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GI AM > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

What are the risk factors for sporadic cases of colorectal cancer?

A

Age
Male
Previous adenoma/colorectal cancer
Environmental influences- diet, obesity, lack of exercise, smoking, diabetes mellitus

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2
Q

What are the risk factors for colorectal cancer?

A

Familial risk
Inherited conditions
Underlying IBC

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3
Q

What do the majority of colorectal cancers arise from?

A

Existing colorectal polyps

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4
Q

What are colorectal polyps?

A

Protuberant growths with a variety of histological types, which can be epithelial or mesenchymal, benign or malignant

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5
Q

What are adenomas?

A

Benign, premalignant, epithelial growths which can develop to tumours

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6
Q

How do adenomas develop to tumours?

A

Activation of oncogenes
Loss of tumour suppressor genes
Defective DNA repair pathway genes

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7
Q

What are the main histological types of adenomas?

A

Tubular

Villous

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8
Q

What is the usual presentation of colorectal cancer?

A

Rectal bleeding
Altered bowel habits
Iron deficiency anaemia- in men and non menstruating women
Palpable rectal or lower right abide mass
Acute colonic obstruction
Weight loss, anorexia

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9
Q

What investigations are carried out for colorectal cancer?

A

Colonoscopy- gold standard
Imaging- barium enema, CT colonography
CT abdo/pelvis

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10
Q

What are the risks of colonoscopy?

A

Perforation

Bleeding

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11
Q

What are the benefits of a colonoscopy?

A

Diagnostic and therapeutic-
Biopsy can be taken
Polypectomy can be carried out

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12
Q

How is colorectal cancer staged?

A

CT
MRI for rectal tumours
PET or rectal endoscopic ultrasound

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13
Q

What classification systems are used for colorectal cancer?

A

TMN

Dukes

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14
Q

What is Dukes classification of colorectal cancer?

A 
A= tumour confined to mucosa
B= tumour extended through mucosa to muscle layer
C= involvement of lymph nodes
D= distant metastases
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15
Q

What are the treatment options for colorectal cancer?

A

Surgery
Chemo
Radiotherapy

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16
Q

How is Dukes A cancer treated?

A

Endoscopic or total resection

17
Q

What does operative procedure depend on?

A

Site, size and stage of tumour

18
Q

What surgical procedures can be used to treat colorectal cancer?

A

Tumour or bowel resection
Stoma formation
Removal of lymph nodes for histological analysis
Partial hepatectomy for metastases

19
Q

How is chemotherapy used in colorectal cancer?

A

Advanced B cancer onwards
Adjuvant therapy
Clears any micrometastases

20
Q

How is radiotherapy used in colorectal cancer?

A

Rectal cancer
Neoadjuvant therapy
Shrinks tumour before resection

21
Q

What is the 5year survival of each of the Dukes classifications?

A

A 5 year survival 83%
B 5 year survival 64%
C 5 year survival 38%
D 5 year survival 3%

22
Q

How is screening down in the general population?

A

5 yearly FOB test for 50-74 year olds

23
Q

What is the aim of screening in the general population?

A

Detect premalignant carcinomas and early cancers

24
Q

Who are high risk groups for colorectal cancer?

A 
Heritable conditions
IBD
Familial risk
Previous adenomas
Previous colorectal cancer
25
Q

What inheritable conditions can cause colorectal cancer?

A

Familial adenomatous polyposis

Hereditary non polyposis colorectal cancer

26
Q

What does familial adenomatous polyposis cause?

A

Multiple adenomas throughout colon

Extracolonic manifestations

27
Q

What is done for those with familial adenomatous polyposis?

A

Annual colonoscopy from age 10-12
Prophylactic protocolectomy at age 16-25
NSAIDs chen-prevention- reduces polyp number and prevents re-occurance of higher grade adenomas

28
Q

What does hereditary non-polyposis cause?

A

Early onset right sided colorectal cancer

29
Q

What is hereditary non-polyposis associated with?

A 
Cancers in colorectal
Endometrium
Geritourinary
Stomach
Pancreas
30
Q

What screening is done for those with hereditary non polyposis?

A

Colonoscopy every 2 years

31
Q

What screening is done for those with IBD?

A

Colonoscopy 10 years after diagnosis then repeated at intervals depending on duration, extent and activity of inflammation

32
Q

What screening is done for those with a high familial risk?

A

5 yearly colonoscopy from 50 years

33
Q

What is done for those with a low familial risk?

A

Colonoscopy at 55

34
Q

What screening is done for those with a history of colorectal cancer?

A

5 yearly colonoscopy

GI AM (34 decks)

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