L15: Cancer Colon Flashcards
(144 cards)
1
Q
Arterial Supply of The Colon
A
2
Q
Branches of SMA to The Colon
A
a) Ilio-colic
b) Right colic
c) Middle colic:
3
Q
Level of SMA
A
L1
4
Q
Branches of IMA to The Colon
A
a) Upper and lower left colic
b) Sigmoid arteries
c) Superior rectal artery
5
Q
Level of IMA
A
L3
6
Q
Arterial Supply of The Rectum
A
7
Q
SRA
A
(hemorrhoidal) artery - branch of IMA
8
Q
MRA
A
branch of internal iliac artery
9
Q
IRA
A
branch of internal iliac artery
10
Q
What are the “watershed” areas of the colon?
A
11
Q
Venous Drainage of Colon
A
12
Q
Venous Drainage of Rectum
A
13
Q
Lymphatic Drainage of Colon
A
14
Q
Lymphatic Drainage of Rectum
A
15
Q
Histology of Colon
A
16
Q
Mucosa of Colon
A
Columnar epithelium
17
Q
Musclosa of Colon
A
1) Inner circular
2) Outer longitudinal (condensed into 3 bands)
18
Q
Serosa of Colon
A
1) (Visceral peritoneum)
2) Peritoneal covering incomplete (except transverse & sigmoid)
19
Q
Which portions of the colon are retroperitoneal?
A
20
Q
Why Surgery of The Colon is More Hazardous Than SI?
A
21
Q
Why is Colonic Anastomosis Leakage More Common Than SI?
A
22
Q
Preoperative Colon Preparation for Elective Surgery to Decrease Risk of Anastomosic Leak
A
23
Q
Incidence of Cancer Colon
A
3rd most common cancer in both male & female
24
Q
Age of Cancer Colon
A
- 90% of cases above 50 years
- uncommon below 40 y unless hereditary
25
Sex in **Cancer Colon**
Equal "Maybe Males"
26
Sites of **Cancer Colon**
1/3 are in the rectum and 2/3 in the colon.
27
Synchronous & Metasynchronous **Cancer Colon**
5%
28
Why is **Cancer Colon** more common in Rectum & Sigmoid?
1) Contents are solid, stagnant.
2) It is often seat of precancerous lesions as polyps and UC
29
Categories of **Cancer Colon**
- Sporadic colon cancer
- Familial colon cancer
30
Percentage of **Sporadic Cancer Colon**
75%
31
Risk Factors For **Sporadic Cancer Colon**
1) Diet
2) Chronic irritation
3) Precancerous lesion
32
Predisposing factors for **Sporadic Cancer Colon**
1) Diet
2) Chronic irritation
3) Precancerous lesion
33
Diet & **Sporadic Cancer Colon**
34
Chronic Irritation & **Sporadic Cancer Colon**
35
Precancerous Lesions & **Sporadic Cancer Colon**
36
Percentage of **Familial Cancer Colon**
25%
37
Risk Factors for **Familial Cancer Colon**
38
Nature of **Familial Adenomatous Polyposis (FAP)**
Autosomal dominant
39
Gene Defect in **Familial Adenomatous Polyposis (FAP)**
Defect in (APC) gene on chromosome 5
40
Colon Cancer Risk in **Familial Adenomatous Polyposis (FAP)**
COLON CANCER: 100%
41
Age of polyps & cancer in **Familial Adenomatous Polyposis (FAP)**
- Polyps appear by the age of 15 years
- Cancer occurs berore age of 40 years
42
Types of **Familial Adenomatous Polyposis (FAP)**
43
Attenuated Type of **Familial Adenomatous Polyposis (FAP)**
(number of polyps is less than 100)
43
Classic Type of **Familial Adenomatous Polyposis (FAP)**
(number of polyps is more than 100)
44
Nature of **Heridetery non-polyposis Colon Cancer (HNPCC)**
Autosomal dominant
45
Gene defect in **Heridetery non-polyposis Colon Cancer (HNPCC)**
Defect in mismatch repair MMR gene (chromosome 2)
46
Risk of Cancer in Heridetery non-polyposis Colon Cancer (HNPCC)
COLORECTAL CANCER: 80 %
47
Age of cancer in **Heridetery non-polyposis Colon Cancer (HNPCC)**
Occurs before 45 years
48
Types of **Heridetery non-polyposis Colon Cancer (HNPCC)**
49
Lynch I
isolated CRC
50
Lynch II
CRC associated with:
* Endometrial
* Ovarian
* Prostatic
* Gastric
* Renal
* Ureteric tumors.
51
Amesterdam Criteria for HNPCC
52
Presentation of FAP
53
Colonic Manifestations of FAP
54
Extra-Colonic Manifestations of FAP
55
Investigations in FAP
56
Screening in FAP
57
TTT of FAP
58
Asymptomatic Cancer Colon
59
Emergency symptoms of **Cancer Colon**
60
Shape of **Cancer Right Colon**
Cauliflower
61
CP of **Cancer Right Colon**
- AAA (Commonest presentation)
- Pain
- Mass in RIF
- Acute presentations of cancer caecum
62
Commonest Presentation of **Cancer Right Colon**
**AAA (Commonest presentation)**
a. Anorexia (Decrease appetite)
b. Asthenia (Unintended weight loss)
c. Anemia
63
Pain in **Cancer Right Colon**
- Type: Colicky pain
- Cause: Hyper-peristalsis to get rid of tumor
64
Mass in RIF in **Cancer Right Colon**
**tumor itself, late symptom**
65
Acute Presentation of Cancer Caecum
a. Acute intestinal obstruction. (Rare)
b. Acute appendicitis: due to obstruction
to its lumen by carcinoma
c. Perforation of the caecum & peritonitis.
