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Hugh's MD2 Core Conditions and Presentations > Bowel Cancer > Flashcards

Bowel Cancer Flashcards

1
Q

Describe the different stages of colon cancer

A

Stage 0 - Carcinoma in situ

Stage 1 - Invasion of the muscularis mucosa or into the muscularis externa (T1 and T2)

Stage 2 - Invasion beyond the muscularis externa or into adjacent organs (T3 and T4)

Stage 3 - T1-4 plus N1-2

Stage 4 - Stage 3 plus distant metastasis

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2
Q

How might colon cancer present?

A

Fe deficiency anaemia

Weight loss

Rectal bleeding

Bowel obstruction

Change in bowel habits

Abdominal pain

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3
Q

What does obstipated mean?

A

Not passing gas

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4
Q

What is the gene in FAP?

A

APC (adenomatous polyposis coli)

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5
Q

Which chemotherapy drugs can cause mucositis?

A

Fluorouracil

Capecitabine

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6
Q

Why do people with colon cancer perforate?

A

Bowel obstruction

Ulceration of the cancer

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7
Q

How many polyps do you require for the diagnosis of FAP?

A

>100

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8
Q

What are the three most common locations for a colon cancer to met to? How do you investigate for them?

A

LNs

Liver

Lungs

CT CAP with contrasts

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9
Q

How does the staging of rectal cancer differ from colon?

A

They can be down staged due to the use of neoadjuvant radiotherapy as the cancer location is fixed

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10
Q

What does the APC gene control?

A

Beta-catenin desmosomes

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11
Q

When is surgery indicated?

A

Stages I-III

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12
Q

What is the typical chemotherapy regimen for colon cancer?

A

Folinic acid

5FU

Oxaliplatin

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13
Q

What is Lynch syndrome/HNPCC? What is the most important defects? What other cancers does predispose people to?

A

Hereditary non-polyposis colon cancer

Causes a fault in DNA mismatch repair resulting in microsatellite instability

Endometrial, bladder, small bowel carcinomas

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14
Q

What is HNPCC?

A

Hereditary non-polyposis colon cancer syndrome

AKA Lynch syndrome

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15
Q

What is the T staging for colon cancer?

A

T1 - Lamina propria

T2 - Into the muscularis externa

T3 - Breaches the muscularis externa

T4 - Invaded surrounding viscera

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16
Q

What are the typical chemotherapy regimen options for stage III colon cancer?

A

Fluorouracil and folinic acid

Folfox - Fluorouracil, folinic acid, and oxaliplatin

Capecitabine

17
Q

What does the surgery performed from each section of the colon?

A

Right - Right hemicolonectomy

Transverse - Right extended hemicolonectomy

Splenic flexure - Subtotal colonectomy (ileo-sigmoid anastomy)

Left - Left hemicolonectomy

Rectum - Low/Ultra low anterior resection

18
Q

Which part of the bowel is most likely to perforate?

A

Caecum - largest portion > most tension per area of wall

19
Q

When is chemotherapy indicated?

A

Stage II-IV

20
Q

When does an adenoma become an adenomacarcinoma?

A

When it invades the lamina propria

21
Q

What are the three sources of gas in a distended bowel obstruction?

A

Swallowed

Nitrogen diffusion

Bacterial production

22
Q

Which type of bowel cancers are most likely to cause change in bowel habit and rectal bleeding?

A

Left sided and rectal as the stool is more formed there

23
Q

How much iron can be adsorbed per day? How much iron is lost in a 1L of blood?

A

1mg

500mg

24
Q

What is Gardener’s syndrome?

A

Subtype of FAP causing multiple skin tags

25
Q

What are the revised Bethesda criteria for? Outline the criteria

A

Identifying patients who warrant screening for Lynch syndrome

CRC <50

Present of synchronous or metachronous HPNCC related carcinomas regardless of age

CRC with specific features <60 years

CRC in 1 or more FDR with HPNCC or <50

CRC in 2 or more first or second degree relatives regardless of age

26
Q

How do you test for Lynch/HPNCC?

A

Immunohistochemistry staining on tumour tissue for mismatch repair proteins

27
Q

What pathological features are associated with CRC with mismatch repair mutations?

A

Synchronous development

Right sided tumours

Mucinous or signet ring differentiation

Medullary growth pattern

Lymphocytic infiltrate

Peritumour Crohn’s like lymphocytic infiltrate

28
Q

What are the techniques available for screening for Lynch’s?

A

IHC

Microsatellite Instability Analysis

Hugh's MD2 Core Conditions and Presentations (67 decks)

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