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Year 2 Gastrointestinal > Colon cancer > Flashcards

Colon cancer Flashcards

1
Q

superior hemorhoidal / rectal arteries arise from which artery?

A

IMA

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2
Q

lower rectal cancer will have more systemic or localized spread?

A

systemic

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3
Q

in which layer of the GI tube are the lymphatics located?

A

submucosal

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4
Q

what are protective factors limiting colon cancer?

A

hormone replacement
NSAID use
fiber, fruits, vegetables

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5
Q

what type of gene is APC?

A

tumor suppressor

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6
Q

what type of gene is K-RAS?

A

proto oncogene

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7
Q

what type of gene is DCC?

A

tumor suppressor

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8
Q

what type of gene is p53?

A

tumor suppressor

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9
Q

what is the sequence of gene mutations leading to carcinoma?

A

APC - K-RAS - DCC - p53

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10
Q

what is the mutation in FAP? which chromosome?

A

APC gene

chromosome 5q

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11
Q

what is the inheritance of FAP?

A

autosomal dominant

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12
Q

what is the lifetime cancer risk by age 50 for FAP?

A

100%

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13
Q

what is the treatment for FAP?

A

total colectomy and rectum

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14
Q

what is the pathogenesis of lynch syndrome?

A

mismatch repair gene defects

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15
Q

how does lynch syndrome differ from FAP?

A

progression to cancer is quick with lynch

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16
Q

which gene is responsible for development of early adenoma?

A

APC

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17
Q

which gene is responsible for development of intermediate adenoma?

A

K-RAS

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18
Q

which gene is responsible for development of late adenoma?

A

DCC

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19
Q

which gene is responsible for development of colon carcinoma?

A

p53

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20
Q

advanced polyps may produce what screening sign?

A

positive fecal occult blood test

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21
Q

what are the screening modalities for colon cancer? what is the gold standard?

A 
colonoscopy 
flexible sigmoidoscopy 
high sensitivity guaiac / FOBT 
double contrast barium enema 
CT colonoscopy

GOLD STANDARD: colonoscopy

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22
Q

colonoscopy scope can reach how far?

A

cecum and terminal ileum

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23
Q

sigmoidoscopy scope can reach how far?

A

splenic flexure

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24
Q

what does a stool guaiac blood test assay for?

A

peroxidase activity

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25
Q

what does a fecal immunochemical test assay for?

A

antibody

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26
Q

a positive stool-based test requires what next step?

A

colonoscopy

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27
Q

a positive double contrast barium enema requires what next step?

A

colonoscopy

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28
Q

what are the screening regimens for colon cancer?

A

colonoscopy every 10y, or

flexible sigmoidoscopy every 5y plus high sensitivity FOBT every 3 years, or

high sensitivity FOBT every year

29
Q

if a patient has family hx of colon cancer when does colonoscopy start? when are they repeated?

A

age 40

repeat every 5 years

30
Q

when do patients with IBD get screened for colon cancer? what else is done? how often is the screening?

A

colonoscopy every 8-10 years after symptoms
collect 4x random biopsies every 10cm
repeat every 1-2 years

31
Q

when do patients with lynch syndrome get screened for colon cancer? when is it repeated?

A

colonoscopy age 20-25

repeat 1-2 years

32
Q

when do patients with FAP get screened for colon cancer? when is it repeated?

A

colonoscopy age 10-12

repeat 1-2 years

33
Q

what is the serum tumor marker for colon cancer?

A

CEA

34
Q

what test should be used for equivocal CT findings?

A

PET

35
Q

what staging is Tis?

A

intraepithelial

36
Q

what staging is T1?

A

muscularis mucosa into submucosa

37
Q

what staging is T2?

A

invades muscularis propria

38
Q

what staging is T3?

A

invades pericolorectal tissues

39
Q

what staging is T4a?

A

penetrates peritoneum

40
Q

what staging is T4b?

A

invades adjacent organs

41
Q

intraepithelial staging

A

Tis

42
Q

muscularis mucosa into submucosa

A

T1

43
Q

invades muscularis propria

A

T2

44
Q

invades pericolorectal tissues

A

T3

45
Q

penetrates peritoneum

A

T4a

46
Q

invades adjacent organs

A

T4b

47
Q

nodal staging N0

A

no regional node met

48
Q

nodal staging N1

A

met in 1-3 regional nodes

49
Q

nodal staging N2

A

met in 4 or more regional nodes

50
Q

how many nodes should be examined for adequate staging?

A

15

51
Q

where are nodes collected from?

A

visceral mesentery

52
Q

what are the met stagings?

A

M0 - no met

M1 - distant met

53
Q

how far must resection margins be?

A

5cm

54
Q

resection is largely determined by what factor?

A

blood supply

55
Q

what is involved in a low anterior resection?

A

rectosigmoid resection extending below the peritoneal reflection with associated mesorectum

56
Q

what is involved in an abdominal perineal resection?

A

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

57
Q

what is involved in a colectomy?

A

resected colon with associated mesentery

58
Q

T1, T2, T3 colorectal cancer are treated with what modality?

A

surgical resection

59
Q

surgical resection is indicated for what staging?

A

T1, T2, T3

60
Q

some T3, T4 colorectal cancer is treated with what modality?

A

surgical resection with chemo

61
Q

surgical resection with chemo is indicated for what staging?

A

T4, some T3
N1, N2
surgical resection with chemo

62
Q

N1, N2 colorectal cancer are treated with what modality?

A

surgical resection with chemo

63
Q

liver or lung met is treated with what modality?

A

surgical resection with chemo

64
Q

how is metastatic disease treated for colorectal cancer?

A

chemo

65
Q

what is the treatment for Tis, T1 rectal cancer?

A

transanal excision

66
Q

what is the treatment for T2 rectal cancer?

A

surgical resection

67
Q

what is the treatment for T3, T4, N plus rectal cancer?

A

neoadjuvant chemo and resection

68
Q

when is rectal cancer neoadjuvant therapy indicated?

A

T3 and T4
node-positivity
locally unresectable

Year 2 Gastrointestinal (38 decks)

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