Colorectal screening and cancer, rectal cancer and anal cancer Flashcards Preview

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Flashcards in Colorectal screening and cancer, rectal cancer and anal cancer Deck (45):
1

When do you start obtaining a family history and when do you update it?

Age 20 and update every 5-10years

2

Who are we suspicious of for colorectal malignancy?

any patient over 40 with bowel changes and hematochezia

3

Who is average risk patient for colorectal screening?

asymptomatic and over 50 or over 45 if African American

4

When do we stop colorectal screenings?

over 85

5

Gold standard cancer prevention test?

colonoscopy every 10 years

6

Do we offer cancer prevention or cancer detection test first?

cancer prevention tests

7

Cancer detection tests

Annual fecal immunochemical test - don't have to change diet, do at home and mail in
Annual fecal occult blood test- ptn can't take aspirin or certain food; office or at home
Fecal DNA every 1-3 years- most sensitive; need to give a whole stool sample

8

If a cancer detection test is positive then do what?

cancer prevention test

9

Patient has one 1st degree relative with CRC or advanced adenoma less than 60yo

begin screening at age 40 or at an age 10 yrs younger than when person diagnosed. Get a colonoscopy every 5 yrs after.
Ex. Mother diagnosed at 45, you start getting tested at 35.

10

Patient has one first-degree relative with CRC or adenoma over 60 is screened how?

same as average risk person

11

Patient has over 2 first-degree relative with CRC or advanced adenoma of any age

begin screening at age 40 or at an age 10 yrs younger than when person diagnosed. Get a colonoscopy every 5 yrs after.
Ex. Mother diagnosed at 45, you start getting tested at 35.

12

Patient with lynch syndrome risk screening

Start at 20-25 or 10 yrs less than youngest affected relative and get colonoscopy every 1-2 yrs until 40, then yearly.
Genetic testing

13

Patient with FAP risk screening

Age 10-12 get sigmoidoscopy yearly
colonoscopy yearly after first polyp discovered
genetic testing

14

Patient with personal history of CRC

Total colon examination within 1 yr of resection and repeat at 3 yrs and 5 yrs if normal

15

Patient with personal history of adenoma

poylps removed and colonoscopy based on timeline

16

IBD patient

begin 8 years after onset of pancolitis
colonoscopy every 1-2 yrs

17

Who is most likely to get colorectal cancer?

age 50 -65; males; african americans

18

Where are colorectal cancers prevalent?

W. industrialized countries due to diet

19

Location of colorectal cancers

L. colon most common
R. colon is inherited in African Americans

20

Cause of CRC

genetic and molecular alterations

21

RF CRC

Modifiable
- W. diet (red meat, fats)
- obesity
- smoking
- alcohol
- diabetes
Non-modifiable
- African American
- Hereditary Polyposis Syndromes
- FHx of colon cancer
- increase in age
- IBD
- Childhood abdominal radiation

22

Modifiable prevention CRC

diet and macronutrients- veggie, fruit, less red meat, fiber
physical activity
Low dose aspirin

23

Clinical R. side CRC

- vague abdominal pain
- iron deficient anemia
- fatigue
- GI bleed
- weakness due to blood loss
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor

24

Clinical L. side CRC

- obstructive symptoms
- colicky abdominal pain
- change in bowel habits
- constipation alternating with loose stools
- stool streaked with blood
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor

25

Dx CRC

colonoscopy with biopsy

26

Labs for CRC

LFT- elevated with metastasis
Carcionembryonic antigen (CEA) level- staging; drops/normalize means treatment working
CT chest and abdomen

27

Staging CRC

T- depth of tumor penetration into the bowel wall
N- presence of lymph node involvement
M- presence/ absence of distant metastasis

28

Tx CRC

Surgery- resection of primary colonic or rectal cancer is tx of choice
Chemo- stage 3 and 4
Radiation and chemo- rectal cancer stage 2-4 (decrease mass and preserve sphincter)

29

Monoclonal antibodies that work against epidural growth factor receptor

cetuximab and panitumab; rash is good

30

What is patient is KRAS and NRAS wildtype?

improved tx with monoclonal antibodies

31

Clinical Rectal cancer

- rectal tenesmus
- urgency
- recurrent hematochezia
- narrow caliber stools
- rectal bleeding
- cachexia
- weight loss
- back pain
- ascites
- pallor

32

What imaging can help with operative management of rectal cancer?

endorectal ultrasonography

33

Tx rectal cancer

- higher recurrence rate and lower long-term survival
Stage 1= surgery
Stage 2 and 3= chemoradiation and surgery

34

Anatomy of anal cancer

tumors arise in mucosa- glandular, transitional, squamous

35

Anatomy of peri-anal/anal margin cancer

arise distal to the squamous mucocutaneous junction or within the skin

36

Where is the cutoff line in anal cancer?

pectinate line

37

MC histology for anal cancer

Small cell carcinoma

38

Cause of anal cancer

HPV

39

RF anal cancer

HPV
Female
lifetime number of sexual partners
genital warts
smoking
HIV
receptive anal intercourse
chronic immunosuppresive condition

40

Clinical anal cancer

- rectal bleeding
- anorectal pain
- rectal mass sensation
- rectal mass on digital rectal exam
- condylomata
- bleeding

41

Initial Dx anal cancer

endoscopy with biopsy
anoscopy
rigid proctosigmoidoscopy

42

Once dx work up of anal cancer

CT scan of abdomen/pelvis
PET
Fine needle aspirate or biopsy of node

43

Stages of anal cancer

Stage 0-2= node negative
Stage 3= node +
Stage 4 = metastatic disease

44

Tx anal cancer

Stage 0-3
- chemoradiotherapy: 5-FU + Mitomycin + radiotherapy
- surgery is disease progressing
Stage 4
-systemic chemo: cisplatin + 5-FU
- palliative chemoradiotherapy

45

Post tx surveillance of anal cancer

Every 3-6 months for 5 yrs:
- DRE, anoscopy, inguinal node palpitation
CT chest, abdomen, and pelvis every 3 years