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Clin med GI > Colorectal/ pancreatic cancer > Flashcards

Colorectal/ pancreatic cancer Flashcards

(75 cards)

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1
Q

What is a colectomy

A

Resection/removal of any extent of the large bowel

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2
Q

What is a colonic polyp

A

mass of tissue that arises form bowel wall and protrudes into the lumen

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3
Q

What is the main concern of colonic polyps

A

Malignant transformation
*most colon cancer arise from previously benign adenomatous polyp

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4
Q

What is the treatment for polyps

A

colonoscopies removal

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5
Q

What are the two shapes of a colonic polyp

A

sessile
pedunculate

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6
Q

What may multiple polyps represent

A

familial adenomatous polyposis

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7
Q

Where are polyps most common

A

rectum and sigmoid
*decrease frequency in cecum

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8
Q

What is the polyp with the greatest concern

A

adenomatous (neoplastic) polyp

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9
Q

What are the different types of adenomas that a polyp can have

A

tubular
tubulo-villous
villous

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10
Q

How are non-adenomatous polyps classified

A

hyperplastic
hamartomas
juvenile
pseudo-polyp
leiomyomas

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11
Q

When is treatment done for non-neoplastic polyps

A

uncontrollable bleeding
intussusception

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12
Q

What is the most frequent complain with colonic polyps

A

rectal bleeding

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13
Q

What type of polyp may cause watery diarrhea and what might it cause

A

Large villous adenoma
hypokalemia

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14
Q

How are polyps diagnosed

A

Colonoscopy

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15
Q

Where is a colonoscopy done

A

complete, including the cecum

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16
Q

what helps prevent colonic polyps

A

ASA + COX2 inhibitors

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17
Q

What is familial adenomatous polyposis (FAP)

A

hereditary disorder causing numerous colonic polyps and frequently resulting in colorectal cancer by 40y/o

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18
Q

How do you treat FAP

A

Colectomy

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19
Q

When do polyps generally present with FAP

A

by age 15

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20
Q

What is indicative of classic FAP

A

100+ polyps
*surgical removal manages and reduces CRC risk

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21
Q

What is indicative of attenuated FAP

A

20-100 polyps with continued polyp development and increased CRC if not removed
*generally occurs later in life

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22
Q

What is Gardner syndrome

A

FAP variant with multiple colonic polyps and tumors outside the GI tract

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23
Q

What is Turcot syndrome

A

multiple colonic polyps and increased risk of CRC and brain tumors (glioblastoma/ medulloblastoma)

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24
Q

How do you diagnose/work up FAP

A

Colonoscopy
Genetic testing of patient & first degree relative

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25
What are offspring of those with FAB screened for
hepatoblastoma
26
When are children screened for hepatoblastoma and How is it completed
From birth - 5year with annual serum alphafetoprotein and liver US
27
What is the treatment guideline for FAP
Endoscopic surveillance of remainder of GI tract Annual thyroid screening w/ US NSAIDs
28
What is hematochezia
blood in stool
29
What are the symptoms of CRC
blood in stool and change in bowel habits
30
What is the treatment for CRC
surgical resection with chemotherapy +/- radiotherapy
31
Where does CRC generally present in the body
Rectum and sigmoid *generally adenocarcinoma
32
What is the third most common cancer
CRC
33
Where in the world does CRC have the highest incidence rate
Australia New Zealand
34
Where is the lowest incidence rate of CRC
Western Africa
35
What are some predisposing factors for CRC
FAP Ulcerative colitis and crohns Diet low in fiber, high in fat, refined carbs, and animal protein (red meat specifically)
36
How does CRC spread
Spreads by extension through bowel wall, hematogenous metastasis, regional lymph node metastasis, and perineurial spread
37
How long does it generally take classic CRC to occur
10-15 years for enough mutations and epigenetic alterations to occur
38
When should colonoscopy be done for average risk patients
45-75
39
If a first degree relative has CRC, when should screening begin
40y/o OR 10 years before the age of relative at time of dx
40
What is a FOBT and when is it preformed
fecal occult blood test every year
41
How often do first degree relatives of those with CRC need to be screened
Q 5 years
42
If someone has a + fecal DNA-FIT test, what is the next step in their screening
colonoscopy within 6 months
43
Does a - fit test r/o cancer
no
44
What is a blood based test for CRC screening
Septin 9 assay *avg risk patients only and not very sensitive
45
What are properties of right colon cancer
large caliber/thin wall tube contents are liquid bleeding is usually occult tumors grow large enough to palpate through abd wall before sx present
46
What are properties of left colon cancer
smaller lumen, semisolid feces obstruction earlier than r. colon stool streaked with blood sx. of perf partial obstruction with colicky abd pain Complete obstruction generally initial manifestation
47
What is the initial symptoms of rectal cancer
Bleeding with defecation
48
What is tenesmus
sensation of incomplete evacuation
49
What diagnostic testing is used for CRC
colonoscopies bx CT to evaluate tumor growth genetic testing
50
How are sessile polyps removed
surgical excision
51
What is preformed once CRC is diagnosed
met search via CT and CXR routine labs to evaluate anemia and overall condition
52
What is serum carcinoembryonic antigen (CEA) utilized for
**NOT for screening will be low after colon tumor removal so may detect reoccurrence earlier
53
What does follow-up look like post CRC removal
1 yr post surgery then 3yrs then every 5 years
54
What are the different forms of pancreatic cancer
adenocarcinoma neuroendocrine cystadenocarcinoma intraductal papillary-mutinous tumor
55
Where does most of pancreatic cancer arise from
ductal** and acinar cells *generally adenocarcinoma
56
When are adenocarcinoma diagnosed
55years old *generally in men
57
What are the risk factors for pancreatic cancer
smoking chronic pancreatitis obesity male African American
58
What are early s/sx of pancreatic cancer
pain and weight loss *upper abd pain that radiates to back
59
If the cancer is in the head of the pancreas, what are the signs
obstructive jaundice
60
If there is cancer in the body/tail of the pancreas, what are the signs
splenomegaly, gastric/esophageal varices, GI hemorrhage
61
What are more severe clinical presentations of pancreatic cancer
diabetes exocrine insufficiency malabsorption
62
What imaging is done for working up pancreatic cancer
CT (pancreatic technique) or MRI followed by endoscopic US (EUS)
63
How is the pancreatic cancer workup when someone has obstructive jaundice
ERCP
64
What lab tests are done for workup of pancreatic cancer
CBC, CMP, CA 19-9 *amylase and lipase generally normal
65
What is the prognosis for pancreatic cancer
5 years
66
Who will use CA19-9 for screening
High risk individuals BRCA2 HNPCC mutations
67
What is the treatment for pancreatic cancer
Whipple + adjunctive chemo/radiation
68
What is the treatment for pancreatic CA with an unresectable tumor
symptom control -billiary stent -duodenal stent
69
Is addiction a concern in regards to pain control with pancreatic cancer tx
NO
70
What do pancreatic neuroendocrine tumors arise from
islets and gastrin producing cells *generally produce many hormones
71
What is the treatment for neuroendocrine pancreatic cancer
surgical resection
72
What is the presentation of a cystadenocarcinoma
upper abdominal pain with a palpable mass *rare pancreatic cancer
73
What causes an intraductal papillary-mucinous tumor
mucus hyper secretion and ductal obstruction
74
Where are intraductal-mucinous most common
Women tail of pancrea *presents as chronic pancreatitis
75
When is pancreatic cancer typically diagnosed
Late stage

Clin med GI (9 decks)

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