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Gastrointestinal > Colon Cancer > Flashcards

Colon Cancer Flashcards

1
Q

What is the flexure of the right colon?

A

Hepatic flexure

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2
Q

What is the flexure on the left side of the colon?

A

Splenic flexure

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3
Q

What are the folds that help hold stool in the rectum?

A

Transverse rectal folds

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4
Q

What are the branches of the SMA?

A

ileocolic
Right colic
Middle colic

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5
Q

What are the branches of the IMA?

A

Left colic
Sigmoidal
Rectal

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6
Q

What is the blood supply to the superior part of the rectum? What is this a branch of?

A

Superior hemorrhoidal

Branch of the IMA

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7
Q

What is the blood supply to the inferior part o the rectum? What are these branches of?

A

Middle rectal
Inferior rectal

Both branches of the internal iliac

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8
Q

What are the four histological layers of the colon?

A

Mucosa
Submucosa
Muscularis propria
Serosa

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9
Q

What are the three big CAs? (as far as incidence, in order)

A

Prostate/breast
Lung
Colon

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10
Q

What are the risk factors for the development of colon CA?

A

IBDs

Obesity

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11
Q

What diet is a risk factor for colon cancer?

A

Red meats and animal fats

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12
Q

What are the three protective factors for colon cancer?

A

Hormone replacement therapy
NSAID use
Fiberous diet

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13
Q

What are the four DNA proteins that are implicated in colon CA?

A

APC
KRAS
DCC
p53

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14
Q

What is the order of genetic mutations of the adenoma-carcinoma sequence?

A

APC
KRAS
DCC
p53

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15
Q

How long does it take for the adenoma-carcinoma sequence to develop?

A

10 years

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16
Q

What changes with APC gene mutation?

A

Dysplastic aberrant crypt foci

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17
Q

What changes with KRAS mutation?

A

Intermediate adenoma

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18
Q

What happens with DCC mutation?

A

Late adenoma

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19
Q

What happens with -53 mutation?

A

Carcinoma development

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20
Q

Most etiologies of colon cancer are from what?

A

sporadic (80%)

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21
Q

What is the genetic mutation in familial adenomatous polyposis? How does this present? What is the treatment for this?

A

APC gene mutation on chromosome 5q

Tons o’ polyps early on
Total colectomy

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22
Q

What is Hereditary Non-Polyposis Colon Cancer (HNPCC/lynch syndrome)? Presentation? Treatment?

A

Mismatch defect in repairing chromosomes

Hundreds of polyps
Total colectomy

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23
Q

What are the ssx of early poylps? Late?

A

asymptomatic early

Maybe positive fecal occult blood test for late

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24
Q

What are the three major screening modalities for colon CA screening?

A

Colonoscopy
Flexible sigmoidoscopy
FOBT

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25
Q

What are the two radiological modalities of screening for colon cancer?

A

Double contract Ba enema

CT colonography

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26
Q

What is the gold standard for colon CA screening?

A

Colonoscopy

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27
Q

What is flexible sigmoidoscopy? Advantages/disadvantages?

A

similar to colonoscopy, but only reaches the splenic flexure

Do not have to prep as much and less sedation

Cannot excise polyps***

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28
Q

What does stool guaiac blood test assess for?

A

Peroxidase activity

29
Q

What does the fecal immunochemical test assess for?

A

Antibody test

30
Q

What is a double contrast Ba enema?

A

Rectal air and contrast instilled and visualize the colon wall

Requires cathartic bowel prep

31
Q

What is a CT colonography?

A

Rectal air and contrast instilled, as well as cathartic bowel prep

32
Q

How often do you repeat colonoscopies? Flexible sigmoidoscopies? FOBTs?

A

Colonoscopy = 10 yrs
Flexible sigmoid = 5 yrs + FOBT 3 years
FOBT = every 1-3 years

33
Q

What are the three characteristics of “average risk” for colon CA?

