General Surgery/GIT / Colorectal Cancer Flashcards
(28 cards)
In the United States, what is the third leading cause of cancer and cancer death in men and women?
CRC
What are risk factors for CRC?
- Age >40-50 years
- personal history of CRC
- personal history of polyps, first-degree relative diagnosed with CRC
- IBD
- cigarette smoking
In most cases of CRC, there is a positive family history of the disease. True or false?
False
What is familial adenomatous polyposis (FAP)?
A familial colon cancer syndrome in which a germline mutation in the adenomatous polyposis coli (APC) gene results in numerous colonic adenomas appearing during childhood
What percent of patients with FAP develop colon cancer?
90% by age 45
What is Lynch syndrome/HNPCC (hereditary nonpolyposis colorectal cancer)?
A familial colon cancer syndrome associated with defects in DNA mismatch repair
What genetic disorders predispose a person to CRC?
- FAP
- Gardner syndrome
- HNPCC/Lynch syndrome
What is the most common presenting symptom of CRC?
Abdominal pain
What other symptoms may help localize the CRC lesion to the Right side?
- IDA
- weight loss
- anorexia
What other symptoms may help localize the CRC lesion to the left side?
- Decreased stool caliber
- constipation
- obstipation
- diarrhoea
What other symptoms may help localize the CRC lesion to the rectum?
- bright red blood per rectum
- and/or tenesmus
What is the diagnostic test of choice for patients with symptoms suggestive of CRC?
Colonoscopy
What if the colonoscope cannot reach the tumor site in a patient with CRC - what diagnositc test of choice?
Double-contrast barium enema
What is the differential diagnosis of CRC?
- Other malignancies
- lymphoma
- carcinoid
- Kaposi sarcoma
- metastases
- hemorrhoids
- IBD
- diverticulitis
- infection
What are the most common sites of metastases of CRC?
- Regional lymph nodes
- liver
- lungs
- peritoneum
Can carcinoembryonic antigen (CEA) be used as a screening test for CRC?
No
When do you use CEA?
In patients newly diagnosed with CRC for both prognosis and evaluation
What does the metastatic workup of CRC involve?
- CXR
- LFTs
- abdominal CT
What is the most important prognostic factor in CRC?
- Depth of bowel wall invasion
What is the only curative modality for localized CRC?
Surgical resection
For average-risk individuals, at what age should CRC screening begin?
50 years
What are the different options for CRC screening?
- Annual fecal occult blood test (FOBT)
- flexible sigmoidoscopy alone every 5 years
- flexible sigmoidoscopy every 5 years with FOBT yearly
- colonoscopy every 10 years
Which CRC screening option/modality has the greatest sensitivity and specificity?
Colonoscopy
What are some disadvantages to colonoscopy?
- Risk of bleeding/perforation
- patient has to do bowel prep
- costly
- sedation leads to longer recovery time (and adds indirect costs for transportation, absenteeism, etc)
