Colorectal Cancer

Question 1

What are 3 kinds of polyps?

Answer 1

Pseuduopolyps/inflammatory, Hyperplastic, Adenomatous

Question 2

What are pseudopolyps?

Answer 2

Not cancerous, due to IBD

Question 3

What are hyperplastic polyps?

Answer 3

90% of all polyps, low risk for malignancy

Question 4

What are adenomatous polyps?

Answer 4

Cancerous, 10% of polyps

Question 5

How long does it take for adenomatous polyps to become cancerous?

Answer 5

10-20 years

Question 6

What are the most common adenoma polyps?

Answer 6

Tubulous polyps

Question 7

What are the adenoma polyps that have the highest risk of being cancerous?

Answer 7

Villous adenoma

Question 8

What is the pathophys of colorectal cancer?

Answer 8

Progression of adenomatous polyp into malignancy (adenocarcinoma) after about 10-20yrs

Question 9

Colorectal cancer is the ____ leading cause of cancer deaths

Answer 9

3rd

Question 10

What is the biggest risk factor?

Answer 10

Age > 50

Question 11

What kind of diet is a risk factor?

Answer 11

Low fiber, high in red/processed meat

Question 12

What autosomal dominant disease is a risk factor?

Answer 12

Peutz-Jehgers

Question 13

What will you see in Peutz-Jehgers disease?

Answer 13

hyper pigmentation of lips, buccal, and hands

Question 14

What are common clinical manifestations of colorectal disease?

Answer 14

Iron deficiency anemia, change in bowel habits, rectal bleeding, abdominal pain, intestinal obstruction

Question 15

What side of the colon is proximal and what side is distal?

Answer 15

Right is proximal lesions, left is distal lesions

Question 16

What s/s are most common with right-sided lesions?

Answer 16

Bleeding seen by anemia & fecal occult blood, diarrhea

Question 17

What s/s are most common with left-sided lesions?

Answer 17

Bowel obstruction presented later on, changes in stool diameter

Question 18

How do you Dx?

Answer 18

Colonoscopy with biopsy, barium enema

Question 19

What is classic for colorectal cancer on colonoscopy?

Answer 19

Apple core lesion classic

Question 20

What labs will be increased?

Answer 20

Increased CEA marker

Question 21

What is the main treatment?

Answer 21

5FU is mainstay of chemo

Question 22

What else can you do?

Answer 22

Surgical resection

Question 23

What do you monitor throughout treatment?

Answer 23

CEA

Question 24

At what age does annual stool guaiac test begin for screening?

Answer 24

50y for average risk person, or 40y if 1st degree relative has had been Dx (or 10y before that family member had it)

Question 25

What are the colonoscopy screening recommendations?

Answer 25

Average risk: Every 10 years (stop at age 75)
1st degree relative > 60: Every 10 years
1st degree relative < 60: Every 5 years