Colon polyps and neoplasms [3] Flashcards Preview

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Flashcards in Colon polyps and neoplasms [3] Deck (17):
1

Non neoplastic polyps

inflammatory polyps
Hamartomatous polyps
- Juvenile
- peutz jeghers
Hyperplastic polyps

2

Hamartomatous polyps
- what
- who

"tumor like" overgrowth where it is normally present.
- risk for GI carcinoma

Mostly occuring in childhood (pre-pubertal)

Juvenile + peutz jeghers type

3

peutz jeghers syndrome (Hamartomatous polyps)
median age
GI lesions
cancer risk

10-15
arborizing polyps:
SI>colon>stomach

Colonic adenocarcinoma

4

juvenile polyps (hamartomatous)
median age
GI lesions
cancer risk

5

Hyperplastic polyps
median age
sessile or peduncular?
GI lesions
cancer risk
architecture

increase with age
sessile
Commonly seen in left sided colon/rectum
No dysplasia (but SSP are premalignant)
star shaped

6

Serrated polyps/adenoma

right side of colon most common
- (*hyperplastic is Left)
serrated architecture
Dysplastic epithelium may be present
DEFINITELY can progress to adenocarcinoma

7

What features of neoplastic polyps confer increased risk for malignancy?

size matters! bigger = bigger risk of malignancy
increase with age (50% by age 50)
presence of high grade dysplasia

8

adenomatous changes

1. cells
- no respect 4 boundary - piling on eachother
2. Nuclei
- darker
- lose basal orientation
3. cytoplasm ↓: N↑
4. mitotic figures

9

4 molecular pathway abberation associated with colon cancer

WNT/APC/Beta catenin pathway
- mut in APC at 5q21 → mutation of APC can no longer form complex to degrade beta catenin

10

Does adenoma formation represent increase in the rate of cell proliferation in early stage of polyp formation?

no.
polyps represent an increase in the size of the proliferating crypt compartment

11

APC mutations can run in families, producing _______.

Familial adenomatous polyposis
FAP pts have increased risk of colon cancer, but accounts for small fraction of total case of colon cancer

(but if you have FAP autosomal dominant germline mut of APC gene, youre screwed, 100% will get invasive adenocarcinoma b4 age 30)

12

Microsatellite instability

defects in mismatch repair proteins

13

If pt has KRas/MAP kinase/PI3 kinase WT, what can you treat the GI cancer with?

FOLFOX + cetuximab (against Epidermal growth factor)

14

Risk factors for colorectal carcinoma

Strong:
advanced age
country of birth
FAP/HNPCC
Long standing UC

Mod:
high red meat, prev cancer, high fat, smoking, alcohol, obesity, cholecystectomy

15

Protective factors for colorectal carcinoma

high physical activity
Aspirin + NSAID use
High vegetable/fruit diet
high fiber, high Ca2+

16

Hereditary non-polyposis colorectal cancer (HNPCC) aka

Lynch syndrome

Indiv more at risk and develop colon cancer at earlier stage
Right sided usually
Due to inherited mutation of mismatch repair gene allele → 2nd allele mutation over time leading to microsatellite instability

17

colon cancers most commonly metastasize to ____

liver