Dr.Merter Gulen Flashcards
(51 cards)
Right colon tumors:
-its contents are liquid
-More ulcerated type on the right
-The most common symptoms are blunt, persistent
-lower quadrant pain and anemia
(Iron deficiency anemia due to occult bleeding, weakness, weight loss Mass in the right lower quadrant)
Left colon tumors:
-the content is solid
-Left colon cancers are of the scirous and annular type.
-obstructive symptoms **
-change in bowel habits,progressive decrease in stool diameter
Rectal tumors:
Bloody – mucous stool, tenesmus, feeling of tightness Obstruction may be late
What is hartmann procedure?
A type of colectomy that removes part of the colon and sometimes rectum.
What are the differences between colostomy and colectomy ?
A colectomy can also be called a large bowel resection. A colostomy may be needed after colectomy.A colostomy is an opening to the outside of your body that lets stool exit into a bag.
Where are the high risk of colon tumors risk?
Rectum>sigmoid >cecum> ascending colon
What are the inflammatory bowel disease
ulcerative colitis, Crohn’s disease
The development of CRC relatively increased 3.5-6.5 in which patients?
Adenomatous polyp larger than 1 cm
Villous or tubulovillose polyp
high-grade dysplasia
What can increase the risk of CRC?
-Consumption of red and processed meat; long-term consumption
-Smoking-Cigaret
-Alcohol
-Androgen therapy;
-who have undergone a GnRH agonist or orchiectomy for prostate cancer (SEER database).
-BRCA gene mutations
Types of COLUMN POLYPS
a-Inflammatory, b- Hamartomatosis, c- Neoplastic (Adenamatous polyp): ,d- Hyperplastic polyps
HYPERPLASTIC POLYPS
*They are usually less than 5 mm in diameter
* Can be found in 50% of adults The most common are colonic polyps
* Dysplasia is not seen
* has no symptoms
* It is only removed for histological diagnosis.
JUVENILE POLYPS
*It is most common in children.
*It peaks at 5 years old
*70% solitary
*Most commonly found in the rectum
*The most common symptom is bloody stool and rarely rectal bleeding. Invagination, colic pains
Familial juvenile polyposis:
*Autosomal dominant. T
*here are hundreds of polyps in the colon.
* They can transform into adenoma and carcinoma. *Prophylactic colectomy is recommended
(Solitary juvenile polyps have no malignant potential)
Peutz-Jegher Syndrome
*Autosomal dominant (Serine-threonine kinase 11 gene defect)
*Hyperpigmentation and hamartomatous polyps in the mucocutaneous regions
* Polyps are mostly in the small intestine but can be found in the colon and rectum.
Cronkheit-Canada Syndrome
*Generalized hamartomatous polyposis *hyperpigmentation,
*alopecia
*onychodystrophy
*It does not show inheritance.
*There is no risk of malignancy.
*Diarrhea, enteropathy, and malabsorption may develop.
Is every polyp cancer?
Degree of dysplasia type of polyp
, Tubular Adenoma: 5% cancer risk Tubulovillous adenoma: 22% cancer risk
Villous adenoma: has a 40% cancer risk
Polyp size:
<1 cm = <1% cancer risk
1 cm = 10% risk of cancer
2 cm = 15% cancer risk
If the normal adenomatous polyp is larger than 0.5 cm, it should be treated.
What are Hereditary CRC syndromes?
FAP (Familial Adenomatous Polyposis)
Atenue FAP
HNPCC/Lynch syndrome
familial colorectal cancer
MUTYH-associated polyposis (MAP)
FAP (Familial Adenomatous Polyposis)
-Gardner syndrome, Turcot syndrome, and attenuated variants of FAP
-From childhood, there are a large number of adenomatous polyps.
- It becomes symptomatic at about 16 years of age and if left untreated, 90% develops CRC by the age of 45, the lifetime risk is 100%. Thousands of polyps.
-Chromosome 5q, (75%)APC germline mutation (+)
-Colonoscopic screening is performed at the age of 10-15 for first-degree family members of an individual with FAP.
-If the APC gene is negative, it is taken into general screening after the age of 50.
FAP extra GIS involvement;
-retinal pigment epithelial hypertrophy
-Desmoid tumor Osteomas of the mandible (gardner)
-CNS tumors (turcot)
Atenue FAP
-There are mutations at the 3rd and 5th ends of the APC gene
-10-100 polyps present
-APC 60%
-Screening colonoscopy at age 15 if APC positive
-Surgical treatment is like FAP.
MUTYH-associated polyposis (MAP
-autosomal recessive
-It occurs as a result of biallelic mutation in the mutY homolog (MUTYH) gene.
-There are less than 500 polyps.
Lynch syndrome (HNPCC)
*Autosomal dominant syndrome. RER pathway, DNA mismatch repair gene defect (hMLH1, hMSH2)
*It constitutes 3% of CRCs.
* It is frequently seen in extra colonic cancers such as endometrial, ovarian, hepatobiliary, gastric cancer. *Younger age 40-45 years,
* the prognosis is better 40% risk of synchronous-metachronous cancer *Colonoscopic screening 20-25 years or 10 years before first diagnosis
Amsterdam criteria for HNPCC diagnosis
*3 relatives with colorectal cancer , where one is 1st degree relative of other two
*2 generations of colorectal cancer
*1 colorectal cancer before age 50
* FAP is excluded
Bethesda Criteria
Amsterdam criteria or one of the following;
*Two cases of HNPCC-related cancer in one patient,
* including synchronous and metachronous cancers
*First-degree relative with HNPCC-associated cancer and/or colon adenoma (up to 45 percent of cancer cases) age,
*adenoma diagnosed before age 40) and colon cancer
* Colon or endometrial cancer diagnosed before age 45
*Signet ring cell or undifferentiated right colon cancer before age 45 *Diagnosed with adenoma before age 40
