Appendix and colon tumors Flashcards

1
Q

Appendix tumors are very ___ and are usually discovered accidently post ___.

A

rare

appendectomy

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2
Q

What is the most and second most common tumors in the appendix?

A

carcinoid

AC

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3
Q

The ___ of the appendix tumor is the best predictor to the level of its aggressiveness and malignancy

A

size

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4
Q

Appendix carcinoid tumor < 1 cm should be treated as a ___ tumor- treating with regular ___

A

benign

appendectomy

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5
Q

Appendix carcinoid tumor > 2 cm should be treated aggressively with ____ and regional ___

A

right hemicolectomy

lymphadenectomy

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6
Q

Appendix AC should be treated like AC of the cecum with- ____ and regional ___. We can also use adjuvant treatment of ____

A

right hemicolectomy
lymphadenectomy
FOLFOX (5 fu, leucovorin, oxaliplatin)

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7
Q

When finding cyst in the appendix, we should consider ___ tumor. Beware of leakage to prevent ___

A

mucinous

seeding

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8
Q

Colon polyps frequency increase with ___

A

age

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9
Q

__% of the polyps are found in the ___

A

50

rectum-sigmoid

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10
Q

Most colon polyps are ____, but may cause rectal ___ and ___

A

asymptomatic
bleeding
constipation

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11
Q

How can we characterize polyps as ___ or ___

A

non-neoplastic

neoplastic

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12
Q

Non-neoplastic polyps can be: (3)

A

inflammatory
hamartomatous
hyperplastic

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13
Q

Neoplastic polyps can be: (2)

A

adenomas

adenocarcinoma

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14
Q

2/3 of all polyps in the colon are of ___ type

A

adenoma

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15
Q

Inflammatory polyps develop in the ___ are called solitary ___ ___ syndrome and may lead to damage to the ___ sphincter, long lasting ___ leading to ___

A
rectum
rectal
ulcer
anorectal
constipation
ulceration
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16
Q

Juvenile tumors are ___, usually found in the ___ and characterized with rectal ___, usually in children < age of ___

A

pedunculated
rectum
bleeding
5

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17
Q

Peutz- Jeghers syndrome is __ with large ___ polyps scattered all around the GI. It leads to increased risk for different cancers

A

AD

pedunculated

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18
Q

Cronkhite–Canada syndrome ____tumors all along the GI with cutaneous ___, alopecia, nail ___, and ___ atrophy. This has no genetic disorder and not malignancy potential.

A

hamartomatous
hyperpigmentation
atrophy
tonsils

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19
Q

Name the 3 hamartomatous polyps

A

juvenile polyps
Peutz- Jeghers syndrome
Cronkhite–Canada syndrome

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20
Q

What are the most common non neoplastic polyps?

A

Hyperplastic

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21
Q

Hyperplastic polyps are usually found at the ages of __-__. It is an epithelial hyperplasia with ___ malignancy potential. Their hallmark is ___, usually located on the __ colon.

A

50-60
no
serrated
left (recto sigma)

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22
Q

Adenomatous polyps has ___ characteristics with risk to convert into ___

A

dysplastic

CRC

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23
Q

What are the macroscopic strictures of polyps? (2)

A

sessile :(

pedunculated :)

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24
Q

What kind of histological types adenomas can present with?
___ (65-80%)
___ (5-10%)
___ (10-25%)

