New posters/review posters 22/05/2016

Question 1

What is a polyp?

Answer 1

A protrusion above an epithelial surface. It is a tumour (swelling)

Question 2

Describe the shapes polyps can arise in?

Answer 2

Penduncle- has a neck
Flat
Sessile- hairy looking and lumpy

Question 3

Benign polyps of epithelia

Answer 3

Adenoma
Inflammatory
Peurtz Jeghers syndrome

Question 4

Malignant polyps of epithelia

Answer 4

Adenocarcinoma

Question 5

Benign polpys of mesentary

Answer 5

Lipoma
Lymphangioma
Haemangiomas
Fibromas
Leiomyoma

Question 6

Malignant polyps of mesentary

Answer 6

Sarcomas

Question 7

The differential diagnosis of polyps

Answer 7

Serrated polyps
Adenomas
Polypoid carcinoma

Question 8

Adenoma polyps

Answer 8

Dysplastic epithelial lining- not invasive and do not metastasise.
Described as pre- malignant- easily develop from normal mucosa to adenoma and then on to adenocarcinoma.

Question 9

Treatment of adenoma polpys

Answer 9

Must be removed immediately because of pre-malignancy.

This is done endoscopically or surgically.

Question 10

Treatment of adenocarcinoma polyp

Answer 10

Surgical- colon/rectum is removed and sent for pathological staging

Question 11

Staging of polyps

Answer 11

Dukes staging
Dukes A- confined by muscularis externa
Dukes B- through muscularis externa
Dukes C- metastatic to lymph nodes.

Question 12

Hereditary polyps

Answer 12

Familial adenomatos polyposis (FAP) or hereditary non-polyposis coli (HNPCC)

Question 13

Familial adenomatous polyposis

Answer 13

Autosomal dominant. Early onset. Defect in tumour suppression gene (inherited mutation in FAP gene).

Question 14

Pathology of FAP

Answer 14

occurs throughout colon. Adenocarcinomas. No specific inflammatory response. Associated with desmoid tumours and thyroid carcinomas.

Question 15

Hereditary non-polyposis coli

Answer 15

Autosomal dominant. Late in onset. Defect in DNA mismatch repairin MLH 1 gene (other genes also).

Question 16

Pathology of non-polpysis coli

Answer 16

Mucinous tumours. Crohns like inflammatory response. Associated with gastric and endometrial carcinomas.

Question 17

Colorectal neoplasia

Answer 17

Benign- adenoma

Malignant- adenocarcinoma

Question 18

Genes associated with cell cycle.

Answer 18

Oncogenes- Promote cell growth. When mutated- excess cell growth.
Tumour suppressor genes- suppress cell growth and division. When mutated- stop suppressing.

Question 19

TNM staging of colorectal carcinoma

Answer 19

T1- submucosa only
T2-into muscle
T3- through muscle
T4-adjacent structures

N1= 3 nodel involved
N2 >3 nodes involved

Question 20

Lifestyle adjustments for colorectal carcinoma

Answer 20

Protective foods- fibre, vegetables.
Also exercise

Causative things are- alcohol, smoking, obesity, processed/red meat.

Question 21

Pre-disposing conditions for colorectal carcinoma

Answer 21

Adenomatous polpyps
Ulcerative colitis
Crohns disease

Question 22

Clinical features of a carcinoma in the ascending colon

Answer 22

Anorexia and weight loss

Question 23

Clinical features of a carcinoma in the descending colon

Answer 23

Pain, change in bowel habit and rectal bleeding

Question 24

Clinical features of a carcinoma in the sigmoid colon/rectum

Answer 24

Rectal bleeding

Tenesmus

Question 25

General symptoms of colorectal carcinoma

Answer 25

``` Lymphadenopathy Anaemia Cachexia (weakness and fatigue). Mass may be palpable Haptomegaly Distension ```

Question 26

Investigations into colorectal carcinoma

Answer 26

``` Barium enema CT colography Sigmoidoscopy Colonscopy Faecal occult blood test ```

Question 27

In the community- screening occurs by?

Answer 27

Every two years- 50-75 years olds are screened using a home FOBT

Question 28

Emergency presentation of colorectal carcinoma

Answer 28

Obstruction- presents as abdominal distension, constipation, pain and vomiting Bleeding or perforation.

Question 29

Treatment of obstruction

Answer 29

Colostomy Resection plus colostomy Resection plus anastomosis Stenting

Question 30

Treatment of colonic cancer (surgical)

Answer 30

``` iIn the abdomen: Right hemicolectomy Left hemicolectomy Sigmoid colectomy Subtotla colectomy ``` In the rectum Abdomino-perineal incision Anterior resection

Question 31

Treatment of colonic cancer (radiotherapy)

Answer 31

Generally add on therapy Could be used pre or post op. Reduces recurrence

Question 32

Treatment of colonic cancer (chemotherapy)

Answer 32

5 flourouracil or capeltabine