66
Shape of **Cancer left colon**
annular
67
CP of **Cancer left colon**
- Change in the bowel habits (Commonest presentation)
- Bleeding per rectum
- mass in LIF
- Intestinal obstruction (common)
68
Change in the bowel habits in Cancer left colon
a. Progressive constipation
b. Attacks of constipation are followed by false diarrhea
c. Change in the shape of stool (narrower than normal)
69
Mass in LIF in **Cancer left colon**
fecal impaction above tumor
70
CP of **Rectal cancer**
71
Bleeding Per Rectum in **Rectal cancer**
**is the early & common symptom**
72
Tenesmus in **Rectal cancer**
sense of incomplete defecation
73
PR Examination in Rectal cancer
a. Rectal tumors felt in 90% of cases
b. Mucus & blood per rectum.
74
general Examination in **Colon Cancer**
75
Local Examination in **Colon Cancer**
76
Abdominal Mass in **Colon Cancer**
77
INVx in **Colon Cancer**
- Labs
- **Colonoscopy & biopsy: gold standard**
- Rads
- metastatic Workup
78
Labs in **Colon Cancer**
79
Occult Blood in **Colon Cancer**
always positive.
80
CBC in **Colon Cancer**
Anemia
81
Tumor Markers in **Colon Cancer**
- CEA (> 2.5 ng/ml): prognostic rather than diagnostic
- CA 19-9 — more specific
82
Is CEA Specific to **Colon Cancer**?
83
What is The gold Standard in INVx of **Colon Cancer**?
Colonscopy + Bx
84
Role of Colonoscopy & Bx in **Colon Cancer**
85
NE of **Colon Cancer**
86
ME of **Colon Cancer**
87
Rads in **Colon Cancer**
- Barium Enema
- Double Contrast Barium Enema (DCBE)
- CT Virtual Colonoscopy
88
Barium Enema in **Colon Cancer**
a. Filling defects in polypoidal lesions
b. or (Apple core appearance): in annular lesions
(irregular stricture with mucosal destruction and shouldering)
89
Double Contrast Barium Enema in **Colon Cancer**
90
CT Virtual Colonoscopy in **Colon Cancer**
91
Advantages of Colonoscopy in **Colon Cancer**
- Evaluation of entire colon
- Biopsy
- Treatment of poiyps
92
Disadvantages of Colonoscopy in **Colon Cancer**
* Perforation, bleeding
* require bowe!: preparation
93
Advantages of Sigmoidscopy in **Colon Cancer**
- Fairly quick and safe
- Does not require full bowel preparation
94
Disadvantages of Sigmoidscopy in **Colon Cancer**
- Perforation
- Missed lesion (40-50% of CRC and polyps)
95
Advantages of CT Colonography **Colon Cancer**
- Non-invasive
- Detection of extracolon lesions/disease
- Can see proximal to obstructing lesion
96
Disadvantages of CT Colonography **Colon Cancer**
- No biopsy
- Bowel preparation
97
Metastatic Work up in **Colon Cancer**
- CT abdomen with contrast
- Endoluminal US
- (PET) scan
98
CT Abdomen With Contarst in **Colon Cancer**
99
EUS in **Colon Cancer**
100
Duke's Staging in **Colon Cancer**
101
Duke's Modified Staging in **Colon Cancer**
102
TNM Staging in **Colon Cancer**
103
TNM Staging in **Colon Cancer**
- T
104
TNM Staging in **Colon Cancer**
- N
105
TNM Staging in **Colon Cancer**
- M
106
What Does Grading of **Colon Cancer** depend on?
107
Grades of **Colon Cancer**
108
Spread of **Colon Cancer**
109
Direct Spread of **Colon Cancer**
110
Lymphatic Spread of **Colon Cancer**
111
Blood (Distant) Spread of **Colon Cancer**
112
Most Common Method of Spread of **Colon Cancer**?
113
Intra-Luminal Spread of **Colon Cancer**
114
Trans-Peritoneal Spread of **Colon Cancer**
115
Prevention of **Colon Cancer**
116
1ry Prevention of **Colon Cancer**
117
2ry Prevention of **Colon Cancer**
118
Screening of **Colon Cancer**
119
Methods of Screening of **Colon Cancer**
120
Average Risk Screening for **Colon Cancer**
121
Mild Risk Screening for **Colon Cancer**
122
High Risk Screening for **Colon Cancer**
123
Who are at mild Risk of **Colon Cancer**?
124
Who are at High Risk for **Colon Cancer**?
125
Principles of Colonic Resection
126
TTT options in **Colon Cancer**
127
TTT of Localized uncomplicated **Colon Cancer**
128
Neo-Adjuvant Therapy in **Colon Cancer**
128
Adjuvant Therapy in **Colon Cancer**
129
Pre-operative Colonic Prerparation in **Colon Cancer**
130
Operation for Tumor in Hepatic Flexure
130
Types of Operation in **Colon Cancer**
131
Operation for Tumor in Caecum - ascending
colon
132
Operation for Tumor in Transverse Colon
133
Operation for Tumor in descending Colon
134
Operation for Tumor in sigmoid Colon
135
Operation for Tumor in Recto-Sigmoid Junction
136
Operation for Tumor in low rectum
137
Operation for Synchronous Colon Cancer
138
managment of Metastatic Colon Cancer
139
The most important prognostic factor in Colon Cancer
140
5 year survival differs according to the stage
- Explain
141
Done
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