Bowel Cancer Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > Bowel Cancer > Flashcards

Flashcards in Bowel Cancer Deck (28):
1

Describe the different stages of colon cancer

Stage 0 - Carcinoma in situ

Stage 1 - Invasion of the muscularis mucosa or into the muscularis externa (T1 and T2)

Stage 2 - Invasion beyond the muscularis externa or into adjacent organs (T3 and T4)

Stage 3 - T1-4 plus N1-2

Stage 4 - Stage 3 plus distant metastasis

2

How might colon cancer present?

Fe deficiency anaemia

Weight loss

Rectal bleeding

Bowel obstruction

Change in bowel habits

Abdominal pain

3

What does obstipated mean?

Not passing gas

4

What is the gene in FAP?

APC (adenomatous polyposis coli)

5

Which chemotherapy drugs can cause mucositis?

Fluorouracil

Capecitabine

6

Why do people with colon cancer perforate?

Bowel obstruction

Ulceration of the cancer

7

How many polyps do you require for the diagnosis of FAP?

>100

8

What are the three most common locations for a colon cancer to met to? How do you investigate for them?

LNs

Liver

Lungs

CT CAP with contrasts

9

How does the staging of rectal cancer differ from colon?

They can be down staged due to the use of neoadjuvant radiotherapy as the cancer location is fixed

10

What does the APC gene control?

Beta-catenin desmosomes

11

When is surgery indicated?

Stages I-III

12

What is the typical chemotherapy regimen for colon cancer?

Folinic acid

5FU

Oxaliplatin

13

What is Lynch syndrome/HNPCC? What is the most important defects? What other cancers does predispose people to?

Hereditary non-polyposis colon cancer

 

Causes a fault in DNA mismatch repair resulting in microsatellite instability

 

Endometrial, bladder, small bowel carcinomas

14

What is HNPCC?

Hereditary non-polyposis colon cancer syndrome

AKA Lynch syndrome

15

What is the T staging for colon cancer?

T1 - Lamina propria

T2 - Into the muscularis externa

T3 - Breaches the muscularis externa

T4 - Invaded surrounding viscera

16

What are the typical chemotherapy regimen options for stage III colon cancer?

Fluorouracil and folinic acid

 

Folfox - Fluorouracil, folinic acid, and oxaliplatin

 

Capecitabine

 

 

17

What does the surgery performed from each section of the colon?

Right - Right hemicolonectomy

Transverse - Right extended hemicolonectomy

Splenic flexure - Subtotal colonectomy (ileo-sigmoid anastomy)

Left - Left hemicolonectomy

Rectum - Low/Ultra low anterior resection

18

Which part of the bowel is most likely to perforate?

Caecum - largest portion > most tension per area of wall

19

When is chemotherapy indicated?

Stage II-IV

20

When does an adenoma become an adenomacarcinoma?

When it invades the lamina propria

21

What are the three sources of gas in a distended bowel obstruction?

Swallowed

Nitrogen diffusion

Bacterial production

22

Which type of bowel cancers are most likely to cause change in bowel habit and rectal bleeding?

Left sided and rectal as the stool is more formed there

23

How much iron can be adsorbed per day? How much iron is lost in a 1L of blood?

1mg

 

500mg

24

What is Gardener's syndrome?

Subtype of FAP causing multiple skin tags

25

What are the revised Bethesda criteria for? Outline the criteria

Identifying patients who warrant screening for Lynch syndrome

 

CRC <50

Present of synchronous or metachronous HPNCC related carcinomas regardless of age

CRC with specific features <60 years

CRC in 1 or more FDR with HPNCC or <50

CRC in 2 or more first or second degree relatives regardless of age

26

How do you test for Lynch/HPNCC?

Immunohistochemistry staining on tumour tissue for mismatch repair proteins

27

What pathological features are associated with CRC with mismatch repair mutations?

Synchronous development

Right sided tumours

Mucinous or signet ring differentiation

Medullary growth pattern

Lymphocytic infiltrate

Peritumour Crohn's like lymphocytic infiltrate

 

28

What are the techniques available for screening for Lynch's?

IHC

Microsatellite Instability Analysis