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Flashcards in colorectal CA Deck (36):
1

DDx of BRBPR (4)

- hemmoroids
2. proctiis (IBD)
3. polyps
4. CA

2

*** what is important about hemmooids

diagnosis of exclusion - need to rule out all others

3

what is important in workup of anemia

scope

4

what is only way to say lesion is not malig.

look under a microscpe

5

what is part of blood supply to colon that systemic

middle and inferior rectal

6

epi

3rd most common CA
- 12% of all CA in ont.
- male>female
- 1/3 local, 1/3 regional, 1/4 mets

7

sporadic causes (majority

- AGE
- men
- env. (diet, obese, DM)
- personal Hx of CRC or polyps
- fam. Hx
- IBD

8

3 known hereditary

1. HNPCC
2. FAP
3. MYH polyposis

9

what is precursor to CA

adenoma that can then be removed- target for screenign

10

what is tubular adenoma

adenomatous epi with a stalk

11

what is villous adenoma

sessile ( no stalk) with finger-like projections

12

2 features of high grade dysplasia

1. nuclear atypia
2. architectural complexity

13

WHO definition

metastitis (carcinoma def.) of the colon and rectum requires invasion of the muscilaris mucosa into the submucosa

14

3 variants

1. mucinous - > 50% of lesion has extracellula mucin epithelium
2. signet ring cell - > 50% with prominent intracytoplasmic mucin
3. other rare types

15

2 grade types

low - 50-100% gland formation
high - 0-49% gland formation

16

3 margins

1. proximal
2 distal
3. radial - around fatty edge

17

what is problematic margins

1mm is same as being at the edge

18

2 types of polyps

neoplastic and non

19

3 non-neoplastics

1. hyperplastic
2. inflammatory
3. juvenile

20

3 neoplastic

1. adenomatous - all dysplastic
2. serrated
3. hamarotomatous

21

3 types of adenomatous polyps

1. pedunclulated
2. sessile or tubular
3. villous

22

epi of adenomatous polyps

v. common
- 1/4 will become CA
- need to be removed

23

what is FAP

1-2% of patients with CRC
- develop in teens
- carpet of polyps
- APC gene mutation
- ALL NEED prophylactic colectomy

24

what is attenuarted FAP

- later age
- less polyps
- may spare rectum
- same APC, but point mutation

25

what is HNPCC

3% of all CRC
- other associated CAs
3,2,1 rule - 3 relatives, 2 gens, 1 first degree
- mismatch repair gene mutation
- 80% risk of CRC

26

screening for avg.

- no family Hx, or over 60
@ 50, scope q10 years
annual FOBT

27

screening for moderate risk

fam Hx, or 1st degree relative

28

screening for FAP

scope annually in teens until surg

29

screen for HNPCC

scope biannually from 20-25 and annually from 40 onward

30

screen for IBD

scope q 1-2 years after 8 years of colitis

31

5 common presentations of CRC

1. BRBPR
2. change in bower habits
3. abdo pain or mass
4. weight loss
5. anemia

32

diagnosis

scope with biopsy

33

***best predictor of survival

nodal status

34

what is treatment

curable - surg with 5cm margins
node + - adjuvant chemo
incurable - chemo

35

what is treatment for incurable

chemo and pallaitice surgery or stents

36

what is done for survors

- followed 5-10 years
- scopes q 1,3,5 years
- CEA q 6 months

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