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GI (Gastroenterology) > The Large Intestine - Colonic and Rectal Polyps and Neoplasms > Flashcards

The Large Intestine - Colonic and Rectal Polyps and Neoplasms Flashcards

1
Q

What is Bowel Cancer?

A

Cancer of the Colon/Rectum - Small Bowel and Anal Cancers are less common.

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2
Q

Risk Factors of Colorectal Cancer (8).

A
  1. Family History.
  2. FAP.
  3. HNPCC - Lynch Syndrome.
  4. IBD.
  5. Increased Age.
  6. Diet (High in Red/Processed Meat and Low Fibre).
  7. Smoking.
  8. Alcohol.
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3
Q

What is FAP?

A

Familial Adenomatous Polyposis - Autosomal Dominant condition where there is malfunctioning of the tumour suppressor genes - Adenomatous Polyposis Coli (APC) in Chromosome 5.

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4
Q

What is the consequence of FAP?

A

Adenomas (Polyps) develop along large intestine - potential to become cancerous (usually before 40) (and increased risk of duodenal tumours).

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5
Q

Prophylaxis of FAP.

A

Panproctocolectomy (removal of entire large intestine) to prevent development of colorectal cancer with an ileo-anal pouch.

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6
Q

What is HNPCC - Lynch Syndrome?

A

Hereditary Nonpolyposis Colorectal Cancer - Autosomal Dominant condition resulting from mutation in DNA Mismatch Repair Genes.
- MSH2 (60%) and MLH1 (30%).

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7
Q

What is the consequence of HNPCC - Lynch Syndrome?

A

Higher risk of a variety of cancers, especially colorectal cancers (and endometrial cancer).

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8
Q

What is the difference between HNPCC - Lynch Syndrome and FAP?

A

HNPCC does not cause adenomas - tumours develop in isolation.

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9
Q

Red Flags of Colorectal Cancer (6).

A
  1. Change in Bowel Habit (More Loose and Frequent Stools).
  2. Unexplained Weight Loss.
  3. Rectal Bleeding.
  4. Unexplained Abdominal Pain.
  5. Iron Deficiency Anaemia (Microcytic + Low Ferritin).
  6. Abdominal/Rectal Mass on Exam.
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10
Q

Criteria for 2 Week Wait Referral (4).

A
  1. Over 40 + Abdominal Pain + Unexplained Weight Loss.
  2. Over 50 + Unexplained Rectal Bleeding.
  3. Over 60 + Change in Bowel Habit or Iron Deficiency Anaemia.
  4. Unexplained Iron-Deficiency Anaemia (?Microscopic Bleeding in Bowel Cancer) : Colonoscopy and Gastroscopy.
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11
Q

Screening of Bowel Cancer (5).

A
  1. FIT - Faecal Immunochemical Test : Amount of Haemoglobin in Stool.
  2. Replaced FOB Test (Faecal Occult Blood) which detected blood but with false positives e.g. from red meats and only 1 sample (compared to 2-3).
  3. Useful in patients who do not meet criteria for a 2 week wait.
  4. Age : 60-74 every 2 years or Risk Factors like FAP, HNPCC, IBD.
  5. If Positive - Colonoscopy.
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12
Q

Investigations of Colorectal Cancer (5).

A
  1. Colonoscopy - Gold-Standard (Endoscopy of Entire Large Bowel with biopsy or tattooing).
  2. Sigmoidoscopy (Endoscopy of Rectum + Sigmoid) : Only Rectal Bleeding.
  3. CT Colonography (CT Scan with Bowel Prep and Contrast to visualise the colon) : alternative to Colonoscopy but no biopsy/less detailed.
  4. Staging CT : CT TAP.
  5. CEA (Carcinoembryonic Antigen) Tumour Marker Blood Test - predict relapse (not screening).
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13
Q

Staging Systems of Colorectal Cancer (2).

A
  1. Dukes’ (OLD) - A (Confined to Mucosa) : D (Metastatic Disease).
  2. TNM System.
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14
Q

Management of Colorectal Cancer (5).

A
  1. MDT Meeting.
  2. Surgical Resection (Curative/Palliative).
  3. Chemotherapy.
  4. Radiotherapy.
  5. Palliative Care (Stent, Bypass, Diversion Stoma).
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15
Q

Surgery in Colorectal Cancer (4).

