Neoplastic lesions

Question 1

Are SB neoplasms common?

Answer 1

No. Only 5% of GIT neoplasms.

Question 2

What is the aetiology of SB neoplasms?

Answer 2

• inherited conditions
• immunocompromise (esp Kaposi sarcoma, adenocarcinoma and lymphoma)
• geographical location: middle east (? infectious agent)
• Crohn’s disease (increase SB adenocarcinoma)

Question 3

What are the inherited conditions associated with small bowel neoplasms?

Answer 3

• Familial adenomatous polyposis (FAP): most neoplasms in duodenum
• Peutz-Jeghers Syndrome
• Gardner’s syndrome

Question 4

What are the circumstances of immunocompromise facilitating SB neoplasms?

Answer 4

3 circumstances:

• Coeliac disease
• AIDS: liable to Kaposi sarcoma
• Immunosuppression: esp transplant patients

Question 5

What is Peutz Jeghers syndrome?

Answer 5

Inherited condition associated with SB neoplasm. Intestinal polyps mainly in jejunum and marginal pigmentation around anal and buccal mucosa. Presentation usually with intussusception.

Question 6

What is Gardener’s syndrome?

Answer 6

Inherited condition a/w SB neoplasms. Rare.

SB neoplasms associated with skeletal abnormalities and desmoid tumours.

Question 7

What are the 4 most common cancers?

Answer 7

Lung, prostate, breast, CRC

Question 8

RFx for CRC?

Answer 8

• Age >50
• Genetic (FAP, HNPCC, FHx)
• Colonic conditions (adenomatous polyps, IBD, PMHx CRC)
• Diet
• DM and acromegaly

Question 9

Why are DM and acromegaly RFx for CRC?

Answer 9

Insulin and IGF1 are growth factors for colonic mucosal cells

Question 10

CFx CRC?

Answer 10

• Often asymptomatic
• Haematochezia / melaena / change in bowel habit
• Anaemia Sx
• LoW/ palpable mass / obstruction

Question 11

Where does CRC spread?

Answer 11

• Direct extension
• Lymphatic
• Haematogenous

Question 12

Where does CRC usually met to?

Answer 12

• Liver (most common)
• Lung
• Bone
• Brain

Question 13

Where may a tumour of the distal rectum metastasise to?

Answer 13

Tumour of distal rectum –> IVC –> lungs

Question 14

Ix in CRC?

Answer 14

• Colonoscopy
• FBE/UEC/LFTs / CEA
• Staging Ix

Question 15

What is CEA?

Answer 15

Carcinogenic embryonic antigen

Question 16

Additional investigations in rectal cancer?

Answer 16

Pelvic MRI or endorectal US to determine T and N stage

Question 17

Staging Ix in CRC?

Answer 17

• CT CAP
• Bone scan
• CT head only if lesions suspected

Question 18

Rx of colon cancer?

Answer 18

• Wide surgical resection and regional LNs

- Adjuvant chemotherapy (5FU or oral capecitabine with oxaliplatin) can be considered for stage II or III

Question 19

how is cancer bearing portion of colon removed in surgical excision?

Answer 19

According to vascular distribution of the segment

Question 20

T staging of CRC?

Answer 20

T0 = no 1' tumour
Tis = ca in situ
T1 = invasion into submucosa
T2 = invasion into muscular propria.
T3 = invasion through muscularis propria and into series
T4 = invasion into adjacent structures or organs

Question 21

N staging of CRC?

Answer 21

N0= no nodal involvement
N1 = 1-3 reg nodes
N2 = 4+ regional nodes

Question 22

M staging in CRC?

Answer 22

Binary
M0 = no distant met
M1 = distant met