Sketchy Path: Colorectal Polyps and Cancer

Question 1

Hamartomatous Polyps are defined as?

Answer 1

Disorganized growth of the normal tissue found in that area (Mature Cell types that are well organized-BENIGN)
So in the colon it is composed of connective tissue, smooth muscle, and glands
(Old man polyp holding the hammer to the sign that is disorganized)

Question 2

Peutz-Jeghers Syndrome has what type of polyps? And what other symptoms do you see?

Answer 2

AD; Harmartomatous Polyps with hyperpigmentation of the lips, hands, and genitalia
(Small baby polyp holding a hammer with a hyperpigmentation popsicle next to the domino bridge)

Question 3

Juvenile polyposis syndrome is composed of what types of polyps?

Answer 3

Hamartomatous Polyps

Question 4

Juvenile polyps are located where? What is the most common presenting symptom?

Answer 4

Rectum
Hematochezia is most common symptom
(Baby polyp with hammer on the pedunculated mushroom that is dripping red intoa red pool)

Question 5

Juvenile polyps histologically?

Answer 5

Display small cystic spaces with glands filled with mucin and inflammatory debris
(Small cystic spaces on the head of the pedunculated mushroom)

Question 6

Are juvenile polpys neoplastic?

Answer 6

No but Juvenile Polyposis does have an increase risk of colon adenocarcinoma
(crab pinch pug crawling up pedunculated mushroom to the small kid with hammer)

Question 7

Hyperplastic polyps are benign or cancerous?

Answer 7

Benign

happy mushroom people on the giant purple mushroom

Question 8

What are hyperplastic polyps made of?

Answer 8

Epithelial proliferation with abundant goblet cells

Overgrowth of mucus secreting plants near the hyperplastic mushroom

Question 9

How can you tell the difference between a hyperplastic polyp and a serrated polyp?

Answer 9

A hyperplastic polyp is only serrated at the surface and smooth in the crypts
(Two happy mushroom people on the hyperplastic mushroom with a serrated saw at the surface but smooth in the middle)

Question 10

Serrated polyps are most commonly located where in the colon?

Answer 10

Proximal Colon

Question 11

What is the characteristic pattern of serrated polyps?

Answer 11

Serrated throughout entire polyps even in the crypts

two mushrooms sawing all the way through a flat mushroom

Question 12

Which polyp (hyperplastic, hamartomatous, serrated) is considered to have malignant potential?

Answer 12

Serrated

Serrated non-pedunculated polyp being sawed all the way thru is being charged at by a large claw pincher bug

Question 13

What is the most common type of colon polyp?

Answer 13

Adenomatous

mushroom man ADDing shingles to is mushroom house

Question 14

Which adenomatous polyps are more likely to transform to cancer?

Answer 14

Large polyps (over 1cm)
(large mushroom near the ADDing shingles house  with giant cancer pincher next to it)

Question 15

Which histological type of adenoma tends to have less malignant potential?

Answer 15

Tubular

also the most common

Question 16

What is familial polyposis syndrome? What is the gene that is implicated?

Answer 16

AD inherited syndrome that causes thousands of polyps to develop in the colon
APC gene
(Family of polyps with the black domino behind them; one is pulling a carrot “A Pulled Carrot” for APC gene while surrounded by many little mushrooms)

Question 17

What is the pathogenesis of FAP regarding inheritance?

Answer 17

Inherit one faulty APC gene from parents then sometime later in life develop a mutation to the second- also called the second hit hypothesis
(One carrot string has been pulled out entirely while the other carrot string is almost pulled out)

Question 18

What are the aspects of Gardner’s Syndrome?

Answer 18

FAP
Soft tissue tumors
Retinal pigment hypertrophy
Dental Abnormalities
(Gardner polyp in garden surrounded by bones)

Question 19

What is it called when FAP is assc with medulloblastoma?

Answer 19

Turcot Syndrome

Polyp wearing a turban

Question 20

The vast majority of cancers in the colon are?

Answer 20

Adenocarcinoma

Question 21

Which IBD is more assc with colorectal cancer?

Answer 21

UC

Question 22

The first step in the adenoma-carcinoma sequence is?

Answer 22

APC gene mutation gives rise to adenomatous polyp

a pulled carrot by polyp guy

Question 23

What is the second step in the adenoma-carcinoma sequence?

Answer 23

K-ras mutation which activates unstoppable cell division- large adenoma
(cancerous rat with polyps on top)

Question 24

What is the third step of the adenoma-carcinoma sequence?

Answer 24

p53 or DCC mutation allows for cancer to cross basement membrane
(Don’t CCross sign fallen with broken checkoint

Question 25

Which side of the colon tends to have non-obstructive lesions?

Answer 25

Right

Question 26

Which side of the colon do you suspect when someone presents with iron deficiency anemia?

Answer 26

Right

right side of field polyp hiding behind calliflower dropping his iron tools

Question 27

Tumors on the left side of the colon present more commonly with?

Answer 27

Obstructive symptoms
(Path obstructed sign)

Question 28

What tumor marker is used to monitor progression or regression of colon cancer?

Answer 28

CEA

CEA telescope- CEA helps you SEE

Question 29

Regular use of what drugs can decrease your risk of colorectal cancer?

Answer 29

ASA

ASA umpire gaurding the village

Question 30

An AD syndrome that increases your risk for abdominal/pelvic cancers (endometrial, ovarian, stomach, small bowel, hepatobiliary)

Answer 30

Lynch Syndrome

Question 31

What genes are affected in Lynch Syndrome?

Answer 31

MSH2 or MLH1
(mismatch repair)
(inch worm on a mismatch domino)