Neoplasms and Anorectal Diseases Flashcards by Indy P

Colorectal cancer is the ____ most frequently diagnosed cancer and the ____ leading cause of cancer death in the US.

4th

2nd

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Esophageal Carcinoma epi

6th most common cause of cancer death
M > W

Subtypes:
Adenocarcinoma
SCC

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What are the major risk factors of SCC of esophagus?

Smoking and EtOH

SCC risk decreases substantially after smoking cessation

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What are risk factors of adenocarinoma of esophagus?

Obesity (high BMI)

GERD and Barrett’s esophagus

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How do you dx esophageal carcinoma?

Direct tissue biopsy via upper endoscopy

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How do you stage esophageal carcinoma?

Upper endoscopy (length, bulky tumor) 
Endoscopic US (regional nodes) 
CT scan PET scan  (distal mets)

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Therapies of esophageal carcinoma?

Low stage (Tis and T1) - endoscopic, chemo/surgery if needed

Higher stage (T2 and above) - chemo/XRT then surgery

Long term survival is poor

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Gastric cancer is the ____ leading cause of cancer worldwide

3rd

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When is gastric cancer typically diagnosed?

At a later stage

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Risk factors of gastric cancer

H. Pylori
High salt intake
Smoking
Heavy EtOH use

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How do you dx gastric cancer?

Direct tissue biopsy via upper endoscopy

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How do you stage gastric cancer?

Upper endoscopy (size, location) 
Endoscopic US (depth/nodes) 
CT scan PET scan (distal mets)

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What is the treatment for gastric cancer?

Low stage (Tis and T1) - endoscopic therapy (EMR/ESD)

Higher stage (T2 and above) - chemo/XRT then surgery (morbid)

Long term survival is poor

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Small bowel cancers

Rare
Less than 2% of GI cancers

Types:
Adenocarcinoma 
Carcinoids
Sarcomas 
Lymphomas 
GISTs

M> F

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What are the risk factors of small bowel cancer?

FAP

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Where in the small bowel is adenocarcinoma more common?

50% duodenum
30% jejunum
20% ileum

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What is the treatment for small bowel adenocarcinoma?

Surgery + chemo

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Colorectal cancer is the ____ leading cause of cancer death in the US

2nd

5% lifetime risk

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What is the treatment for colon cancer?

Stage 1 and low risk stage 2 - surgical resection is curative (no chemo)

All other stages - surgical resection if possible + chemo

Rectal cancers respond well to radiation upfront followed by surgery

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Pancreas cancer is the _____ leading cause of cancer related deaths

4th

Most pts present late stage with obstructive jaundice, abdominal pain, and weight loss

How do pts with pancreas cancer present?

Late stage with obstructive jaundice, abdominal pain, and weight loss

Anal fissure presentation

Anal pain
Anal itching
Outlet bleeding

What is the medical treatment for anal fissure?

High fiber diet (30-50 g) 
Warm baths 
Nitrates 
CCB 
Steroid creams

What are the surgical treatments for anal fissures?

BoTox injection 
Sphiceterotomy 
Anoplasty
Advancement flap 
Anal dilation

Path behind anal fissure

Anal spasm MC Traumatic stooling causing tear

What positions can pts be in for anal examination?

Left lateral decubitus Prone jack knife position Be sure to ask the pt to bare down

What is the path behind thrombosed external hemorrhoid?

NOT DONE HERE

How do pts with thrombosed external hemorrhoids present?

Constant pain Protrusion Bleeding

What are the PE of thrombosed external hemorrhoid?

Tender mass protrusion Secondary findings -skin necrosis -prolapsed internal hemorrhoids

What is the treatment of thrombosed external hemorrhoids?

Non-operative management Excision Evacuation

What is the risk of death (in %) of pts with esophageal CA?

90% mortality

What is the most common risk factor for Gastric Ca?

H. Pylori

What is the % mortality of gastric cancer?

60%

FAP risk factor for

Gastric Cancer Small bowel cancers Colon cancer

Where in the stomach is gastric cancer most common?

Lesser curve

What does a central ulceration of a mass on endsocpy or colonscopy indicate?

Having an ulcer in the middle is a sign of progression of the CA

Fish mouth appearance

Pancreas cancer

MC location of anal fissure

Posterior aspect

What is the major difference between treatment of Stage 1 - 4 internal hemorrhoids?

Stage 1 and 2 you can do conservative treatment Stage 3 and 4 need surgery

Can you band external hemrrhoids?

Which hemorrhoids can you do banding for?

Stage 1 and 2 internal hemorrhoids

Who gets perianal abscess?

Infected anal crypt gland Infected fissure Crohns Post surgical

How to pts with perianal abscess present?

``` Constant pain Pressure Subacute onset Fever Malaise ```

What are the PE to perianal abscess?

``` Erythema Induration Swelling Drainage Sometimes minimal ```

How do you dx perianal abscess?

Exam under anesthesia CT US Evaluation for IBD, diverticulitis Watch closely - untreated perianal abscess could lead to necrotizing soft tissue infection

What is the treatment for perianal abscess?

``` I and D ABX if: -immunocompromised -DM -extensive cellulitis Seton placement ```

What is the treatment for pilonidal cyst?

I and D

What causes proctalgia fugax?

Smooth muscle spasm secondary to stool withholding in adults Tx. Antispasmodics, BoTox injection

How do nitrates work in anal fissure treatment?

increase blood flow to the area to aid in healing