A
  1. Identify tumour - tattoo during endoscopy.
  2. Remove the section of the bowel containing the tumour.
  3. Create an end-to-end anastomosis (sew remaining ends back together).
  4. OR Create a stoma (open section of bowel onto skin).
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16
Q

Types of Surgical Operations (6).

A
  1. Right Hemicolectomy.
  2. Left Hemicolectomy.
  3. High Anterior Resection.
  4. Low Anterior Resection.
  5. Abdominoperineal Resection.
  6. Hartmann’s Procedure.
17
Q

What is a Right Hemicolectomy?

A

Removal of the Caecum, Ascending and Proximal Transverse Colon.
Anastomosis : Ileo-colic.

18
Q

What is a Left Hemicolectomy?

A

Removal of the Distal Transverse and Descending Colon.
Anastomosis : Colo-Colic.

19
Q

What is a High Anterior Resection?

A

Removal of the sigmoid colon - also known as sigmoid colectomy.
Anastomosis : Colorectal.

20
Q

What is a Low Anterior Resection?

A

Removal of the sigmoid colon and upper rectum but sparing the lower rectum and anus.
Anastomosis : Colorectal.

21
Q

What is an Abdominoperineal Resection?

A

Removal of the rectum and anus (plus or minor the sigmoid colon) + suturing over anus, leaving the patient with a permanent colostomy.
This is required if there is involvement of the sphincter complex.

22
Q

What is Hartmann’s Procedure?

A

Emergency procedural removal of the rectosigmoid colon and creation of a colostomy and the rectal stump is sutured closed.

23
Q

Common Indications of Hartmann’s Procedure (2).

A
  1. Acute Obstruction by a Tumour.
  2. Significant Diverticular Disease.
24
Q

Complications of Colorectal Surgery (3).

A
  1. Post-Operative Ileus.
  2. Intra-Abdominal Adhesions.
  3. Incisional Hernias.
25
Q

What is Low Resection Syndrome? (3)

A
  1. Urgency and Frequency of Bowel Movements.
  2. Faecal Incontinence.
  3. Difficulty Controlling Flatulence.
    *** after resection of bowel from the rectum, with a colorectal anastomosis.
26
Q

Emergency Presentation of Colorectal Cancer.

A

Obstruction - if tumour blocks the passage through the bowel.

27
Q

Follow-Up with Colorectal Surgery.

A

After curative surgery : follow-up for 3 years with CT TAP and serum CEA.

28
Q

Sites of Colorectal Cancer (5).

A
  1. 40% - Rectal.
  2. 30% - Sigmoid.
  3. 15% - Ascending Colon/Caecum.
  4. 10% - Transverse Colon.
  5. 5% - Descending Colon.
29
Q

When is an end colostomy preferred?

A

Where the bowel has perforated and the anastomosis is colon-colon.

30
Q

Genetic Types of Colorectal Cancer (4).

A
  1. Sporadic (95%) - series of genetic mutations : Activation of Oncogenes + Inactivation of Tumour Suppressor Genes.
  2. HNPCC (5%).
  3. FAP (<1%).
  4. Serrated Pathway (30%) - Activation of BRAF Oncogene and Silencing of MMR Genes.
31
Q

What criteria are used to help diagnose HNPCC?

A

Amsterdam :
1. At least 3 family members with colon cancer.
2. Cases span at least 2 generation.
3. At least 1 case is diagnosed before 50.

32
Q

What is Gardner’s Syndrome?

A

Variant of FAP featuring osetomas of skull and mandible, retinal pigmentation, thyroid carcinoma and epidermoid cysts on the skin.

33
Q

What is a colorectal adenoma?

A

DYSPLASTIC (Pre-Malignant) Polyp derived from the epithelial cells lining the mucosa - a mass that projects from a mucosal surface.

34
Q

Descriptions of a polyp (4).

A
  1. Pedunculated - attached to mucosa by a stalk.
  2. Sessile - attached to mucosa by a broad base.
  3. Tubular - composed of tubular structures.
  4. Villous - composed of finger-like structures.
35
Q

What features are associated with a malignant progression of the polyp? (4)

A
  1. Increasing Size.
  2. High Grade of Dysplasia.
  3. Histology - Villous > Tubular.
  4. Invasion of Submucosa - Metastatic Potential.
36
Q

What is an adenoma?

A

Definition : benign tumour of glandular epithelium, with no potential to become cancerous.
GI : premalignant lesions.

GI (Gastroenterology) (32 decks)

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