Colon Cancer

Question 1

Which two polyp types are not precancerous?

Answer 1

1. Hyperplastic

2. Pseudopolyps (IBD)

Question 2

Which two polyp types are precancerous?

Answer 2

1. Adenomas*
   - Tubular adenoma*** (MC)
   - Tubulovillous adenoma
   - Villous adenoma
2. Sessile serrated polyps

Question 3

What 3 characteristics of polyps influence surveillance interval recommendations

Answer 3

1. #
2. Size
3. Histology (degree of dysplastic change)

Question 4

Most common type of colon cancer?

Answer 4

adenocarcinoma

• MC on left side (sigmoid, rectum)
• Right-sided are increasing in prevalence

Question 5

Colorectal cancer risk factors

Answer 5

1. Age >50
2. IBD (>8-10 years)
3. African American
4. Family history (familial Adenomatous Polyposis, Hereditary nonpolyposis colon cancer)
5. Smoking
6. Alcohol
7. DM type 2
8. Obesity
9. Red meat

Question 6

What test may be elevated if colorectal cancer spreads to the liver?

Answer 6

Alk phos

Question 7

What lab is a good prognostic indicator and is used to monitor for recurrence?

Answer 7

Carcinoembryonic antigen (CEA)

Question 8

Hemoccult SENSA test

Answer 8

• take home
• 2 specimens on 3 consecutive stools
• Avoid red meat, iron supplements, Vitamin C and NSAIDS before test

Question 9

FIT (CRC screening test)

Answer 9

Preferred CRC detection test**

• tests for human hemoglobin
• Fewer false positives
• 1 specimen

Question 10

FIT DNA (Cologuard)

Answer 10

• $$$$
• Higher false positive rate than the FIT
• Excellent negative predictive value

Question 11

When should normal healthy folks begin screening for colorectal cancer?

Answer 11

age 50

45 if African American

Question 12

When should you start screening for colorectal cancer in increase risk individuals?

Answer 12

Family history:

• one first degree relative with CRC, or advanced adenoma before age 60
• two 2nd degree relatives
• *Start at 40 or 10 years prior to age of diagnosis
• ->Colonoscopy every 5 years

Question 13

When do you stop screening for colorectal cancer?

Answer 13

age 75 (if they are up to date with screening)

or

life expectancy <10 years

Question 14

If a patient has never been screened for colorectal cancer, up to what age can you consider to screen?

Answer 14

85

Question 15

How often should the FIT test be done?

Answer 15

annually

Question 16

Familial Adenomatous Polyposis (FAP)

Answer 16

• Autosomal dominant
• Increased risk of other cancers: duodenal and gastronomas**, thyroid (so–>also need endoscopy)

Screening: start annual colonoscopy 10-12 through age 40 if negative

Tx: prophylactic colectomy **

Question 17

Hereditary NonPolyposis Colon Cancer

Answer 17

• “Lynch Syndrome”
• Autosomal Dominant
• right sided colon CA**
• Increased risk of endometrial cancer**

-Amsterdam Criteria for diagnosis:
"3-2-1"
3 affected members
2 generations
1 under age 50

Screening:
-colonoscopy starting at age 20-25 (or 2-5 years prior to earliest age of onset in affected family member)

• Pelvic exam with endometrial bx with transvaginal US
• EGD at age 30-35 every 2-3 years