Colorectal Cancers Flashcards
(118 cards)
1
Q
What is the age factor for colorectal cancers
A
90% are over the age of 50 so this is why screening starts at age 50
2
Q
Cancer in the large bowel usually occurs in which part
A
Usually occurs in the distal colon and rectum (sigmoid or descending colon)
3
Q
At what age should a person of average risk have his or her first screening colonscopy
A
50 for average risk. For high risk, it should be BEFORE 50 years old.
4
Q
Familial adenomatous polyps is (FAP) ad hereditary non-polyposis colorectal syndrome (HNPCC) are most closely associated with what cancer
A
Colorectal cancer
5
Q
The vermiform appendix is most closely associated with which portion of the digestive tract?
A
Cecum
6
Q
What is the dose limiting structure of most concern for radiation treatments of colorectal cancer
A
Small bowel
7
Q
What substance is responsible for the brown color of feces?
A
Bilirubin
8
Q
_________ has the highest incidence of cancer related deaths in the US compared to esophageal cancers, stomach cancers, and anal cancers.
A
Colorectal cancers
9
Q
What are the risk factors for anal cancer
A
HPV Anal intercourse in those under 30 Immunosuppression Genital warts Genital infections Cigarette smoking
10
Q
There is an increased incidence of anal cancer in men under 45 and this is attributed to…
A
An increased in homosexuality and anal intercourse
11
Q
What condition is most closely associated with adenomatous polyposis
A
Gardner syndrome
12
Q
The most common histology of anal carcinoma
A
Squamous cell carcinoma
13
Q
T/F
About 50 percent of patients with colorectal cancer present with positive nodes
A
True
14
Q
Foods that patient should avoid while undergoing radiation treatments for colorectal cancer
A
Whole grains Fresh fruits Raw veggies Fried, fatty foods Milk and dairy products
15
Q
Foods that patients are encouraged to consume while undergoing radiation treatments for colorectal cancer
A
White bread Baked, broiled, or roasted meats Peeled apples Banana Macaroni, noodles Cooked veggies
16
Q
What are the anti-diarrheal agents to help patients with diarrhea while undergoing colorectal radiation treatments
A
Immodium
Lomotil
17
Q
Lymphatics of the descending colon drain following the path of the ……
A
Inferior mesenteric artery
18
Q
What staging system is most widely used today for colorectal cancer
A
TNM
19
Q
What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall
A
Surgery, chemo, and XRT
20
Q
Between colon cancer and rectum cancer, which one have a higher incidence
A
Colon cancer
Rectum and colon effects men and women equally
21
Q
It has been noted that cancers in the proximal (right) colon have increased in _______(male or female)
A
Female
22
Q
________ is the 2nd leading cause of cancer deaths in the US
A
Colorectal cancer
23
Q
Factors that has been linked to colorectal cancer
A
Diet (high fat low fiber, processed and red meats, low fruit/veg.
Obesity
Smoking
Excessive alcohol
Minimal physical activity
LIFESTYLE greatly affects development of colorectal cancer
24
Q
(Colorectal cancer)
Chronic ulcerative colitis usually occurs in the __________
A
Rectum and sigmoid colon
25
Other medical factors that contributes to colorectal cancer
chronic ulcerative colitis
Chronic's disease
FAP (familia adenomatous polyposis)
Hereditary non-polyposis colorectal syndrome
26
How is FAP treated
Complete removal of the colon and return
27
Adenomatous polyps are growths that arise in the _______ of the bowel
Mucosal lining and it is either villous or tubular
28
Which type of adenomatous polyps is 8 to 10 times more likely to be malignant
Villous adenomatous polyps
29
(Colorectal cancer)
| Another factor that contributes to colorectal cancer that is similar to FAP is ______
Gardner's syndrome
30
What are the 8 regions that the colon is divided into
```
Cecum
Ascending colon
Hepatic flexure
Transverse colon
Splenic flexure
Sigmoid
Rectum
```
31
Cancer of the large bowel is divided into ______ and ______ because the symptoms, diagnosis, and treatments are different based on the location of the disease
Colon and rectum
32
Cancer of the colon is treated with ________
Surgery and chemo
33
Cancer of the rectum is treated with ______
Surgery, chemo and XRT due to its location, it only allows for small surgical margins and adjuvant treatment is often needed
34
Which part of the large bowel is located INTRAperitoneally
Cecum, transverse colon, and sigmoid
35
Which portion of the large bowel is located RETRO-peritoneally
Ascending and descending colon,
| Hepatic and splenic flexures
36
What is the difference between the organs that is located INTRAperitoneally to that is located RETROperitoneally
the INTRAperiotneal have a complete mesenteric and serosa and are FREE mobile while the RETROperitoneal does NOT. However, seeding is common in the INTRA peritoneal
37
The rectum is continuous of the ______
Sigmoid
38
The rectum begins at the level of the ______
3rd sacral vertebrae
39
Just like the sigmoid, the upper rectum is covered by _____ on the anterior and lateral surfaces
Peritoneal
40
The lower half to 2/3 of the rectum is located
RETROperitoneally
41
What are the 3 valves that the rectum is divided into
Superior, middle and inferior
42
The rectum acts as ___________
Acts as a holding station for fecal matter before it is ready to be excreted out of the body
43
Because the rectum is located RETROperioneally, tumors can invade structures such as....
