Colorectal Cancer

Question 1

Colorectal cancer

Answer 1

Second highest cause of cancer death in U.S. after lung cancer

Question 2

Type polyps

Answer 2

Non-neoplastic hamartoma (juvenile polyp)
Hyperplastic mucosal proliferation (hyperplastic polyp)
Adenomatous polyp

Question 3

Risk factors

Answer 3

Upper socioeconomic groups who live in urban areas

Diet: animal fat

Streptococcus bovis bacteremia (occult colorectal tumors and a possible increase in upper GI cancers. )

DM

Ureterosigmoidostomy
(where colonic mucosa is chronically exposed to both urine and feces )

Question 4

Genes

Answer 4

K-ras = oncogen

APC+DCC =tumor suppresor genes

Question 5

Histologic features of polyps that lead to cancer.

Size

Answer 5

Villous >Tubulovillous >Tubular

> 2.5cm احتمال اعلى

Question 6

Polyposis coli

1/familial adenomatous polyposis
2/ Gardner’s syndrome
3/ Turcot’s syndrome
4/HNPCC

Answer 6

All are autosomal dominant

Distribution, all just large intestine except gardner (large +small)
مسوي كل الأمعاء حديقة اله

All are adenoma

Question 7

Associated lesions with HNPCC

Answer 7

endometrial and ovarian tumors
families often include persons with multiple primary cancers

Question 8

Associated lesions with gardner syn

Answer 8

osteomas
fibromas,
lipomas,
epidermoid cysts,
ampullary cancers,
congenital hypertrophy of retinal pigment epithelium

Question 9

Associated lesions with turcot syndrome

Answer 9

brain tumors

Question 10

Peutz-jegr syndrome + juvenile polyp

Answer 10

Distribution of polyps: small and large intestines, stomach
Histologic type: hamartoma

Associated lesions with juvenile polyps : various congenital abnormalities

Associated lesions with Peutz-jegr syndrome
Mucocutaneous pigmentation
Tumors of the ovary, breast, pancreas, endometrium

Mucocutaneous pigmentation
Tumors of the ovary, breast, pancreas, endometrium

Question 11

55% of cancers occur proximal to the…………..,

…………… primary cancers have increased the most.

Answer 11

Splenic flexure

Cecal

Question 12

Plasma carcinoembryonic antigen (CEA) level

Answer 12

Low predictive value for screening

Useful for preop. Staging & postop. Followup

Question 13

Sigmoidoscopy +biopsy for whom at high risk

FOBT

Answer 13

Every 5 years

Annually

Question 14

5-year survival: fairly reliable indicator of cure,

Answer 14

as most recurrences after surgical resection occur within the first 4 years

Question 15

Offspring of patients with polyposis coli

Answer 15

Annual flexible sigmoidoscopy until age 35 years

Question 16

Sister Mary Joseph nodule,

Answer 16

A palpable periumbilical nodule in a patient with colon cancer often reflects metastatic disease to an umbilical node