Cancer

Question 1

How well do FOBT and flexible sigmoidoscopy work for CRC screening?

Answer 1

• FOBT not very sensitive or specific; PPV only 20% but if pos must get colonoscopy
• Flexible Sigmoidoscopy - 60 cm; reaches area of 50-70% cancerous polyps

Question 2

CRC Metastasis

Answer 2

• Staging involves CT chest, abdomen and pelvis (liver is most common site of mets; followed by lungs)
• Travels hemetogenously thru portal veins and lumber/vertebral veins

Question 3

Which adenomatous polyps are worst?

Answer 3

• Villous worse than tubular

- Sessile worse than pedunculated

Question 4

Gardner Syndrome

Answer 4

• FAP + osteomas + dental abnormalities + benign soft tissue tumors + desmoid tumors + sebaceous cysts

Question 5

Turcot Syndrome

Answer 5

polyps + cerebellum meduloblastoma or glioblastoma multiforme

Question 6

Peutz Jeghers

Answer 6

-GI hamartomas (low malignant potetntial but chance of intussception)

+ pigmented spots (lips, face, genitalia, palmar surfaces)

Question 7

How might colorectal cancer first present?

Answer 7

Ab pain from bowel obstruction or peritoneal spread

• Wt loss
• Bloody stools
• Asymptomatic
• L sided = smaller lumen; more often changes in stool caliber; alternating constipation and diarrhea; may have hematochezia (bright red blood because lower in tract)
• R sided = larger lumen; more often blood in stools (melena); anemia/weaknessauto dominant

Question 8

Post-Tx CRC Surveillance

Answer 8

• Check pre and post-operative CEA levels; cont to check q 3-6 mo
• Annual CT of abdomen/pelvis and CXR
• Colonscopy at 1 yr then q 3 yrs

Question 9

Basal Cell Carcinoma

Answer 9

• Most common
• Basal cell layer of epidermis
• Risk = sun exposure to often in sun exposed areas of skin (esp head and neck)
• Pearly pink papule w/ rolled edges and teleangiectasias
• Mets rare
• Surgical resection

Question 10

Squamous Cell Carcinoma

Answer 10

• Actinic keratosis (rough scaly lesions in sun-exposed areas) are precursor
• In epidermal cells undergoing keratinization
• Crusting/ulcerate nodule or erosion
• Inc risk if on immunosuppressive agents
• Excellent prognosis and low risk mets unless LN involvement

Question 11

Marjolin Ulcer

Answer 11

• SCC arising from chronic wound such as previous burn scar

Question 12

Melanoma

Answer 12

• Risks - fair complexion, sun exposure, family hx, xeroderma pigmentosa, age, having large # nevi
• Radial growth in epidermis (horizontal) then vertical growth later –> reticular dermis and beyond
• DEPTH OF INVASION IS #1 PROGNOSTIC FACTOR
• ABCDE (asymmetry, borders irregular, color, diameter > 6 mm, evolution)
• May itch or bleed
• Do excisional biopsy w/1-3 cm margins + LN dissection if palpable