Q

List some risk factors for gastrointestinal lymphoma [4]

A
  1. H. pylori infection
  2. Coeliac disease
  3. Immunodeficiency
  4. Mediterranean lymphoma
67
Q

List 3 monoclonal antibodies that can be used to treat metastatic colon cancer

A
  • Cetuximab
  • Panitumumab
  • Bevacizumab

GIHEP (24 decks)

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