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Gastrointestinal Conditions (JBR) > Small & Large Bowel Tumours and Polyps > Flashcards

Small & Large Bowel Tumours and Polyps Flashcards

1
Q

What are examples primary small bowel tumours?

A

Lymphomas
Carcinoid tumours (most common in appendix)
Carcinomas

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2
Q

Carcinomas of the small bowel are associated with?

A

Crohn’s Disease

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3
Q

What are features of lymphomas of the small bowel?

A 
Rare
All non-Hodgkins
Maltomas (B-cell derived) 
Rarely enteropathy associated T-cell lymphomas 
Associated with Coeliac's disease
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4
Q

What are common sources of secondary tumours (metastases) to the small bowel?

A

Ovary
Colon
Stomach (more common)

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5
Q

What is a polyp?

A

Protrusion above an epithelial surface (easily removed tumour)

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6
Q

What is the macroscopic appearance of a polyp?

A

Pedunculated, sessile, fat, irregular surface

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7
Q

What is the microscopic appearance of a polyp?

A

Tubulo-villous

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8
Q

How do you distinguish between an adenoma and a polyp?

A

Histopathology

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9
Q

Adenomas are at high risk of?

A

Malignant transformation

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10
Q

All adenomas are?

A

Pre-malignant (dysplastic)

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11
Q

What is HNPCC?

A

Hereditary non-polyposis colorectal cancer

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12
Q

How many polyps are found for HNPCC?

A

<100

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13
Q

What are features of HNPCC inheritance and onset?

A

Late onset
Autosomal dominant
Defect in DNA mismatch repair

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14
Q

What are features of the tumours of HNPCC?

A

Right sided, mutinous tumours
Crohn’s like inflammatory response
Associated with gastric and endometrial carcinoma

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15
Q

How do you investigate HNPCC?

A

Surveillance - colonoscopy every 2 years from age 25 - upper GI endoscopy from age 50

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16
Q

HNPCC is managed the same way as?

A

Colorectal Cancer

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17
Q

What is FAP?

A

Familial andenomatous polyposis

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18
Q

How many polyps are found with FAP?

A

> 100

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19
Q

What are features of the inheritance of FAP?

A

Early onset
Autosomal dominant
Defect in tumour suppression

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20
Q

What are features of the tumours of FAP?

A

Throughout colon
Adenocarcinoma NOS (nitrous oxide system)
No specific inflammatory response
Associated with desmoid tumours and thyroid caricnom

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21
Q

How does a colonic polyp present?

A

Rectal bleeding
Diarrhoea
Abdominal pain
Mucous discharge

22
Q

How do you treat colonic polyps?

A

Remove (endoscopically / surgically)

Send biopsy to pathology

23
Q

Which mutation allows transition from normal epithelium to small adenoma?

A

APC

24
Q

Which mutation allows transition from small to large adenoma?

A

K-ras

25
Q

Which mutations allow transition from large adenoma to invasive adenocarcinomas?

A

p53

chromosome 17p, 18q deletion

26
Q

Which mutation allows an invasive adenocarcinoma to metastasise?

A

nm23 deletion

27
Q

What are risk factors for colorectal cancer?

A 
FHx
IBD
FAP
AFAP
HNPCC
Nulliparity
Late age at 1st pregnancy
Early menopause
Western diet 
Smoking 
Obesity
Alcohol intake 
Diabetes
28
Q

What is nulliparity?

A

Never having given birth

29
Q

What predisposes to CRC?

A

Adenomatous polyps and IBD

30
Q

What are possible macroscopic appearances of CRC?

A

Polypoidal, annular (stenosing), ulcerative

31
Q

With increasing stage of CRC the microscopic appearance becomes increasingly?

A

Poorly differentiated

32
Q

Lymphatic spread of CRC is commonly to?

A

Pericolic and perivascular nodes (need to remove colon + associated vasculature/lymphatics)

33
Q

Haematogenous spread of CRC is first to the _____ then distant sites

A

liver

34
Q

What are causes of CRC?

A

Environment (red/processed meat, smoking, alcohol, obesity)

35
Q

What is protective against colorectal cancer?

A

Vegetables, fibres, and exercise

36
Q

Why is exercise protective against CRC?

A

Acts on AMPK - same enzyme that tumour suppressors activate to decrease cell turnover and increase glucose uptake by muscle

37
Q

How does CRC present?

A 
Weight loss 
Anaemia 
Change in bowel habit 
Abdominal mass 
Abdominal pain
38
Q

What is the distinguishing feature of CRC in the ascending colon?

A

Anaemia (esp. after menopause)

39
Q

What is the distinguishing feature of CRC in the descending colon?

A

Mass, hepatomegaly, distension

40
Q

What is the distinguishing feature of CRC in the rectum?

A

Rectal bleeding

Tenesmus

41
Q

What are general signs of CRC?

A

Anaemia
Cachexia
Lymphadenopathy

42
Q

What are abdominal signs of CRC?

A

Mass
Hepatomegaly
Distension

43
Q

What are rectal signs of CRC?

A

Mass

Blood

44
Q

What is an emergency presentation of CRC?

A

Obstruction (distension, constipation, pain, vomiting)
Bleeding
Perforation

45
Q

Which investigations can be done for CRC?

A 
Barium enema
(+/- CT) Colonoscopy +/- biopsy
CEA
Sigmoidoscopy
FOBT
46
Q

What is CEA?

A

Carcinoembryonic antigen - tumour protein marker)

47
Q

What is FOBT?

A

Faecal output blood testing

48
Q

FOBT is used to?

A

Screen for CRC

49
Q

If the FOBT screening is positive, patients are invited for?

A

Colonoscopy

50
Q

How do you treat CRC?

A

Remove affected part of bowel + associated lymph/vasculature

51
Q

How do you treat CRC obstruction?

A 
Colostomy (alone)
Colostomy + resection
resection + anastomosis
Stenting 
Radiotherapy

Gastrointestinal Conditions (JBR) (33 decks)

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