Colorectal

Question 1

Haggit classification

Answer 1

0- Mucosal
1- Submucosal, only head of polyp
2- SM, neck
3- SM, stalk
4- SM, below polyp, but above musc propria

Question 2

CRC T stage compared to esophagus?

Answer 2

Tis (Equivalent of T1a in esophagus)
T 1 equial to T1b

Question 3

MMR protein names?

Answer 3

MLH1, MSH2, MSH 6, PMS2

Question 4

If MLH 1 deficient next steps?

Answer 4

• Check BRAF V600E mutation or MLH1 promoter hypermethylation
• If abnormal, sporadic

Question 5

Tumor budding?

Answer 5

Isolated tumor cells at growing margin

Question 6

Micrometastatic disease CRC?

Answer 6

• 10-20 tumor cells or 0.2-2 mm nodal deposits
• N1c status

Question 7

Minimum lymph node harvest CRC?

Answer 7

12 nodes

Question 8

IDEA trial CRC?

Answer 8

• For T1-T3, N1 CRC
• CapeOx 3 and 6 months equal, FOLFOX 6 months superior
• T4 and N2 CapeOx/ FOLFOX 6 months superior

Question 9

FOXTROT trial?

Answer 9

NAC (6 pre + 18 post) vs adjuvant CHT in >T3 >N0
Reduced LR with NAC

Question 10

CRC DYNAMIC trial?

Answer 10

• Stage 2 CRC, ctDNA guided vs std mgmt for adjuvant CHT
• ctDNA non-inferior, less chemo used
• High ctDNA with tx same outcome as no ctDNA with tx

Question 11

Anal cancer T stage?

Answer 11

T 1 < 2
T2 2-5 cm
T3 > 5
T4 local invasion

Question 12

Nigro protocol?

Answer 12

5-FU infusion days 1-4 and 29-32
Mitomycin C days 1 and 29
RT 50.4 Gy in 28 fractions (54 Gy if bulky)
Nodal radiation if > T3 or involved nodes (50.4-54 Gy)

Question 13

PROSPECT trial?

Answer 13

T2 and T3, N+ rectal cancer
Preop Folfox + CRT only if tumor shrinkage < 20%
DFS and OS same at 5 years

Question 14

OPRA trial

Answer 14

Induction chemo (8 cycles )+ CRT( 50-56gy) vs induction CRT + consolidation chemo
41 vs 53% organ preservation (chemo first vs CRT first)
Induction CRT superior TME free survival

Question 15

Anal cancer follow up for partial response after Nigro?

Answer 15

4 weekly for 3 months

Question 16

Perianal cancer indications for Nigro

Answer 16

T1 poorly differentiated and above

Question 17

Appendiceal vs colonic serrated mutations?

Answer 17

Colon BRAF, Appendix kras

Question 18

CRC N stage?

Answer 18

N1 (a=1 node, b= 2 or 3, c= no node but satellites or tumor deposits)
N2 (a= 4-6, b= >6)

Question 19

CRC M stage

Answer 19

M1a- single organ
M1b- multiple organs
M1c- peritoneum only

Question 20

Colonoscopy synchronous cancer and polyp rate?

Answer 20

3-5% synchronous cancer
30 % other polyps

Question 21

Rectal tumor location landmarks?

Answer 21

Low- 6 cm
Mid- 6-11
High- above 11

Question 22

SCRT vs LCRT rectal?

Answer 22

45-54 Gy in 28 fractions
25 Gy in 5 fractions

Question 23

CRC adeno IHC markers?

Answer 23

CK 20 positive, CK7 negative