Prostate, bladder, vagina, and sacrum
44
What are the 4 layers of the bowel
Mucosa- lumen of bowel
Submucosa- rich in lymphatics an blood vessels
Muscularis propria- muscle layer responsible for peristalsis
Serosa- layer of fat
45
The right colon follows the _______
Superior mesenteric vessel
46
The left colon follows the .....
Inferior mesenteric vessels and includes regional nodes
47
The sigmoid drains into the ....
Inferior mesenteric vessels and also include nodes along the superior rectal, sigmoidal and the sigmoidal mesenteric vessels
48
The rectal node drainage all depends on how high or low. So the upper rectum follows the
Superior rectal vessel and terminates in the inferior mesenteric nodes
49
The middle and lower rectum drain to the ....
Internal iliac and pre-sacral nodes
50
The lower rectum lesions that spread into the anal canal may end up in the ...
Inguinal nodes
51
As you get further down the anus, you have more concerns with the ________ nodes then you would if you were more superior
Inguinal nodes
52
What are the clinical presentation of colorectal cancer
Rectal bleeding
Bright red on paper or in stool (hematochezia)
Change in bowel habitus (diarrhea or constipation)
Change in stool form (pencil thin indicates rectal valve blockage)
Tumor extension can cause buttock pain
53
T/F
| Colonscopy should always follow any positive test result for colorectal cancer
True
54
What are the tests ACS recommends for avg people risk less than 50 o face for colorectal cancer
Annual fecal occult blood test
| Sigmoidoscopy or double contract BA every 5 yrs or colonoscopy every 10 yrs, CT colonoscopy every 5 yrs
55
What are the ACS recommendations for high risk colorectal
Colonoscopy before 50
History and physical
Digital rectal exam
56
(Colorectal cancer)
| Which is better, the lesion to grow inward or outward
You want the lesion to grow outward into the lumen of the bowel because then it is not affecting anything. Lesions that grow inward into the muscle have a much worst prognosis
57
_________ is the most common malignancy of the large bowel (90-95 percent of all tumors)
Adenocarcinomas
58
What is the 5 yr survival rate of G1-G2 of colon Adenocarcinoma
55 percent
59
What is the 5 yr survival rate for G3-G4 of colon Adenocarcinoma
30 percent
60
What are the 2 most important prognostic indicator for colorectal cancer
The number of positive nodes and the depth of penetration through the bowel wall
61
Colorectal cancer usually spread through
Direct extension
Lymphatics
Hematogenous - distant mets
62
The initial nodes involved for rectal cancer are the
Perirectal nodes
63
T/F
| About 50 percent of all patients have positive nodes at diagnosis for rectal cancer
True
64
(Colon cancer)
| _______ is the treatment of choice
Surgery (colon tumor surgery= right or left hemicolectomy is common)
65
(LAR) low anterior resection is done for
Colon cancer and some rectal cancer and DOES NOT REQUIRE COLOSTOMY
66
(APR) Abdominal peritoneal resection is done for
Done for distal rectal cancer and some anal cancer and REQUIRES COLOSTOMY
67
___________ is the goal in conjunction with LAR
Sphincter preservation
68
Disadvantage of pre-op treatment is
Lack of pathological staging
69
Advantage of pre-op treatment is
The clinical down staging of the tumor and prevention of possible seeding that might be caused by surgery
70
Why are patients set up on prone board for colorectal treatment
Bowel is a crital structure so the prone belly boards move the bowel out of the way
71
(Rectum)
| What is the field design
Encompass primary tumor plus 2-5cm margins and any pelvic lymph nodes (pre sacral and internal iliac S included because this is whee we see a lot of reoccurrence)
72
Rectal cancer recurrences most often occur in the
Posterior aspect of the pelvis- pre sacral and internal iliacs
73
Portal design for rectal cancer
Presacral and internal iliacs nodes included
3 or 4 field treatments usually used
PA and POF laterals
AP/PA and POF for anterior involvements (like prostate)
74
The most common histology for colorectal cancer
Adenocarcinoma
75
The most common histology for anal cancer
Squamous cell carcinoma
76
What are the staging systems used for colorectal cancer
TNM
Dukes
Astler-Coller
77
What is the treatment of choice for colorectal cancer
