Flashcards in Intestinal Problems 4 - Colorectal Carcinoma Pathology Deck (35):
Normal appearance of the large bowel?
Flat with no villi but contains straight crypts lined by absorptive and mucus-producing goblet cells
What is a polyp?
An abnormal growth of tissue projecting from a mucous membrane (it is a swelling and therefore a tumour)
What are the general categories of benign epithelial polyps with examples? (4)
Neoplastic e.g. adenomaInflammatory e.g. in inflammatory bowel diseaseHamartomatous (different to neoplasm as if the tissue stops growing the polyp will too) e.g. juvenile polypMetaplastic (or hyperplastic)
What are the general malignant types of colon polyps (tumours) found in the epithelium?
Polypoid e.g. adenocarcinomasCarcinoid polyps
What are the 5 types of benign mesenchymal tumours?
Lipoma (fat)Lymphangioma (lymphatics)Haemangiomas (vascular)Fibromas (fibrous/ connective tissue)Leiomyoma (smooth muscle)
What are 2 possible malignant mesenchymal polyps that develop in the large intestine?
What are the differential diagnosis of a colonic polyp? (4)
AdenomaSerrated polyp ("saw-tooth" like structure)Polypoid carcinomaOther *need histopathology to tell them apart
Macroscopic descriptions of a polyp (5)?
Pendunculated (attached via a stalk)Sessile (like a carpet - harder to treat)Flat (barely prude above the peithelial surface)Irregular surfaceLong stalk
What is a polyp which has a dysplastic epithelial lining on histopathological examination?
Adenomas (adenomas are always dysplastic but not all dysplasia is adenomas - mostly is)
Do adenomas invade or metastasise?
No - they can becomes adenocarcinomas however
What are the 3 microscopic appearances of adenomas?
Tubular (contains tubular crypts)Villous (velvety surface made up from numerous epithelium-lined projections)Tubullovillous (mixture of both of the above features)
What is the 5 stages of the adenoma-carcinoma sequence?
Normal mucosaSmall Adenoma (dysplastic)Large adenoma (dysplastic)Adenocarcinoma (invasive)Metastases
Main genetic mutations that cause normal epithelium to develop a small adenoma? (5)
APC mutationMCC mutation5q deletionc-myc activationbci-2 mutation(not all adenomas have the same molecular genetic origins - separate pathways for inherited tumours and serrated adenomas)
Main 2 genetic mutations that cause a small adenoma to become a large adenoma?
K-ras mutationc-yes mutation
Main 3 genetic mutations that causes a large adenoma to become an invasive adenocarcinoma?
Chromose 17p18qp53 mutation
Main mutation that causes invasive adenocarcinoma to metastasise?
Do adenomas have to be removed?How are they removed? (2)
Yes as they are all premalignantEither endoscopically or surgically
How are malignant tumours of the large bowel removed?
Surgically (as they tend to be quite big) - mesentery is removed at the same time in order to get rid of the lymph nodesRemoved section is sent to pathology for staging
What types of cancers are most large bowel malignant tumours?
Microscopic features of large bowel cancers?
Moderately differentiated"dirty" necrosis patternInvades through muscularis propria
Colorectal carcinoma staging method?
Dukes (predicts prognosis)
Dukes staging for colorectal carcinoma + 5 year survival?
Dukes A = confined by muscularis propria - 90+%Dukes B = through muscularis propria - 75%Dukes C = metastatic to lymph nodes - 50-60%
what is the most common side to develop colorectal carcinoma?What are the common side effects for this sided colon cancer? (3)
Left sided - 75%Blood PRAltered bowel habitObstruction(tend to be more genetic related)
What % of colorectal cancers are right sided (caecum and ascending)?What are the presenting complaints for this? (2)
25% right sided Anaemia, weight loss(tend to be more dietary related)
What are 3 examples of gross appearance of colorectal carcinomas?
PolypoidStricturingUlcerating(varied gross appearance)
What is the typical histopathological appearance of colorectal carcinomas?
Where do colorectal carcinomas tend to locally invade? (3)
Where do colorectal carcinomas lympatically spread?
Where do colorectal cancers tend to spread maematogenously?
Liver, distant sites
What are 2 inherited cancer syndromes which cause multiple polyps?How many polyps does each tend to cause?Onset?Autosomal dominant/ recessive?
Hereditary non polyposis coli (HNPCC) - 100 polyps - tends to have an early onset with many patients having their colon removed in their teenage years to prevent them dining of colorectal cancerBoth autosomal dominant
In both HNPCC and FAP, what is the defect in?What genes are the inherited mutation in?
HNPCC - defect in DNA mismatch repair-MLH-1, MSH-2, PMS-1 or MSH-6 genes mutatedFAP = defect in tumour supressionInherited mutation in FAP gene
Where are the polyps found in HNPCC and FAP?
Right sided in HNPCCThroughout the colon in FAP
What type of tumours develop in HNPCC and FAP?
Mucinous in HNPCCAdenocarcinoma in FAP
Inflammatory responses in HNPCC and FAP?
HNPCC - chron's like inflammatory responseFAP - no specific inflammatory response