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SL32113 - Clinical Therapeutics > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

(63 cards)

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1
Q

What is the primary goal of surgery in cancer treatment?

A

Remove the cancer completely without damage to surrounding structures.

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2
Q

Why must lymph nodes draining the cancer be removed during surgery?

A

For staging and for regional control of disease.

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3
Q

What is a consequence of removing lymph nodes that run alongside the arteries supplying the bowel?

A

You have to remove the arteries, which results in taking away more bowel than just the tumor.

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4
Q

What are the four main aims of cancer surgery?

A
  • Control local disease
  • Stage disease (TNM)
  • Offer cure, extended life, and quality of life
  • Palliate symptoms
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5
Q

What psychological benefits does surgery provide to cancer patients?

A

Improves psychological well-being.

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6
Q

What is the significance of the TNM staging system in cancer?

A

It helps determine how advanced the cancer is.

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7
Q

What is colorectal cancer?

A

A cancer characterized by abnormal growth of cells in the bowel.

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8
Q

List the three phenotypes of colorectal cancer.

A
  • Narrow/Annular tumour
  • Polypoidal tumour
  • Ulcerated tumour
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9
Q

What factors influence the management of colorectal cancer?

A
  • Diagnosis
  • Stage of cancer
  • Patient factors
  • Tumor factors
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10
Q

What percentage of colorectal cancer cases are adenocarcinomas?

A

98% of colorectal cancers are adenocarcinomas.

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11
Q

What are the bowel wall layers?

A
  • Mucosa
  • Submucosa
  • Muscularis propria
  • Serosa
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12
Q

What is the median age of diagnosis for colorectal cancer?

A

60 years.

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13
Q

What are the common symptoms of colorectal cancer?

A
  • Rectal bleeding
  • Change in bowel habit
  • Weight loss
  • Iron deficiency anemia
  • Bowel obstruction
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14
Q

What is the prognosis for Stage 1 colorectal cancer?

A

95% 5-year survival rate.

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15
Q

What are the main aetiological factors for colorectal cancer?

A
  • Polyps
  • Diet (western diet)
  • Family history
  • Inflammatory bowel disease (IBD)
  • Genetic syndromes (HNPCC, FAP)
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16
Q

What is the adenoma-carcinoma sequence?

A

A stepwise progression from polyps to cancer.

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17
Q

What is HNPCC also known as?

A

Lynch syndrome.

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18
Q

What genetic mutation is associated with Familial Adenomatous Polyposis (FAP)?

A

APC mutation on 5q.

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19
Q

What are the modes of cancer spread?

A
  • Direct invasion
  • Lymphatic spread
  • Haematogenous spread
  • Transcoelomic spread
  • Implantation
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20
Q

What is the significance of Dukes staging?

A

It classifies the extent of colorectal cancer.

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21
Q

What is the definition of a polyp?

A

A protuberant growth from the mucosa.

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22
Q

What are the three types of adenomas based on villosity?

A
  • Tubular adenoma
  • Villous adenoma
  • Tubulo-villous adenoma
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23
Q

What symptoms are associated with right-sided colorectal tumors?

A
  • Abdominal mass
  • Iron deficiency anemia
  • Small bowel obstruction
  • Perforation
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24
Q

What is the significance of carcinoembryonic antigen (CEA) in colorectal cancer?

A

It can be a good test for surveillance and recurrence.

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25
What are the general symptoms of colorectal cancer?
* Anorexia * Weight loss * Anemia * Fatigue
26
What are the common signs of colorectal cancer?
* Conjunctival pallor * Cachexia * Abdominal mass * Palpable rectal mass
27
What is the typical age of diagnosis for HNPCC?
Average age of diagnosis is 45.
28
What is the survival rate for Stage 4 colorectal cancer?
7% 5-year survival rate.
29
What is the role of endoscopy in colorectal cancer diagnosis?
Used to visualize and biopsy lesions within the colon.
30
What is a critical aspect of surgical staging in colorectal cancer?
Lymphadenectomy is key for staging and treatment.
31
What type of cancer is anal cancer classified as?
A different disease from colorectal cancer.
32
What is the importance of psychological benefits in cancer surgery?
They can enhance the overall well-being of patients.
33
Fill in the blank: Colorectal cancer is the ______ most common cancer in the UK.
4th
34
True or False: Ulcerative colitis is a transmural inflammatory disease.
False
35
What are the goals of cancer treatment?
Cure, palliation, prolongation of life
36
What is lymphadenectomy key for?
Staging and treatment
37
In the case of metastatic disease, what is the usual first treatment?
Chemotherapy
38
What are the principles of surgery in cancer?
Remove the cancer completely without damage to surrounding structures, remove lymph nodes for staging and regional control, clear blood vessels to remove lymph nodes
39
What types of surgical approaches can be used for cancer treatment?
Open, laparoscopic, robotic, transanal
40
What are some risks associated with cancer surgery?
* Anaesthesia * Bleeding * Infection (chest, wound, urine) * Anastomotic leak * Injury to other structures (e.g. ureter) * Stoma * MI * DVT/PE * Death
41
What is awaited after the specimen is removed from cancer surgery?
Histopathological assessment
42
What defines the stage of a tumor?
TNM and excision margins
43
What does it mean if there is no blood vessel or nodal involvement?
The patient is considered surgically cured
44
What is adjuvant chemotherapy used for?
To reduce the risk of developing metastases
45
What is the implication of involved margins in cancer surgery?
May need further treatment such as radiation to the tumor bed
46
What remains the most effective way to cure visceral cancer?
Surgery
47
What is the major determinant of outcome for visceral cancer patients?
Surgery
48
What are the cancer outcomes that surgeons can help with?
* Local recurrence * Overall survival/disease-free survival * In-hospital mortality * Quality of life (sexual/urinary/bowel function)
49
What does complete tumor removal in CRC surgery entail?
Resection of primary tumor, draining lymphatics, and blood vessels within mesenteric envelope
50
What does ontogenetics refer to?
The mapping of body compartments established during early embryologic development
51
What does the ontogenetic theory of local tumor spread claim?
Local dissemination is facilitated in the ontogenetic compartment of origin but suppressed at its borders
52
What is the key to optimal local control of cancer?
Whole compartment resection with intact margins following ontogenetic planes
53
What is necessary for surgery to cure cases of cancer?
R0 resection
54
What is the role of neoadjuvant treatment in cancer surgery?
To prepare for surgery in more advanced cases
55
What does excellence in surgery lead to?
* Less pelvic recurrence * Less intra-abdominal recurrence * Improved survival * Less relapse and costly drug treatment
56
What is adjuvant chemotherapy designed to do?
Reduce the risk of developing metastases
57
Which patients are usually given adjuvant chemotherapy?
'Dukes C' patients
58
What are common chemotherapy agents for cancer treatment?
* 5-Fluorouracil * Leucovorin * Oxaliplatin * Irinotecan * Bevacizumab * Cetuximab
59
What is the bowel cancer screening program age range?
60-74 years
60
What is the follow-up protocol post CRC surgery?
* CT C/A/P years 1 and 2 * Colonoscopy years 1 and 5 * CEA 6 monthly for first three years, then annually for 2 more
61
What is the significance of a negative fecal occult blood test in screening?
Repeat in 2 years
62
What is the result of a positive fecal occult blood test?
Offered colonoscopy
63
Fill in the blank: The traditional cancer surgery is based on _____ with a safe margin.
wide excision

SL32113 - Clinical Therapeutics (4 decks)

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