New posters/review posters 22/05/2016 Flashcards Preview

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Flashcards in New posters/review posters 22/05/2016 Deck (32):
1

What is a polyp?

A protrusion above an epithelial surface. It is a tumour (swelling)

2

Describe the shapes polyps can arise in?

Penduncle- has a neck
Flat
Sessile- hairy looking and lumpy

3

Benign polyps of epithelia

Adenoma
Inflammatory
Peurtz Jeghers syndrome

4

Malignant polyps of epithelia

Adenocarcinoma

5

Benign polpys of mesentary

Lipoma
Lymphangioma
Haemangiomas
Fibromas
Leiomyoma

6

Malignant polyps of mesentary

Sarcomas

7

The differential diagnosis of polyps

Serrated polyps
Adenomas
Polypoid carcinoma

8

Adenoma polyps

Dysplastic epithelial lining- not invasive and do not metastasise.
Described as pre- malignant- easily develop from normal mucosa to adenoma and then on to adenocarcinoma.

9

Treatment of adenoma polpys

Must be removed immediately because of pre-malignancy.
This is done endoscopically or surgically.

10

Treatment of adenocarcinoma polyp

Surgical- colon/rectum is removed and sent for pathological staging

11

Staging of polyps

Dukes staging
Dukes A- confined by muscularis externa
Dukes B- through muscularis externa
Dukes C- metastatic to lymph nodes.

12

Hereditary polyps

Familial adenomatos polyposis (FAP) or hereditary non-polyposis coli (HNPCC)

13

Familial adenomatous polyposis

Autosomal dominant. Early onset. Defect in tumour suppression gene (inherited mutation in FAP gene).

14

Pathology of FAP

occurs throughout colon. Adenocarcinomas. No specific inflammatory response. Associated with desmoid tumours and thyroid carcinomas.

15

Hereditary non-polyposis coli

Autosomal dominant. Late in onset. Defect in DNA mismatch repairin MLH 1 gene (other genes also).

16

Pathology of non-polpysis coli

Mucinous tumours. Crohns like inflammatory response. Associated with gastric and endometrial carcinomas.

17

Colorectal neoplasia

Benign- adenoma
Malignant- adenocarcinoma

18

Genes associated with cell cycle.

Oncogenes- Promote cell growth. When mutated- excess cell growth.
Tumour suppressor genes- suppress cell growth and division. When mutated- stop suppressing.

19

TNM staging of colorectal carcinoma

T1- submucosa only
T2-into muscle
T3- through muscle
T4-adjacent structures

N1= 3 nodel involved
N2 >3 nodes involved

20

Lifestyle adjustments for colorectal carcinoma

Protective foods- fibre, vegetables.
Also exercise

Causative things are- alcohol, smoking, obesity, processed/red meat.

21

Pre-disposing conditions for colorectal carcinoma

Adenomatous polpyps
Ulcerative colitis
Crohns disease

22

Clinical features of a carcinoma in the ascending colon

Anorexia and weight loss

23

Clinical features of a carcinoma in the descending colon

Pain, change in bowel habit and rectal bleeding

24

Clinical features of a carcinoma in the sigmoid colon/rectum

Rectal bleeding
Tenesmus

25

General symptoms of colorectal carcinoma

Lymphadenopathy
Anaemia
Cachexia (weakness and fatigue).
Mass may be palpable
Haptomegaly
Distension

26

Investigations into colorectal carcinoma

Barium enema
CT colography
Sigmoidoscopy
Colonscopy
Faecal occult blood test

27

In the community- screening occurs by?

Every two years- 50-75 years olds are screened using a home FOBT

28

Emergency presentation of colorectal carcinoma

Obstruction- presents as abdominal distension, constipation, pain and vomiting
Bleeding or perforation.

29

Treatment of obstruction

Colostomy
Resection plus colostomy
Resection plus anastomosis
Stenting

30

Treatment of colonic cancer (surgical)

iIn the abdomen:
Right hemicolectomy
Left hemicolectomy
Sigmoid colectomy
Subtotla colectomy

In the rectum
Abdomino-perineal incision
Anterior resection

31

Treatment of colonic cancer (radiotherapy)

Generally add on therapy
Could be used pre or post op.
Reduces recurrence

32

Treatment of colonic cancer (chemotherapy)

5 flourouracil or capeltabine