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Year 2 GI (JK) > Colorectal cancer and screening > Flashcards

Colorectal cancer and screening Flashcards

1
Q

What cell type are most colorectal cancers?

A

adenocarcinoma - 95%

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2
Q

What are some risk factors for sporadic CRC?

A

age, male, smoking, alcohol, diabetes, obesity, low fibre diet, low exercise, adenoma/previous CRC

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3
Q

What are some other risk factors for CRC?

A

IBD and familial risk eg FAP, HNPCC

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4
Q

What do the majority of CRC arise from?

A

pre-existing polyps

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5
Q

What are adenomas and name the 3 subtypes

A

high risk lesions which are benign, pre-malignant tumours of the glandular tissue
tubular, villous, tubulovillous

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6
Q

What are the 3 key moments of an adenoma progressing to a carcinoma? Give some examples

A

activation of oncogenes - k-ras
loss of tumour suppressor genes - p53
defective DNA repair pathway - microsatellite instability

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7
Q

How can CRC present?

A

rectal bleeding, change in bowel habit, weight loss, anaemia, palpable mass

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8
Q

When would you investigate 1 symptom of CRC and when would you investigate >1 symptom of CRC?

A

> 60 years old

>40 years old

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9
Q

What is the main investigation for CRC - what does it allow and what are the risks?

A

colonoscopy - allow biopsies and polypectomy

sedation, bowel preparation, perforation and bleeding

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10
Q

What are some radiological imaging techniques used in CRC and what are the disadvantages?

A

CT abdomen/pelvis, CT colonography and barium enema

ionising radiation, bowel preparation and no biopsies or therapy possible

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11
Q

What scans are used to help stage cancer?

A

CT, PET, MRI, rectal endoscopic ultrasound

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12
Q

What are the 2 staging classifications for CRC and briefly describe the stages

A

TNM - T1-4, N0-1, M0-1

Dukes - A,B,C,D, A = mucosa, B = muscle layer

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13
Q

What are the things to consider in surgeries carried out in CRC?

A

lymph node removal, stoma?, laparotomy vs laparoscopy, endoscopic or local polyp resection and partial hepatectomy for metastases

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14
Q

How is chemotherapy used in CRC?

A

adjuvant = after surgery
mop up micro metastases
Dukes B/C with positive LN histology
palliative

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15
Q

How is radiotherapy used in CRC?

A

Rectal cancer ONLY

neoadjuvant = before surgery to control the primary tumour

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16
Q

Apart from chemotherapy what is the other palliative option for CRC?

A

colonic stenting

17
Q

What is the aim of population CRC screening?

A

detect premalignant adenomas/early carcinomas

18
Q

What are some methods of population CRC screening?

A

FOBT, FIT, colonoscopy, flexible sigmoidoscopy, CT colonography

19
Q

Describe the Scottish bowel screening

A

introduced in 2007 using FOBT to 50-74 year olds every 2 years
If positive are called for a colonoscopy
reduced mortality by 15% and made a large shift to more dukes A being diagnosed

20
Q

What are some risk factors classing you as high risk for CRC?

A

previous adenoma/CRC
Heritable conditions eg FAP/HNPPC
IBD
familial risk - other family members

21
Q

What is FAP?

A

autosomal dominant condition of the mutation of the APC gene on chromosome 5 leading to >100 polyps in the colon leading to high risk of developing CRC early in life

22
Q

How are patients with FAP treated in respect to CRC risk?

A

annual colonoscopy

prophylactic polypectomy

23
Q

What are some extra-colonic manifestations of CRC?

A

retinal hypertrophy and duodenal adenomas so must be given upper GI surveillance aswell

24
Q

What is HNPCC?

A

autosomal dominant condition with early onset right hand side CRC with associated risk of endometrial, stomach and pancreatic cancer

25
Q

How is HNPCC treated in respect to CRC risk?

A

Genetic testing

2 yearly colonoscopy

26
Q

How are other high risk groups surveillance for CRC?

A

IBD - surveillance colonoscopy 10 years after diagnosed
Familial history - depends on number of relatives
previous CRC - 5 yearly colonoscopy
previous adenoma - depend on size, number, degree of dysplasia

Year 2 GI (JK) (39 decks)

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