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Alimentary System: Pathology SA > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

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

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)

A

Endoscopic or local resection

24
Q

What does the operative procedure depend upon

A

Site,
Size,
Stage of tumour

25
Q

Why are lymph nodes removed in surgery

A

For histological analysis to see is metastases has occurred

26
Q

If metastases has occurred what is the surgical procedure put in places

A

Partial hepatectomy - removal of liver

27
Q

What is a permanent or temporary procedure put in places during surgery for colorectal cancer

A

Colostomy - stoma formation

28
Q

When is chemotherapy treatment given in colorectal cancer

A

Adjuvant - after surgery

For palliative care of advanced disease

29
Q

What stage in dukes classification is chemotherapy given

A

Duke C

If there is a positive Lymph node histology

Duke B
tumour extended though mucosa to muscle layer

30
Q

What is the purpose of chemotherapy

A

Mop up micro-metastases

31
Q

What is the agent used in chemotherapy

A

5-FU

fluorouracil

32
Q

When is radiotherapy used in the treatment of colorectal cancer

A

Rectal cancer only

neoadjuvant - before surgery
+/-chemotharapy

33
Q

What is the purpose of using radiotherapy as a neoadjuvant

A

to control primary tumour prior to surgery

possible shrink

34
Q

When is colonic stenting used in colorectal cancer

A

Palliative care - preventing colonic obstruction

35
Q

What are the two screening programmed for colorectal cancer

A

Average risk population

High risk groups

36
Q

What is the aim of population screening

A

detect pre-malignant adenomas/ early cancers in the general population

37
Q

What is the overall all the investigation for colorectal cancer populationg screening

A 
Faecal occult blood test (FOBT)
Faecal immunochemical test (FIT)
Flexible Sigmoidoscopy
Colonoscopy
CT Colonography
38
Q

What is the procedure put in places for the Scottish bowel screening programme

A

Everyone ages 50-74 years does a FOBT every two years

If screen positive referred for a colonoscopy

39
Q

Who is screened as part of the high risk group

A

Heritable conditions

  • FAP (familial adenomatous polyposis)
  • HNPCC (hereditary non-polyposis colorectal cancer)

Inflammatory bowel disease

Familial risk

Previous adenomas/Colorectal cancer

40
Q

What is FAP,

and what is its pathology

A

an autosomal dominant condition caused by mutation of APC gene on chromosome 5

that results in multiple adenomas throughout the colon

41
Q

When is the high risk of malignant change in FAP

A

Early adulthood

by age 40 if left untreated

42
Q

What is the screening procedure for FAP

A

annual colonoscopy from age 10-12

43
Q

What usually occurs at age 16-25 years as a prophylactic procedure in FAP patients

A

proctocolectomy - removal or rectum and colon

44
Q

What is the extracolonic manifestations of FAP

A

benign gastric fundic cystic hyperplastic - gastric polyps

duodenal adenomas -

Desmoid tumours - benign soft tissue tumour

CHRPE – congenital retinal hypertrophy of the pigment epithelia

45
Q

What is the benefit of NSAIDS chemoprevetion

A

reduces polyp number and prevents recurrence of higher-grade adenomas in the retained rectal segment

46
Q

What is HNPCC

A

autosomal dominant condition

that results in mutational DNA mismatch repair
causing micro-satellite instability
eg MLH1 and MSH2

47
Q

Why is duodenal adenomas difficult to manage

A

Because surgery is more challenging

48
Q

Where and when does HNPCC develop into colorectal cancer

A

Early onset colorectal cancer begins in your 40s and located at the right side

49
Q

Where is other associated cancers located in HNPCC

A

endometrial, genitourinary, stomach, pancreas

50
Q

What is needed for the diagnosis of HNPCC

A

clinical criteria

genetic testing

51
Q

What is the screening protocol for HNPCC

A

From age 25 years
every 2 years colposcopy

(not as high protocol of FAP)

52
Q

What is the screening portal for familial history of CRC

A

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
Q

What is the screening protocol for IBD and what is it dependant on

A

10 years post diagnosis

Dependant on:
Duration, extent,
activity of inflammation
Presence of dysplasia

54
Q

What does the screening protocol depend upon for previous adenomas

A

Number of polyps
Size of polyps
Degree of dysplasia

Alimentary System: Pathology SA (27 decks)

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