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Alimentary System: Pathology SA > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

(54 cards)

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1
Q

What is the distribution between cancer in the colon and cancer in the rectal

A

2/3 colorectal cancer is located in the colonic

1/3 colorectal cancer located in the rectal

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2
Q

What is the aetiologies of colorectal cancer

A

Sporadic

Familial risk

Previous CRS

Inheritable conditions:
FAP, HNPCC

underlying inflammatory bowel condition

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3
Q

The greatest aetiology of Colon rectal cancer is Sporadic, what is the risk factors associated

A

Age

Male gender

Previous adenoma/CRC

Environmental influences

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4
Q

What are environmental influences that increase the risk of CRC

A 
Diet 
Alcohol 
Obesity 
lack of exercise
smoking 
Diabetes mellitus
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5
Q

What is the pathology of Colon rectal cancer

A

Arise from existing colorectal polyps

These are Benign adenomas that have a epithelial origin

Cell proliferation occurs, and activates oncogenes/loss of tumour suppressor genes/defective DNA repair pathway genes lead to larger cell growth that causes invasive adenocarcinoma that metastases resulting in leison of colon

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6
Q

What are the oncogenes activated to cause the dysplasia of polyps

A

K-ras

C-mc

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7
Q

What are the different types of histological polyps

A

Tubular
Villous
Interderminate tublovillous

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8
Q

What is the different morphologies of polyps

A

Pedunculated

Sessile

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9
Q

What does the high risk of lesion occurring depend upon

A

Size of polyps
Number of Polyps
degree of dysplasia
Villous architecture

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10
Q

What is the symptoms of colorectal cancer

A

Rectal bleeding

Altered bowel opening - diarrhoea

Iron deficiency anaemia

Weight loss/anorexia

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11
Q

What is the signs of colorectal cancer

A

Palpable rectal

Lower abdominal mass

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12
Q

What can occur in colorectal cancer is the tumour is stenosing

A

acute colonic obstruction

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13
Q

Whoa re more likely to have right sided colonic malignancy

A

Men

Non Menstruating women

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14
Q

What is the best option for investigating colorectal cancer

A

Colonoscopy

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15
Q

What is the benefits of colonoscopy

A

Therapeutic as well as diagnosic

can perform polypectomy

Followed up by tissue biopsy

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16
Q

What is the disadvantages to colonoscopy

A

Perforation and bleeding can occur if therapeutically used

Bowel preparation - disturb electrolyte balance

Sedation

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17
Q

What are 3 radiological imaging used of investigating colorectal cancer

A

Barium enema - not very actuate

CT colonography
- 3D virtual colonoscopy

CT abdo/pelvis

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18
Q

What is the disadvantages to radiological imaging

A

ionising radiation
no histology obtained
No therapeutic intervention

Bowel preparation

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19
Q

What imagery is used for staging investigations

A

CT scan (chest/abdomen/pelvis)
MRI
PET scan
Rectal endoscopic ultrasound

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20
Q

What is MRI scan good for diagnosing

A

rectal tumours

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21
Q

What is ABCD of Dukes Classification on colorectal cancer

A

A – Tumour confined to mucosa

B – Tumour extended through mucosa to muscle layer

C – Involvement of lymph nodes

D - Distant metastatic spread

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22
Q

What is the major treatment for colorectal cancer

Study These Flashcards
A

Surgery

Laparotomy vs Laparoscopic

23
Q

What is the surgical treatment for “cancer polyps” or when the tumour is confined to the mucosa (dukes a)

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A

Endoscopic or local resection

24
Q

What does the operative procedure depend upon

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A

Site,
Size,
Stage of tumour

25
Why are lymph nodes removed in surgery
For histological analysis to see is metastases has occurred
26
If metastases has occurred what is the surgical procedure put in places
Partial hepatectomy - removal of liver
27
What is a permanent or temporary procedure put in places during surgery for colorectal cancer
Colostomy - stoma formation
28
When is chemotherapy treatment given in colorectal cancer
Adjuvant - after surgery For palliative care of advanced disease
29
What stage in dukes classification is chemotherapy given
Duke C If there is a positive Lymph node histology Duke B tumour extended though mucosa to muscle layer
30
What is the purpose of chemotherapy
Mop up micro-metastases
31
What is the agent used in chemotherapy
5-FU | fluorouracil
32
When is radiotherapy used in the treatment of colorectal cancer
Rectal cancer only | neoadjuvant - before surgery +/-chemotharapy
33
What is the purpose of using radiotherapy as a neoadjuvant
to control primary tumour prior to surgery | possible shrink
34
When is colonic stenting used in colorectal cancer
Palliative care - preventing colonic obstruction
35
What are the two screening programmed for colorectal cancer
Average risk population High risk groups
36
What is the aim of population screening
detect pre-malignant adenomas/ early cancers in the general population
37
What is the overall all the investigation for colorectal cancer populationg screening
``` Faecal occult blood test (FOBT) Faecal immunochemical test (FIT) Flexible Sigmoidoscopy Colonoscopy CT Colonography ```
38
What is the procedure put in places for the Scottish bowel screening programme
Everyone ages 50-74 years does a FOBT every two years If screen positive referred for a colonoscopy
39
Who is screened as part of the high risk group
Heritable conditions - FAP (familial adenomatous polyposis) - HNPCC (hereditary non-polyposis colorectal cancer) Inflammatory bowel disease Familial risk Previous adenomas/Colorectal cancer
40
What is FAP, | and what is its pathology
an autosomal dominant condition caused by mutation of APC gene on chromosome 5 that results in multiple adenomas throughout the colon
41
When is the high risk of malignant change in FAP
Early adulthood by age 40 if left untreated
42
What is the screening procedure for FAP
annual colonoscopy from age 10-12
43
What usually occurs at age 16-25 years as a prophylactic procedure in FAP patients
proctocolectomy - removal or rectum and colon
44
What is the extracolonic manifestations of FAP
benign gastric fundic cystic hyperplastic - gastric polyps duodenal adenomas - Desmoid tumours - benign soft tissue tumour CHRPE – congenital retinal hypertrophy of the pigment epithelia
45
What is the benefit of NSAIDS chemoprevetion
reduces polyp number and prevents recurrence of higher-grade adenomas in the retained rectal segment
46
What is HNPCC
autosomal dominant condition that results in mutational DNA mismatch repair causing micro-satellite instability eg MLH1 and MSH2
47
Why is duodenal adenomas difficult to manage
Because surgery is more challenging
48
Where and when does HNPCC develop into colorectal cancer
Early onset colorectal cancer begins in your 40s and located at the right side
49
Where is other associated cancers located in HNPCC
endometrial, genitourinary, stomach, pancreas
50
What is needed for the diagnosis of HNPCC
clinical criteria | genetic testing
51
What is the screening protocol for HNPCC
From age 25 years every 2 years colposcopy (not as high protocol of FAP)
52
What is the screening portal for familial history of CRC
Previous - 5 year colonoscopy High moderate risk 2-3 FDR = 5 year colonoscopy at age 55 year on Low moderate risk 1-2 FDR Once only colonoscopy at 55 years
53
What is the screening protocol for IBD and what is it dependant on
10 years post diagnosis Dependant on: Duration, extent, activity of inflammation Presence of dysplasia
54
What does the screening protocol depend upon for previous adenomas
Number of polyps Size of polyps Degree of dysplasia

Alimentary System: Pathology SA (27 decks)

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