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GI > Pathology of colorectal carcinoma > Flashcards

Pathology of colorectal carcinoma Flashcards

1
Q

what is a polyp?

A

= a protrusion above an epithelial surface

  • it is a tumour (a swelling), it doesn’t tell you what caused it
  • doesn’t indicate benign or malignant
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2
Q

True or False.

All polyps are adenomas?

A

FASLE

- NOT all polyps are adenomas

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3
Q

what are 4 differential diagnosis of a colonic polyp?

A

1) adenoma
2) serrated polyp
3) polypoid carcinoma
4) other

  • need history-pathology to tell them apart
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4
Q

what 3 things can a polyp look like?

A

1) pedunculated - hang on a long stalk
2) sessile - broad carpeted lesion
3) flat

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5
Q

what 2 features do polyps usually have?

A

= irregular surface

= long stalk

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6
Q

when a polyp is sent for histo-pathology and have a dyspeptic epithelial lining what are they?

A

adenomas

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7
Q

describe adenomas of colon?

A

= benign tumours

- not invasive and do not metastases

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8
Q

describe the 3 architectural variabilities of adenoma polyps?

A

1) tubullo-villous
2) villous
3) tubular

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9
Q

True or False.

All adenomas are dysplastic?

A

true

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10
Q

what acts as precursors of colorectal carcinoma?

A

= adenomas

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11
Q

Describe the adenoma-carcinoma sequence?

A

= normal mucosa
= adenoma (dysplastic)
= adenocaricnmam (invasive)

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12
Q

Why must all adenomas be removed and how are they removed?

A

= as they are all pre-malignancy

= either done endoscopically or surgically

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13
Q

Why do not all colorectal adenomas have the same molecular genetic origins?

A
  • separate pathways for;
    = inherited tumours
    = serrated adenomas
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14
Q

most commonly, what would an obstructing mass in the sigmoidal colon, endoscopic biopsy sent to pathology, show?

A

adenocarcinoma

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15
Q

what is the primary treatment in most cases of adenocarcinoma?

A

= surgery

- colon/rectum is removed and sent to pathology for staging

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16
Q

describe the pathology of a tumour in the large bowel?

A

= ulcerating and stricturing tumour mass

= tumour is fixed and transversely section
- tumour has burst through bowel wall to involve pericolic fat
- tumour is invasive through muscularis propria
= tumour has moderately differentiated

17
Q

describe the pathology of the large bowel before adenosine carcinoma?

A

= dirty necrosis pattern

18
Q

describe Dukes staging for colorectal carcinoma, that predicts prognosis?

A

Dukes A
= confined by muscularis propria

Dukes B
= through muscularis propria

Dukes C
= metastatic to lymph nodes

19
Q

describe the position of colorectal carcinoma?

A

= 75% left sided (rectum, sigmoidal, descending)
- p/c: blood PR, altered bowel habits, obstruction

= 25% right sided (caecum, ascending)
- p/c: anaemia, weight loss

20
Q

describe the appearance of colorectal carcinomas?

A

= varied gross appearance (polypoid, stricturing, ulcerating)
= typical histo-pathological appearance (adenocarcinomas)

21
Q

what are the 3 patterns of spread of colorectal carcinoma?

A

1) local invasion
- mesorectum
- peritoneum
- other organs

2) lymphatic spread
- mesenteric nodes

3) haematogenous
- liver
- distant sites

22
Q

describe inherited cancer syndromes.

A

Heriditary

  • non polyposis
  • coli (HNPCC)
  • < 100 polyps

Familial

  • adenomatous
  • polyposis (FAP)
  • > 100 polyp
23
Q

name 2 genes that are autosomal dominant?

A

= HNPCC

= FAP

24
Q

describe the polyp count and inherited mutations in HNPCC and FAP?

A

HNPCC

  • inherited mutation in MLH-1, MSH-2, PMS-1 or MSH-6 genes
  • < 100 polyps

FAP

  • inserted mutation in FAP gene
  • > 100 polyps
25
Q

describe the onset difference between HNPCC and FAP?

A

HNPCC
= late onset

FAP
= early onset

26
Q

describe what HNPCC and FAP gene defects do?

A

HNPCC
= defect in DNA mismatch repair

FAP
= defect in tumour suppression

27
Q

describe where the defects in HPNCC and FAP have an effect?

A

HNPCC
= right sided

FAP
= throughout colon

28
Q

what type of tumours do HNPCC and FAP cause and what are each genes associated to?

A

HNPCC
= mucinous tumours
= associated with gastric and endometrial cancer

FAP
= adenomatous NOS
= associated with desmoid and thyroid tumours

29
Q

describe the difference in inflammatory response between HNPCC and FAP?

A

HNPCC
= Crohn’s like inflammation response

FAP
= no specific inflammatory response

GI (43 decks)

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