A

Tubular (peduncular)
villous (sessile)
mixed

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25
When performing pathology to the polyp, we need > __% to determine the type. If < ___% then mixed
80 | 60
26
The ___ the adenoma, the ___ likely it will progress to malignancy
bigger | more
27
Advanced (invasive) adenoma is defined by high grade ___ / > __cm / ___
dysplasia 1 villous
28
Treating all polyps includes ___ using ___ when performing ___
resection snare colonoscopy
29
Safe removal of polyp requires __ mm of clean margins
2
30
Invasive adenocarcinoma penetrates through the MM (___) and can ___
muscularis mucosa | metastasize
31
Non-invasive adenocarcinoma = carcinoma _____
in situ
32
Which classification is used for cancerous polyps?
Haggitt
33
Every sessile polyp with invasive carcinoma is considered level __
4
34
Pedunculated polyps levels _-_ should be removed. | Every polyp level __ should be considered as CRC
3-4 | 4
35
``` Give 10 risk factors to CRC: old ___ Westman ___ personal ___ family history (remember syndromes (3)) IBD (2) strep bovis bacteremia radiation obesity smoking ```
``` age diet history FAP/HNPCC/MYH UC/CD ```
36
Name 4 protective factors from CRC:
aspirin estrogen calcium/folic acid low BMI
37
What is the relevant marker for CRC?
CEA (Carcinoembryonic antigen)
38
FAP is an ___ disease due to a mutation in the __ gene on chromosome __
AD APC 5
39
We must find at least ___ polyps to diagnose FAP. The mean age at diagnosis is __
100 | 29
40
Although FAP adenomas do not have higher malignancy potential than sporadic adenomas, ___% of untreated patients will develop cancer, usually by the age of ___
100 | 30
41
What is the preferred treatment for FAP
total proctocolectomy with ileoanal pouch
42
FAP can also appear in the ___ or ___, therefor EGD (___) should be performed every __ years
Esophagogastroduodenoscopy | 2
43
Patients with FAP are recommended to go through surgery by the age of
20
44
Describe the screening in FAP patients:
``` yearly colonoscopy starting at the age of 10-12 EGD every 2 years from the age of 30 thyroid every year abdominal US (pancreas cancer) yearly physical examination ```
45
HNPCC= ____ and __
hereditary non polyposis colon cancer | lynch
46
HNPCC may lead mostly to __ and ___, but also (3)
``` CRC endometrium stomach ovary small bowel ```
47
HNPCC is more common in the ___ colon, and at younger (__) age
right | 46
48
What are the common mutations in Lynch syndrome? (2)
MLH1 | MSH2
49
Describe the Amsterdam classification for Lynch (5)
CRC in 3 family members (at least 1 first degree) 2 generations involved at least 1 of the mentioned above <50 when diagnosed FAP ruled out pathology
50
How do you treat Lynch?
abdominal colectomy + ileorectal anastomosis | hysterectomy +BSO
51
Who has better CRC prognosis? HNPCC or regular patient?
HNPCC, why? unclear...
52
Describe the recommended screening for Lynch patient: (3)
colonoscopy every 2 years age 20-40 + every year when >40 or 10 years before the age the family member was diagnosed pelvic examination (US) every 1-2 years from ages 25-35 renal/urinary US every 1-2 years ages 30-35
53
Sporadic CRC adenocarcinoma is the ____ common GI tract malignancy
most
54
The leading way CRC spreads is through the ___ to the regional ___ ___. If ___ than we will find tumors in the ___
lymph system lymph nodes hematogenic liver
55
____ has a protective effect from CRC through COX-2 inhibition
aspirin
56
Name the common late symptoms for CRC: (7)
``` constipation hematochezia iron deficiency anemia abdominal pain tenesmus bowel obstruction fistulas ```
57
Left colon tumors tend to be more ___
obstructive
58
Sigma tumors may imitate ___- (3)
LLQ pain fever leukocytosis
59
Right colon tumors usually ____ and cause ___ and ___
bleed iron deficiency lethargy
60
The gold standard for CRC is ____
colonoscopy
61
Colon with complete obstruction due to tumor should be treated with ___ ___
urgent | surgery
62
Why we should not perform primary anastomosis in urgent surgery due to complete bowel obstruction due to tumor?
lack of preparation which will lead to anastomotic leak
63
Hartman procedure:
sigmoidectomy + end colostomy + rectal stump
64
When dealing with a patient with a partial obstruction due to a tumor there is no indication for an ___ ___, ___ imaging, ___ functions, ___ levels, full ___, CT and MRI
urgent surgery CXR liver colonoscopy
65
Preoperative colon preparation includes: 1) mechanical (___), 2) ABx (PO (__,__,__)
PEG (laxative) | neomycin, erythromycin, Flagel
66
When removing CRC we should strive for clean margin of ___ cm + ___ + ___
5 lymph nodes mesentery
67
Right hemicolectomy surgery requires the dissection of the ___ branches (3) and the right branch of the middle colic.
SMA ilio-colic middle colic right colic
68
Left hemicolectomy surgery requires the dissection of the left ___ artery + left branch of mid ___
colic | colic
69
``` Staging of CRC: 1- ___ 2- ___ 3- ___ 4- ___ ```
T1/2 + N0 + M0 T3/4 + N0 + M0 any T + N1/2 + M0 any T + any N + M1
70
``` What are the 5 years survival of CRC? 1- ___% 2- ___% 3- ___% 4- ___% ```
90 75 50 <5
71
Treating stage 1 colon cancer is with ___ alone, ___ after 1 year. If no polyp, next colonoscopy after ___ years, if we find polyps- after 1 year. ___ levels should be monitored every ___ months in the first 2 years. If increased- CT/MRI/PET
``` surgery colonoscopy 5 CEA 3 ```
72
Treating stage 2 colon cancer is with ___ + consider adjuvant chemotherapy (___) only in very severe patients. Monitor like in stage 1, but add CEA for 5 years every 6 months, and chest/abdomen CT once a year for ___ years
surgery FOLFOX 3
73
Name the 4 criteria for very severe colon cancer patient:
less than 12 nodes were resected T4 tumor poorly differentiated tumor perforation
74
Treating stage 3 colon cancer is with ___ and ___ for all patients. monitor like stage 2. ___ chemotherapy with FOLFOX4 (___)
surgery chemotherapy adjuvant 5fu+oxaliplatin+leucovorin
75
Treating stage 4 colon cancer involves __ + __ + __
chemotherapy biological palliative surgery
76
What does the stage 4 biological treatment include? (3)
Avastin (anti VEGF) Erbitux Panitumumab (anti EGFR)
77
The best prevention test for CRC is ___ every __ years over the age of ___
colonoscopy 10 50
78
For patients refusing colonoscopy- flexible ___/ coronographic __ every 5 years
sigmoidoscopy | CT
79
If patients prefer to avoid all prevention tests- we move to ___ tests: (3)
detection FIT- fecal immunochemical test FOBT- fecal Occult Blood Test Fecal DNA testing
80
When performing colonoscopy and finding >__small adenoma + __ grade -> repeat colonoscopy within the next _-_ years
1 low 5-10
81
``` What is an advanced adenoma? > __cm ___ ___ _-_ small ones in the colonoscopy ```
1 villous high grade 3-9
82
When finding 3-9 small adenomas-> repeat ___ every __ years
colonoscopy | 3
83
When finding >10 small adenomas-> repeat ___ every __ year + ___ study
1 | genetic