A

Asymptomatic
No family h/o CA
No personal h/o polyps/CA

34
Q

What are the three characteristics of the higher risk pt that should start colonoscopies at age 40, and repeat every 5 years?

A
  • First degree relative less than 60 yo
  • 2x first degree relatives any age
  • Second degree relative age less than 50
35
Q

What should colonoscopies begin with IBDs? What is different about these (frequency, what is done)?

A

8-10 years, 1-2 years

must collect 4x random biopsies

36
Q

When should colonoscopies begin with lynch syndrome? Frequency?

A

20-25, repeat 1-2 years

37
Q

When should colonoscopies being in pts with FAP/APC mutation? Frequency? When should a total colectomy be performed?

A

10-12 yo
Repeat 1-2 years

Colectomy as soon as polyps are seen

38
Q

What are the ssx of colon CA (if any)? (5)

A
  • Vague abdominal pain
  • Change in bowel habits
  • Bleeding
  • Obstruction
  • Perforation
39
Q

Where do colon CAs usually metastasize to?

A

inguinal lymph nodes

40
Q

What is the dye that is used to tattooing the site of a polypectomy?

A

Methylene blue

41
Q

During a proctoscopy, from where do you measure from to the polyp?

A

Sphincter

42
Q

What is the serum marker for colon CA? What is this used for?

A

CEA

Used as a surveillance marker

43
Q

What is the purpose of doing a CT/PET scan after biopsy of a malignant polyp?

A

Check for mets

44
Q

T1 tumor = ?

A

Muscularis mucosa into submucosa

45
Q

T2 tumor = ?

A

INvades muscularis propria

46
Q

T3 tumor = ?

A

INvades pericolorectal tissues

47
Q

T4a tumor = ?

A

Penetrates peritoneum

48
Q

T4b tumor = ?

A

Invades adjacent organs

49
Q

Tis tumor = ?

A

Intraepithelial

50
Q

N0 = ?

A

No regional node mets

51
Q

N1 = ?

A

1-3 mets in nodes

52
Q

N2 = ?

A

4+ nodes

53
Q

How many nodes need to be examined for adequate node staging?

A

15 nodes

54
Q

Where are nodes collected from for staging colon CA?

A

Visceral mesentery

55
Q

What are the M stages?

A 
M0 = no mets
M1 = distant mets
56
Q

What are the margins needed for colon resections? How is this determined?

A

5 cm

Based on blood supply–All bowel supplied by the resected vessel must be removed

57
Q

What is involved in a colectomy?

A

Resected colon with associated mesentery

58
Q

What is involved in a low anterior resection (LAR)?

A

Rectosigmoid resection extending below the peritoneal reflection

59
Q

What is involved in an abdominal perineal resection?

A

Rectosigmoid resection including anal sphincters, anal opening, and associated mesorectum

60
Q

What is the treatment for T1, T2, or T3 colon cancers?

A

Surgical resection is enough

61
Q

What is the treatment for T3, T4 colon cancers?

A

Surgical resection with chemo

62
Q

N1 or N2 colon cancers treatment = ?

A

Surgical resection + chemo

63
Q

What is done with mets from colon CA to the live or other nearby organs? Why is this different than other CAs?

A

Resect them–provide better outcome. Others “cat’s out of the bag”

64
Q

What are the three palliative resection cases for colon CA?

A

Bleeding
Perforation
Obstruction

65
Q

What is the treatment for Tis or T1 rectal CA?

A

Transanal excision

66
Q

What is the treatment for T2 rectal CA?

A

Surgical resection

67
Q

What is the treatment for T3, T4, or N+ rectal cancer?

A

Neoadjuvant chemoradiation + surgical resection

68
Q

What are the three surveillance measures for rectal CA? Frequency?

A

H&P ever 3-6 yrs
CEA “ “
Ct x5 years

Gastrointestinal (42 decks)

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