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Gastro > Pathology of the Colorectal Carcinoma > Flashcards

Pathology of the Colorectal Carcinoma Flashcards

1
Q

What is a polyp?

A

A protrusion above an epithelial surface

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2
Q

Is a polyp benign or malignant?

A

Can be either

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3
Q

What are some examples of benign epithelial polyps

A

Neoplastic (adenoma inflammatory IBD)

Hamartomatous (juvenile polyp )

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4
Q

What is a type of malignant epithelial polyp?

A

Polypoid (adenocarcinomas or carcinoid polyps

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5
Q

What are the 3 different types of macroscopic

A

Pedunculated
Sessile
Flat

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6
Q

Describe pedunculated polyps

A

Hangs on a long stalk form the mucosa and is mushroom like- easy to remove

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7
Q

Describe sessile polyps

A

Carpet like - difficult to cut out as over a longer area

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8
Q

What is dysplastic epithelial lining

A

Epithelium that has failed to mature

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9
Q

Describe adenomas of the colon

A

Benign tumours which are not invasive and have the potential to develop into cancers

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10
Q

How can we reduce the risk of cancer?

A

Screen the colon and remove all adenomas

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11
Q

What are the 3 different microscopic architecture variability

A

Tubullovillous (tree like)
Tubular (large circles)
Villous (Finger like projections)

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12
Q

What are all adenomas?

A

Dysplastic

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13
Q

What can happen if adenomas are left?

A

They can lead to cancer

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14
Q

Describe the adeoma-carcinoma sequence

A

Normal mucosa,
adenoma (dysplastic)
Adenocarcinoma (invasive)

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15
Q

Why must all adenomas be removed?

How is this done?

A

Because they are all premalignant

Either done endoscopically or surgically

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16
Q

Do all colorectal adenomas have the same molecular genetic origins?

A

No

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17
Q

What causes the variation in colorectal adenomas

A

separate pathways for injerited tumours

Sparate pathways for serrated adenomas

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18
Q

What is the primary treatment in most cases of adenocarinoma of the large bowel

A

Surgery

19
Q

How is the tumour staged?

A

Endoscopic biopsy sent to pathology

20
Q

Why are gland cells formed?

A

They are derived from stem cells which give rise to large colonic crypts which still contain traces of normality

21
Q

How does cancer spread to the serosal fat?

A

Invades through the muscle

22
Q

How do we stage colorectal carcinoma

A

Using Duke’s staging

23
Q

What are the 3 stages of Duke’s staging?

A

Dukes A: Confined by muscularis propria
Dukes B: Through muscularis propria
Dukes C: Metastatic to lymph nodes

24
Q

Where are most colorectal carcinomas found?

A

75% Left side (rectum,sigmoid descending)

25% Right side (Caecum, ascending)

25
Q

What are the common presentations of left sided colorectal carcinomas?

A

Blood PR, Altered bowel habit and obstruction

26
Q

What are the common presentations of right sided colorectal carcinomas

A

Anaemia, weight loss

No PR bleeding

27
Q

Why do some tumours appear to be glistening?

A

Due to the mucous which is produced from the tumour

28
Q

What might be affected by local invasion

A

Mesorectum, peritoneum, other organs such as the bladder, ovary or prostate, uterus or vagina

29
Q

What might be affected by lymphatic spread

A

Mesenteric nodes

30
Q

What might be affected by haematogenous

A

Liver, distant sites

31
Q

Where is the most common site of metastases from colorectal cancer and why?

A

Liver

Due to the hepatic portal system

32
Q

What are the two types of inherited cancer syndromes?

A

Heriditary Non Polyposis Coli (HNPCC)

Familial Adenomatous Polyposis (FAP)

33
Q

How many polyps are present in HNPCC

A

<100

34
Q

How many polyps are present in FAP

A

> 100 polyps

35
Q

Describe the genetics of HNPCC FAP

A

Autosomal dominant

36
Q

What may be required for patients in FAP

A

removal of the colon and rectum at a young age

37
Q

Describe the onset for HNPCC and FAP

A

HNPCC - Late

FAP - Early

38
Q

What causes HNPCC

A

Defect in DNA mismatch repair

39
Q

What causes FAP

A

Defect in tumour supression

40
Q

Where do HNPCC tumours arise

A

Right side

41
Q

Where do FAP tumours arise

A

Throughout the entire colon

42
Q

What is HNPCC associated with

A

Gatric and endometrial carcinoma

43
Q

What is FAP associated with?

A

Desmoid tumours and thyroid carcinoma

Gastro (67 decks)

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