Staging/ Classifications/ Stats

Question 1

What are the outcome for colon cancer (5 year survival)

Answer 1

Stage 1 (T1-2, N0) - >95%
Stage 2 (T3-4, N0) - 90%
Stage 3 (any T, N1-3) - 75%
Stage 4 (metastatic disease) - 15%

Question 2

Amsterdam II criteria

Answer 2

These pts should have germline testing for Lynch Syndrome

• ≥ 3 relatives with a Lynch Syndrome associated cancer (colorectal, endometrium, small bowel, urothelium)
• ≥2 successive generations
• ≥1 with cancer diagnosis <50y.o

Question 3

Staging parameters for sarcoma

Answer 3

Sacroma type
Tumour grade (mitosis, differentiation, tumour necrosis)
Tumour size
Nodal involvement (rare)
Involvement of distant sites

Question 4

Spigelman classification

Answer 4

Points for
Polyp number (1,2,3)
Polyp size (1-4, 5-20, >20)
Histology (tubular, TV, villous)
Dysplasia (mild, moderate, severe)

Stage 0 (0 points) and Stage I (1-4 points) - endoscopy in 5 years
Stage II (5-6 points) - 2-3 years
Stage III (7-8 points) and stage IV (9-12 points) - repeat endoscopy 6-12 months and surgical evaluation

Question 5

Which cancer genetic conditions have autosomal recessive inheritance?

Answer 5

ATM
MYH-associated adenomatous polyposis
Werner syndrome
Xeroderma pigmentosum

Question 6

Screening for Lynch

Answer 6

Colonoscopy - annual from 25
Pelvic exam and endometrial sampling from 35
Ovarian USS from 35; consider BSO over 40
Gastroscopy 2-3 yearly from age 30-35
Annual uroanalysis from age 30-35

Question 7

AAST Diaphragm injury scale

Answer 7

I - contusion
II - laceration <2cm
III - laceration 2-10cm
IV - laceration >10cm with tissue loss <25cm2
V - laceration is with tissue loss >25cm2

Question 8

NF-1

Answer 8

Autosomal dominant
Mutation on chromosome 17
Loss of function mutation of neurofiromin

Clinical presentation:
Cafe-au-lait macules
Neurofibromas - cutaneous, nodular and plexiform
Freckling of axilla/groin
Lisch nodules (eyes, iris harmartomas)
Skeletal abnormalities (including kyphoscoliosis, sphenoid wing dysplasia and osteopenia)
Neurological abnormalities
Malignancies:
- neurological: optic nerve glioma, astrocytoma, Brainstem glioma and schwannomas
Wilms tumour
Rhadomyosarcoma
mPNSTs
Breast cancer
Melanoma

Question 9

NF2

Answer 9

Neurofibromotosis type 2
Autosomal dominant
Chromosome 22
Loss of function mutation of protein Merlin, a tumour suppressor gene

Present with
Vestibular schwannomas
Meningomas
Spinal tumours