Surgery
78
What is the most common symptom at presentation for anal cancer
Bleeding
79
What is the most common site for distant metastasis for colorectal cancer
Lungs
80
Describe the setup/most commonly used for colorectal cancer and the significance of the position
Prone on belly board with arms up. This position aides with the removal of the bowel out of the way
81
Lymphatics from the right colon follows what drainage
SUPERIOR mesenteric vessels
82
What is the dose limit for small bowel
4500cGy (45Gy)
83
What is the most common histology for anal cancer
Squamous cell carcinoma
84
To which nodal group would you expect DISTAL anal tumors to spread to
Inguinal nodes
85
What 2 side effects most always occur to people receiving radiation for anal cancer
Erythema
| Desquamation
86
What is not a significant risk factor for anal cancer
Drinking and dieting
87
T/F
| A patient receiving radiation for rectal cancer should consume raw vegetables
False!
| Should NOT consume raw vegetables
88
When would a 4 field technique be used for the treatment of racial cancer instead of a 3 field technique
When there's invasion/involvement of the prostate, rectum, bladder or vagina
89
What is the major dose limiting structure when treating a patient for rectal cancer
Small bowel
90
Which patient would be most likely to experience leukopenia while being radiated for rectal cancer
Patient receiving 3 field prone 3DCRT
91
After an abdominal perineal resection APR, the inferior border for a rectal treatment field will change how
The inferior border will become MORE INFERIOR
92
What is the standard treatment for most anal cancer
Radiation and chemo
93
What is the standard of treatment for most colon cancer
Surgery and chemo
94
What is the standard of treatment for most rectal cancer
Surgery, chemo and XRT
95
At what dose should a large rectal field be boosted to include only the tumor bed
5500cGy (55Gy)
96
At what age should a person of average risk have his or her screening colonscopy
50yrs old
97
Familial adenomatous polyposis (FAP) and hereditary no polyposis colorectal syndrome (HNPCC) are most closely associated with which types if cancer
Colorectal cancer
98
The vermiform appendix is most closely associated with its which potion of the disgestive tract
Cecum
99
What is the dose limiting structure of most concern for radiation treatment of colorectal cancer
Small bowel
100
Displacing the small bowel out of the field during treatment with radiation is more easily achievable with...
With pre-op
Because once surgery is done, certain anatomy and organs is removed so other organs will drop down, becoming more inferior
101
What substance is responsible for the brown color of feces
Bilirubin
102
What is NOT a risk factor for Anal cancer
Diet
103
What are the risk factors for anal cancer
HPV
Immunosuppression
Anal intercourse
104
When treating anal cancer with just XRT, what total dose is given
Just XRT, total dose is 60-65Gy
Larger field is 60-65Gy
Smaller field is 55-60Gy
105
IORT typically utilizes
Electrons
106
What is the most common site for distant spread from colorectal cancer
Liver
107
What condition is closely associated with adenomatous polyposis
Gardner syndrome
108
What's the most common histology for anal cancer
Squamous cell carcinoma
109
T/F
| About 50% of patients with colorectal cancer present with positive nodes
TRUE
110
What are the foods patients that undergo radiation for colorectal should AVOID
Whole grains
Fresh veggies
Dairy products
Raw veggies
111
What cancer would radiation treatment to likely include the inguinal lymph nodes
Anal cancer
112
Lymphatics of the DESCENDiNG colon drain follows the....
INFERIOR mesenteric artery
113
What is the inner most lining of the bowel
Mucosa
114
The staging system most commonly used for colorectal cancer
TNM
115
What is considered the most effective treatment regimen for rectal cancer with positive nodes outside the rectal wall
Surgery, chemo and XRT
116
Neoadjuvant chemoradiation is given...
To shrink tumor BEFORE surgery
117
When NOT counting prostate and breast cancer, colorectal cancer is the _______ leading cause of cancer death
Second leading cause of cancer death
118
What is the most common presenting symptom for colorectal cancer
Hematochezia ( blood found in stool)
