Colorectal and pancreatic cancers

Question 1

what is a colectomy

Answer 1

resection/removal of any extent of the large bowel

Question 2

what is a proctocolectomy

Answer 2

entire large intestine and rectum is removed

Question 3

what is an “anastomosis”

Answer 3

remaining section of intestine are connected to complete the tube; may include ileostomy or colostomy, temporary or permanent

Question 4

what is the concern with colonic polyps

Answer 4

malignant transformation; most colon cancers arise from previously benign adenomatous polyp

Question 5

how are colonic polyps diagnosed

Answer 5

colonoscopy

Question 6

what are familial adenomatous polyposis

Answer 6

multiple polyps

Question 7

what are the clinical presentations of colonic polyps

Answer 7

most asymptomatic
rectal bleeding usually occult and rarely massive, is most frequent complain
cramps, abdominal pain, or obstruction may occur with large polyps

Question 8

what is the treatment of colonic polyps

Answer 8

complete removal during colonoscopy
follow up surgical resection
and follow up surveillance colonoscopy

Question 9

what are preventative measures for colonic polyps

Answer 9

ASA and Cox-2 inhibitors may help prevent formation of new polyps in patients with polyps or colon cancer

Question 10

What is FAP

Answer 10

Familial adematous polyposis
hereditary disorder (autosomal dominant) causing Numerous colonic polyps and frequently resulting in colorectal cancer, often by age 40

Question 11

what are the subtypes of FAP

Answer 11

classic FAP
Attenuated FAP (AFAP_
Gardner syndrome
Turcot Syndrome

Question 12

what are clinical presentations of FAP

Answer 12

most are asymptomatic
if symptomatic usu present wtih rectal bleeding, usually occult
other associated findings: Osteomas, usu of jaw, extra missing, unerupted teeth, etc

Question 13

what is the treatment of FAP

Answer 13

yearly colonoscopy once polyps are found until a colectomy is scheduled
colectomy done as soon as possible after diagnosis made

Question 14

what is hematochezia

Answer 14

blood in stool

Question 15

what is the most common colorectal cancer

Answer 15

adenocarcinomas

Question 16

what are predisposing factors for colorectal cancers

Answer 16

FAP
ulcerative colitis and Crohn’s
Diets in low fiber, high animal protein, fat and refined carbs
cacinogens in diet

Question 17

what are risk factors for CRC

Answer 17

smoking, ETOH intake, increased body weight
T2DM
red/processed meats

Question 18

when does CRC screenings start

Answer 18

average-risk patients: start at 45yo and continue until 75
every 10 years or annually FIT as preferred screening test

Question 19

what are the screening tests for CRC

Answer 19

colonoscopy: every 10 years
Fecal occult blood test (FOBT): every year
flexible sigmoidoscopy: every 5 years
CT colonography; every 5 years
Fecal immunochemical test (FIT)
Fecal DNA testing

Question 20

what is the treatment of CRC

Answer 20

surgery
neo/adjuvant therapy: chemo and radiation
Palliation

Question 21

what is CEA level

Answer 21

serum carcinoembryonic antigen
elevated in 70% in pts with CRC
-good for surveillance

Question 22

what are the types of pancreatic CA

Answer 22

adenocarcinoma
neuroendocrine
cystadenocarcinomas
intraductal papillary-mucinous tumor

Question 23

where do most exocrine tumors develop from

Answer 23

ductal and acinar cells: usually adenocarcinomas

Question 24

what are prominent risk factors for adenocarcinomas

Answer 24

smoking
hx chronic pancreatitis
obesity
male
african american

Question 25

what is the clinical presentation of pancreatic CA

Answer 25

Early sx are non-specific: pain and weight loss
cancer can cause diabetes: glucose intolerance
exocrine insufficiency
malabsorption

Question 26

what are the preferred tests for pancreatic CA

Answer 26

abdominal CT or MRI
followed up endoscopic ultrasound with FNA (EUS/FNA)

Question 27

what type of pancreatic cancers present with jaundice

Answer 27

head of the pancreas CA

Question 28

what are the lab tests run with Dx/workup of pancreatic CA

Answer 28

CBC, CMP: elevation of alk phos and bilirubin, amylase/lipase usual normal
CA 19-9

Question 29

what is a pnacreaticoduodenectomy

Answer 29

Whipple procedure

Question 30

what is the treatment of pancreatic CA

Answer 30

whipple +/- chemo/radiation
symptom control/palliative care

Question 31

what is neuroendocrine pancreatic CA

Answer 31

arise from islets and gastrin-producing cells and often produce many hormones
may appear in other organs, particularly duodenum, jejunum andlung

Question 32

what are the manifestations of neuroendocorine pancreatic CA

Answer 32

functioning: hyper-secrete specific hormone, causing various syndrome
non-functioning: may cause obstructive symptoms of biliary tract or duodenum, bleeding into Gi tract or abdominal masses

Question 33

what is the tx of neuroendocrine pancreatic cancer

Answer 33

surgical resection
if mets preclude curative surgery, various anti-hormone tx may be tried

Question 34

what is cystadenocarcinoma

Answer 34

RARE adenomatous pancreatic cancer that arises as malignant degeneration of a mucinous cystadenoma
manifests as upper abdominal pain, palpable abd mass

Question 35

what is intraductal papillary-mucinous tumor

Answer 35

results in mucus hypersecretion and ductal obstruction
symtpoms: pain and recurrent pancreatitis
dx: CT/MRI