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CRC Flashcards

(54 cards)

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1
Q

Most common colorectal cancer

A

95% adenocarcinoma
2/3 colon
1/3 rectal

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2
Q

How many cases of CRC are sporadic?

A

85%
10% familial risk
1% underlying IBD

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3
Q

Risk factors

A 
Age
Male 3:2 Female
Previous adenoma/CRC
Smoking
Obesity
Diabetes mellitus
Diet - decreased fibre, fruit and veg, calcium, increased red meat and alcohol
Streptococcus bovis bacteraemia
IBD - ulcerative colitis > crohns
Congenital
Genetic
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4
Q

Predisposing inheritable factors for CRC

A

HNPCC (Lynch syndrome)

FAP

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5
Q

Which structures give rise to majority of CRCs?

A

Colorectal polyps

100s-1000s by FAP

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6
Q

Classification of colorectal polyps

A

Benign or malignant

Epithelial or mesenchymal

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7
Q

Define an adenoma

A

Benign, pre-malignant growth of epithelial origin

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8
Q

3 types of adenoma and rate of occurence

A

Tubular 75%
Tubuovillous (15%)
Villous 10%

Pedunculated or sessile - stalk or no stalk

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9
Q

What characterises a high risk adenoma

A

Size
Number
Degree of dysplasia
Villous architecture

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10
Q

An adenoma can progress to …

A

An invasive carcinoma

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11
Q

Describe the evolution of an adenoma to an invasive carcinoma

A

Activation of oncogene - kras, c-myc
Loss of tumour suppressor gene - APC, p53, DCC
Defective DNA Repair Pathway genes - microsatellite instability

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12
Q

3 processes in malignancy

A

Cell growth
Proliferation
Apoptosis

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13
Q

Oncogenes involved in CRC

A

K ras, c-myc

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14
Q

TSG lost in CRC

A

APC, p53, DCC

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15
Q

6 Aspects of Presentation

A
  1. Rectal bleeding (faecal occult blood)
  2. Altered bowel opening to loose stools for more than weeks
  3. Iron deficiency Anaemia
  4. Palpable rectal or Right lower abdominal mass
  5. Acute colonic obstruction (stenotic tumour)
  6. Systemic symptoms - weight loss, fatigue, anorexia
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16
Q

Investigation of CRC

A 
Screening- faecal occult blood test
Bloods - FBC for anaemia, CEA
Colonoscopy
Barium enema - apple core sign
CT colonography
CT abdo/pelvis
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17
Q

Staging investigations

A

CT chest/abdo/pelvis
MRI for rectal tumours
PET/rectal endoscopic US

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18
Q

Staging systems

A 
TNM
Dukes
A-confined to muscularis mucosa
B- extended beyond muscularis mucosa
C- lymph nodes
D- distant metastases
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19
Q

Treatment

A

Surgery

  • Duke A and polyps - Endoscopic/ local resection
  • Laparotomy
  • Colostomy
  • Hepatectomy for metastases

Conservative - macmillan nurse and patient education

Chemotherapy

  • Dukes C and B, postive lymph node
  • Agents - oxaliplatin, 5- FU (fluorouracil)

Radiotherapy - rectal cancer only

Palliative
Chemo, colonic stenting to prevent obstruction

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20
Q

Purpose of screening

A

Detect pre-malignancies

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21
Q

Modalities of screening

A 
Faecal Occult Blood Test
Faecal immunochemical test (FIT)
Flexible sigmoidoscopy
Colonoscopy
CT colonography
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22
Q

Uses of colonoscopy

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A

Biopsy

Polypectomy

23
Q

Risks associated with colonsocopy

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A

Perforation and Bleeding

Sedation and bowel prep needed

24
Q

High Risk groups for CRC

Study These Flashcards
A

HNPCC, FAP
IBD
Familial
Previous adenomas/CRC

25
What groups are offered CRC screening?
Ages 50-74 2 yearly FOBT If positive offered colonoscopy
26
Which gene is mutated in Familial Adenomatous Polyposis
APC on chromosome 5
27
What is the inheritance pattern of FAP mutations?
Autosomal dominant
28
How does FAP present?
Multiple adenomas of the colon 50% by age of 15 95% by age 35 Extra-colonic manifestations Desmoid Tumours Congenital Retinal Hypertrophy of the Pigment Epithelia (CRHPE)
29
How often should someone with FAP be screened
Annually from age 10-12
30
Prophylaxis offered with FAP?
Proctocolectomy from 16-25
31
Extra-colonic manifestations of FAP
Benign gastric fundic cystic hyperplasia Duodenal adenomas in 90% Periampullary cancer 5%
32
Chemoprevention in FAP
NSAIDS Sulindac Reduces polyp number Prevents recurrence of high grade adenomas in retained rectal segment
33
Pattern of inheritance of Hereditary Non-Polyposis Colorectal Cancer
Autosomal Dominant
34
What mutation occurs in HNPCC
DNA mismatch repair - MLH1, MSH2 | Causes microsatellite instability
35
Presentation of CRC in HNPCC
Early onset | Right sided
36
Associated cancers with HNPCC
``` Genitourinary Endometrial Stomach Pancreas CNS- glioblastoma ```
37
Diagnostic Criteria for HNPCC
Amsterdam/Bethesda | Genetic testing
38
Screening for HNPCC
From age 25 | 2 yearly colonoscopy
39
Congenital risk factors for CRC
Juvenile Polyposis Syndrome - Autosomal dominant | Peutz-Jeghers - Autosomal dominant, melanosis of oral mucosa
40
Complications of CRC
Obstruction Intussusception Heavy bleeding Metastasis
41
2 expressions of FAP
FAP coli -osteoma, epidermoid cysts, fibromas, desmoid tumours, lipomas, supernumeray teeth, periampullary cancers Gardner Syndrome
42
Most common cancer syndrome
HNPCC lynch
43
Pathology of IBD --> CRC
Inflammation --> dyspasia --> carcinoma
44
Common subtypes of adenocarcinoma
Mucinous Signet ring Medullary
45
Site of CRC with increasing age
RHS Age related change Most present in sigmoid and rectum
46
Difference between left and right tumours
Right tend to be larger, more aggressive, distant metastases | Left - altered bowel habit, obstruction, hematochezia (fresh bleeding in anus)
47
Gold standard treatment
Endoscopy Detection Treatment of minor lesions - polypectomy, mucosal resection, submucosal dissection
48
Most common sites of distant metastases
Liver Lung Bone
49
What are Krukenberg's tumours?
Present first as ovarian lesions | Tumours secondary to Colorectal or GI cancer
50
What plexus is within the submucosa?
Meissner's
51
What plexus is withint the muscularis propria?
Auerbach's
52
Which part of the rectum are lesions most likely to spread to the peritoneum?
Upper rectum | Majority is extraperitoneal
53
Fascia surrounding Mesorectal fascia
Waldeyer;s fascia- separate from sacrum posteriorly | Denonvillier's fascia - separate from prostate anteriorly
54
Mesorectal fascia extends to which set of muscle?
Levator ani - puborectal sling

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