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GI PATHOLOGY > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

(57 cards)

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1
Q

The majority of colorectal cancers are what?

A

Adenocarcinoma (95%)

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2
Q

What are the risk factors for sporadic colorectal cancer?

A

Advanced age
Male
Previous adenoma/CRC
Environmental

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3
Q

What are the environmental risk factors for CRC?

A 
Diet (low fibre, calc, high red meat)
Alcohol
Obesity
Low exercise
Smoking
DM
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4
Q

What are colorectal adenomas?

A

Colorectal polyps, usually benign

Tubular or villous

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5
Q

What factors make colorectal adenomas high risk?

A

Size
Number
Degree of dysplasia
Villous architecture

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6
Q

What actions cause an adenoma to become a carcinoma?

A

Activation of oncogenes
Loss of tumour suppressor genes
Defective DNA repair pathway

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7
Q

What oncogenes are involved in adenocarcinoma formation?

A

k-ras

c-myc

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8
Q

What tumour suppressor genes are involved in adenocarcinoma formation?

A

APC
p53
DCC

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9
Q

How does colorectal cancer present?

A 
Rectal bleeding
Altered bowel habit
Iron deficiency anaemia
Palpable rectal/low right mass
Acute colonic obstruction 
Systemic symptoms
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10
Q

What investigations would you give for a patient with suspected colorectal cancer?

A

Colonoscopy (therapeutic too)

CT abdo - barium enema

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11
Q

How is colorectal cancer staged?

A

CT scan
MRI
PET/EUS

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12
Q

When is MRI used for staging of a colorectal tumour?

A

Rectal tumours

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13
Q

What criteria is used for staging colorectal cancer?

A

TNM

Duke’s

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14
Q

What is Duke’s A criteria?

A

Confined to submucosa

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15
Q

What is Duke’s B criteria?

A

Invasion through muscularis without lymphatic involvement

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16
Q

What is Duke’s C criteria?

A

Invasion through muscularis with regional lymph node involvement

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17
Q

What is Duke’s D criteria?

A

Presence of distant metastases

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18
Q

How does the T staging work for colorectal cancer

A

T1 - confined to submucosa
T2 - Confined to muscularis
T3 - confined to serosa
T4 - breached serosa

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19
Q

How does the N staging work for colorectal cancer

A

N0 - no nodes involved
N1 - Up to 3 regional nodes
N2 - 4+ nodes

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20
Q

How are most colorectal cancers treated?

A

Surgery

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21
Q

When is colorectal cancer treated endoscopically?

A

Dukes A

Cancerous polyps

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22
Q

How is chemotherapy used for colorectal cancer?

A

Dukes C, B
Adjuvant therapy
Micrometastases

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23
Q

How is radiotherapy used for colorectal cancer?

Study These Flashcards
A

Rectal cancer only

Neoadjuvant +/- chemo

24
Q

What therapy is indicated for palliative care?

Study These Flashcards
A

Chemotherapy

Stenting

25
How can the prognosis of colorectal cancer be improved?
Prevention (lifestyle) | Screening
26
What are the main forms of colorectal population screening?
``` Fecal occult blood test Faecal immunochemical test Flexible sigmoidoscopy Colonoscopy CT Colonography ```
27
Who are the high risk groups for colorectal cancer?
Heritable conditions Inflammatory bowel disease Familial risk Previous CRC
28
What is FAP?
Familial adenomatous polyposis
29
What type of genetic condition is FAP?
Autosomal dominant
30
How does FAP affect the body?
50% adenomas in colon by 15yrs | 95% by age 35yrs
31
What causes FAP?
Mutation of APC on chromosome 5
32
How are FAP patients treated?
Annual colonoscopy from age 10-12yrs (screening) | Prophylactic proctocolectomy
33
Extracolonic manifestations of FAP
Duodenal adenomas | CHRPE (retinal epithelium hypertrophy)
34
What is HNPCC?
Autosomal dominant mutation in DNA mismatch repair gene | Microsatellite instability
35
How are HNPCC patients screened?
2 yearly colonoscopy
36
What are HNPCC patients at risk of?
Early onset CRC (right sided) | Other, local cancers
37
How is HNPCC diagnosed?
Bethesda genetic testing
38
How are patients at high moderate risk due family history of CRC screened?
5 yearly colonoscopy from 50yrs
39
How are patients at low moderate risk due family history of CRC screened?
One colonoscopy at 55 years
40
How are IBD patients screened for colorectal cancer?
Colonoscopy 10 years post diagnosis | Dependent thereafter
41
How are previous CRC patients screened for colorectal cancer?
5 yearly colonoscopy
42
Which patients are considered high moderate risk of colorectal cancer?
CRC in 3 FDR, none <50 | CRC in 2 FDR, mean age <60
43
Which patients are considered low moderate risk of colorectal cancer?
CRC in 2 FDR >60yrs | CRC in 1 FDR <50yrs
44
The majority of adenocarcinomas originate as what?
Adenomas - polyps
45
Adenomas can take which shapes?
Pedunculated | Sessile
46
What is the therapeutic benefit of colonoscopy?
You can find and remove any polyps
47
How do you prepare a patient for colonoscopy?
Sedation | Bowel prep - laxatives
48
When is CT colonography indicated in colorectal cancer?
When a patient is ineligible for colonoscopy
49
When is CT abdo/pelvis indicated in colorectal cancer?
When patient cannot undergo bowel prep - only shows very large cancers
50
What treatment is indicated for liver metastases?
Partial hepatectomy
51
Rectal tumour treatment always result with what?
Colostomy | Neoadjuvant radiotherapy
52
Which CRC patients get adjuvant chemotherapy?
Dukes C | - lymphatic spread
53
What lifestyle changes can reduce risk of CRC?
30m exercise a day Maintain healthy BMI Eat 5 a day Smoking cessation
54
Who are screened for CRC, and how often?
50-74 year olds | FOBT every 2 years
55
Why was FOB replaced with FIT?
FOBT has lower sensitivity in women | FIT is a more simple test
56
Patients testing postive in FOBT are followed up how?
Colonoscopy
57
HNPCC is associated with what cancers?
CRC (right colon) Endometrial Genitourinary

GI PATHOLOGY (20 decks)

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