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GI/Liver > Lec 30 > Flashcards

Lec 30 Flashcards

1
Q

What are 4 strong risk factors for colorectal cancer?

A
  • age > 50
  • country of birth
  • hereditary syndrome
  • longstanding IBD
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2
Q

What are 3 protective factors for colorectal cancer?

A
  • physical activity
  • aspirin/NSAIDs
  • colonoscopy
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3
Q

How long does it generally take to go from polyp formation to cancer?

A

5-10 years

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4
Q

Is colorectal cancer more predominant in left vs right colon?

A

pretty even; maybe slightly more in left colon

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5
Q

Which type of adenomas are most likely to become cancerous?

A
  • larger
  • villous
  • sessile
  • more severe dysplasia
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6
Q

What type of plasia is an adenoma?

A

dysplasia

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7
Q

What characterizes colon dysplasia?

A

cytological abnormalities –> loss of goblet cells, increased nuclear: cytoplasm ratio

distorted crypt morphology

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8
Q

What fraction of adenomas progress to cancer?

A

5-10%

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9
Q

What are the 3 pathways of colon carcinogenesis?

A
  • chromosomal instability
  • microsatellite instability
  • CpG island methylation
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10
Q

What is the chromosomal instability path of colon carcinogenesis?

A

normal mucosa –> loss of APC gene –> at risk –> K-ras mutation –> adenoma formation –> loss of tumor suppressor p53, DCC –> carcinoma

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11
Q

What is the microsatellite instability path of colon carcinogenesis?

A

have mutation/loss of DNA mismatch repair gene

increased mutations lead to cancer

Lynch syndrome

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12
Q

What is the CpG island methylation [CIMP] path of colon carcinogenesis? What type of polyp?

A

DNA methylation inhibits key gene expression

associated with sessile serrated polyps

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13
Q

What is most common symptom of colon cancer?

A

no symptoms at all!

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14
Q

What is presentation when colon cancer becomes symptomatic?

A
  • change in nature of stool –> red or black; thinner
  • ab cramps
  • unexplained weight loss
  • loss of appetite
  • low blood count [anemia]
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15
Q

What are signs of colon cancer on physical exam?

A
  • ab mess, tenderness, distension
  • enlarged liver [if met]
  • abnormal rectal exam –> mass or fecal occult blood
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16
Q

What are signs of rectal cancer?

A

tenesmus, pain, bleeding

17
Q

What are signs of descending colon cancer?

A

signs associated with obstruction

overt bleeding

18
Q

What are signs of proximal/right colon cancers?

A

occult bleeding

anemia

19
Q

Are most colon cancers hereditary/family?

A

Nope – 70% are sporadic

20
Q

Who is of “average” risk for colorectal cancer?

A

anyone > 50 yo

21
Q

Who is of high risk for colorectal cancer?

A
  • people with FAP/lynch
  • IBD
  • family history
  • personal history
22
Q

How often should you get a colonoscopy?

A

every 10 years

23
Q

How is familial adenomatous polyposis inherited?

A

autosomal dominant

24
Q

What are clinical feat of familiar adenomatous polyposis?

A
  • hundreds - thousands of colorectal adenomas

- upper GI polyps

25
Q

What is the mutation in FAP?

A

mutation in APC gene on chr 5

26
Q

What is risk of developing colorectal cancer if you have familial adenomatous polyposis?

A

100%

27
Q

What is gardner syndrome?

A

have FAP AND osteomas, soft tissue tumors, congenital hypertrophy of retinal pigment epithelium

28
Q

What is turcot syndrome?

A

have FAP AND malignant brain medulloblastoma, duodenal adenocarcinoma, hepatoblastoma, thyroid carcinoma

29
Q

what is normal activity of APC gene?

A

lives in cytoplasm; sends B-catenin into destruction path and keeps it out of the nucleus to minimize cellular proliferation and make sure apoptosis occurs

mutated –> increased proliferation and decreased apoptosis

30
Q

How do you diagnose FAP?

A

colonoscopy

31
Q

What is treatment for FAP?

A

prophylactic proctocolectomy

32
Q

What is inheritance of lynch syndrome?

A

autosomal dominant mutation of DNA mismatch repair gene

33
Q

What percent of people with lynch get CRC?

A

80%

34
Q

Where are cancers from lynch usually located?

A

proximal colon

35
Q

What is typical histology of lynch carcinoma?

A

signet ring cell
mucinous
medullary
infiltrating lymphocytes

36
Q

What extra-intestinal cancers associated wtih lynch?

A
  • endometrium
  • GU tract
  • small bowel
  • brain [glioblastoma]
  • stomach
  • ovary
  • pancreas
37
Q

What is amsterdam criteria for lynch?

A
  • 3 members affected by one of the lynch-associated cancers
  • 2 or more generations
  • 1 person affected under age 50

GI/Liver (36 decks)

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