Tumours: Colorectal Carcinoma Flashcards

1
Q

It is usually a polypoid mass with ______. This spreads by ___ ____ . It involves ____ and ___ ___ .

A

It is usually a polypoid mass with ulceration. This spreads by direct infiltration through the bowel wall. It involves lymphatics and blood vessels.

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2
Q

what do they look like histologically ?

A

adenocarcinoma with variably differentiated glandular epithelium with mucin production

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3
Q

where are 75% of CRCs?

A

Left sided (rectum, sigmoid, descending)

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4
Q

where are 25% of CRCs?

A

25% Right sided (Caecum, Ascending)

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5
Q

what are the PCs for left sided? 3

A

p/c: Blood PR, Altered bowel habit, Obstruction

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6
Q

what are the PCs for right sided? 2 and why?

A

p/c: Anaemia, Weight loss - get more generalised symptoms because the tumour can grow quite large

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7
Q

what is in the centre of the glands? hallmark of CRC

A

dirty necrosis pattern

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8
Q

what is dukes A?

A

Dukes A: confined by muscularis propria

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9
Q

what is dukes B?

A

Dukes B: through the muscularis propria

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10
Q

what is dukes C?

A

Dukes C: metastatic to lymph nodes

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11
Q

what are some protective associations with colorectal cancer

A

vegetbles, fibre and EXERCISE

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12
Q

what are some associated causes of CRC

A

red and processed meat, smoking, alcohol and OBSESITY

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13
Q

how does exercise help?

exercise has a similar effect to the tumour suppressor gene ____ which stimulates the enzyme ____ responsible for a decrease in cell turnover and glucose uptake by muscle

A

LKB1, AMPK

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14
Q

what are the three types of macroscopic CRC appearances

A

polypoidal

ulcrative

annular

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15
Q

histologically it is an _______ with variably differentiated _____ epithelium with ____ production

A

is adenocarcinoma with variably differentiated glandular epithelium with mucin production

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16
Q

the majority of CRC are _____ in type

17
Q

what are some predisposing conditions for CRC ? 3

A

Adenomatous polyps
Ulcerative colitis
Crohn’s disease

18
Q

clinical features depend on where the cancer is, if it is in the rectum what are the symptoms?

A

Rectal bleeding and tenesmus

19
Q

if it is in the sigmoid what are the symptoms?

A

Pain,

change in bowel habit - stool become looser and get pseudo -diarrhoea

rectal bleeding

20
Q

if it is in the caecum and right side what are the symptoms?

A

Anaemia - Tend not to get rectal bleeding but they become anaemic as they lose small amounts of blood over a long period of time

21
Q

by far the most common cause of unexplained anaemia for both males and females is ____

22
Q

what are the general findings on clinical examination?

A

Anaemia, cachexia and lymphadenopathy

23
Q

what are the abdomen findings on clinical examination?

A

Mass, hepatomegaly and distension

24
Q

what are the rectum findings on clinical examination?

A

mass and blood

25
what investigations are done?
FBC - liver biochemistry - renal function - colonoscopy - barium - CT colography - MRI scan - because CT scan of rectum is not great
26
how is it screened for?
FOBT
27
what are the emergency complications of CRC
obstruction bleeding perforation
28
what are the symptoms of obstruction
distension, constipation, pain and vomiting - the exact symptoms out of these 4 may vary depending on where the obstruction is
29
what are the treatment options for obstruction?
colostomy alone, resection and colostomy, resection and anastomosis but the commonest way nowadays is through stenting
30
what treatment may reduce local recurrence after a rectal excision?
radiotherapy
31
radiotherapy can be used ______
palliatively
32
examples of chemo
5 -fluorouracil or capecitabine
33
chemo is used for ____ disease
advanced