Colon Polyps

Question 1

most polyps that are removed during colonoscopy are _____, the others are _____

Answer 1

adenomatous
serrated

Question 2

both adenomatous and serrated polyps have an increased risk of _____

Answer 2

malignancy

Question 3

what do most colon adenocarcinomas arise from?

Answer 3

polyps

Question 4

polyps in which location may have an increased prevalence of advancing to advanced neoplasia?

Answer 4

polyps in proximal colon

Question 5

what polyps are non-consequential?

Answer 5

polyps < 5mm in rectosigmoid colon region

Question 6

have a higher risk for advancing to carcinoma, are > 1cm, have villous features (wart), and high grade dysplasia

Answer 6

advanced adenomas

Question 7

most adenomas are _____ cm and have a ____ risk of transition to cancer

Answer 7

< 1
low

Question 8

how long does it take for normal mucosa to turn into dysplastic polyp?

Answer 8

5 years

Question 9

how long does it take for normal mucosa to turn into cancer?

Answer 9

10 years

Question 10

arise from hyperplastic polyps and have a similar or greater risk of progression to cancer compared to adenomatous polyps

Answer 10

serrated polyps

Question 11

why is screening of polyps so important?

Answer 11

they’re usually asymptomatic

Question 12

what causes blood from rectum and indicates change from polyp to something more severe?

Answer 12

ulcerated polyp

Question 13

what are 3 possible + labs in polyps?

Answer 13

FOBT
FIT
anemia from chronic blood loss

Question 14

what is the diagnostic of choice and treatment for polyps?

Answer 14

colonoscopy

Question 15

what is an acceptable screening tool that requires rectal air insufflation?

Answer 15

CT colonography

Question 16

what is the treatment of choice for polyps?

Answer 16

colonoscopic polypectomy

Question 17

polyp is considered completely removed and treatment completed only if: (3)

Answer 17

polyp is completely excised + submitted for histologic exam
clean margins
no vascular or lymphatic involvement

Question 18

what is required if completely removed/treated polyp criteria is not met?

Answer 18

bowel resection

Question 19

what is the required f/u for malignant treatment of a polyp?

Answer 19

f/u in 3 months w/ repeat colonoscopy

Question 20

when should screening for polyps begin?

Answer 20

age 45

Question 21

what is the recommended polyp surveillance if there are no findings?

Answer 21

10 years

Question 22

what is the recommended polyp surveillance if there are 1-2 small (<1cm) tubular adenomas without villous features or high-grade dysplasia?

Answer 22

5-10 years

Question 23

what is the recommended polyp surveillance if there are 3-4 adenomas, adenoma > 1cm, or adenoma w/ villous features or high-grade dysplasia?

Answer 23

3 years

Question 24

what is the recommended polyp surveillance if there are > 10 adenomas found? (2)

Answer 24

1-2 years + genetic testing (r/o familial polyposis syndrome)

Question 25

what is the recommended polyp surveillance if there are small (<1cm) serrated polyps without dysplasia?

Answer 25

5 years

Question 26

what is the recommended polyp surveillance if there are large (>1cm) serrated polyps with cytologic dysplasia?

Answer 26

3 years

Question 27

what is the recommended polyp surveillance if there are small, typical hyperplastic polyps in the distal colon and rectum?

Answer 27

no surveillance required until 50 yo

Question 28

germline genetic mutations with high risk for cancer, in which family history is very important in determining screening

Answer 28

hereditary polyposis syndrome

Question 29

what are the criteria for hereditary polyposis syndrome to be met, that need genetic counseling? (3)

Answer 29

> 1 family member affected by it personal or FHx of colorectal cancer < 50 yo personal or FHx of > 20 polyps

Question 30

development of 100s-1000s of colonic adenomatous polyps and extracolonic manifestations like soft tissue tumors, osteomas, or hypertrophy of retinal pigment

Answer 30

familial adenomatous polyposis (FAP)

Question 31

what are the mutated genes associated with familial adenomatous polyposis (FAP)? (2)

Answer 31

APC gene (90%) MUTYH gene (8%)

Question 32

what is the prognosis for familial adenomatous polyposis (FAP)? (2)

Answer 32

colorectal polyps by 15 yo cancer by 40 yo

Question 33

what is the treatment for FAP?

Answer 33

complete proctocolectomy with ileoanal anastomosis OR colectomy with ileorectal anastomosis **before 20 yo**

Question 34

what is recommended post-resection of FAP to check for adenomas and carcinomas?

Answer 34

upper endoscopy q 1-3 years

Question 35

what size lesions found in upper endoscopy of a patient with FAP require resection?

Answer 35

> 2cm

Question 36

what 2 meds reduce the number and size of polyps in rectal stump but not in the duodenum?

Answer 36

NSAID COX-2 inhibitor

Question 37

polyp that exists throughout the intestines (mostly small intestines), presents with pigmented macules on buccal mucosa, lips, and skin. Not malignant but increases changes of malignancy

Answer 37

peutz-jeghers syndrome

Question 38

> 10 polyps in the colon (possibly adenomatous), genetic defect of 18q and 10q gene

Answer 38

familial juvenile polyposis

Question 39

AKA cowden disease; presents as polyps and lipomas throughout GI tract, trichilemmomas, and cerebellar lesions

Answer 39

PTEN syndrome

Question 40

what 2 cancers does lynch syndrome increase the risk for?

Answer 40

colorectal (#1) endometrial (#2)

Question 41

few adenomas that are flat w/ villous features or high grade dysplasia; has rapid transformation from benign to cancerous lesion within 1-2 years

Answer 41

lynch syndrome

Question 42

what patients should receive genetic testing for lynch syndrome?

Answer 42

all colorectal cancer patients

Question 43

what should be done if lynch syndrome gene mutations are found?

Answer 43

all 1st degree relatives should do genetic testing

Question 44

what is the bethesda criteria used for?

Answer 44

determine individuals to get genetic testing for lynch syndrome

Question 45

what is the bethesda criteria? (4)

Answer 45

colorectal cancer < 50 yo multiple/recurrent colorectal cancer colorectal cancer with at least 1 first degree relative before age 50 colorectal cancer with 2 or more 2nd degree relatives with colorectal CA orHNPCC