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GI > Pathology- Colorectal Carcinoma > Flashcards

Pathology- Colorectal Carcinoma Flashcards

1
Q

what is between the epithelium and crypts (mucosa) and the muscularis mucosae in the large bowl

A

stem cells

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2
Q

what is a polyp

A

a protrusion of growth above the epithelial surface- a growth nodule

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3
Q

is a polyp benign or malignant

A

can be either- most are benign

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4
Q

give examples of benign epithelial polyps

A

neoplastic- adenocarcinoma (most important)

inflammatory (IBD)

metaplastic/hyperplastic

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5
Q

give examples of malignant epithelial polyps

A

polypoid- adenocarcinomas

carcinoid polyps

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6
Q

give examples of benign mesenchymal polyps

A

lipoma

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7
Q

give examples of malignant mesenchymal polyps

A

sarcomas

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8
Q

what are the differential diagnosis of a colonic polyp

A
  1. adenoma
  2. serrated polyp
  3. polypoid carcinoma
  4. other

(need histology to tell them apart)

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9
Q

what are the types of polyp

A

pedunculated (hangs on a stalk- easiest to remove and treat if cancerous)
sessile (slightly raised)
flat

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10
Q

what are the features of a polyp

A

irregular surface, long stalk, have normal submucosa that has been heaped into a growth

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11
Q

what is a dysplatic epithelial lining

A

disorganised growth, uncontrolled epithelial proliferation- mostly columnar, don’t really product crypts

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12
Q

describe an adenoma of the colon

A

benign tumours, not invasive- do not metastasise, but are precursors for adenocarcinomas if left unchecked

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13
Q

are all adenomas dysplastic

A

yes- appear darker in microscopy due to increased DNA

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14
Q

what are the precursors for colorectal carcinomas

A

adenomas

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15
Q

give an example of a mutation that causes an adenoma to become an invasive adenocarcinoma

A

p53 mutation

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16
Q

what is p53

A

tumour suppressor- cellular tumour antigen

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17
Q

why must all adenomas be removed and how

A

as they are all premalignant- endoscopically or surgically (if patient fit enough)

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18
Q

what are the different microscopic structures of adenoma polyps

A

tubullovillous, villous, tubular

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19
Q

describe the action of malignant cells in a adenocarcinoma

A

grow and produce gland (circular collects) and destroy the healthy tissue in their path

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20
Q

what is the necrosis pattern in a tumour of the large bowl described as

A

dirty

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21
Q

what does dukes staging predict

A

prognosis

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22
Q

what is dukes staging

A

Dukes A: Confined by muscularis propria

Dukes B: Through muscularis propria to
reach mesenteric adipose tissue

Dukes C: Metastatic to lymph nodes

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23
Q

where are the majority of colorectal carcinomas

A

left side (rectum, sigmoid, descending)- 75%

right side (caecum, ascending)- 25%

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24
Q

what can the presenting complaints of a left sided colorectal carcinoma be

A

blood pressure, altered bowl habits, obstruction

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25
Q

what can the presenting complaints of a right sided colorectal carcinoma be

A

anaemia, weight loss- not obstruction as in caecum tumour has large area to grow

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26
Q

describe the gross appearance of a colorectal carcinoma

A

varied- polypoid, stricturing, ulcerating

raised rolled edges

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27
Q

what happens when a tumour occludes the bowl

A

constipation and diarrhoea and bowl pushes through liquid material only

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28
Q

what can a caecal mass breach

A

mesenteric fat

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29
Q

describe the pattern of spread of a colorectal carcinoma; local invasion

A

mesorectum, oeritoneum, other organs

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30
Q

describe the pattern of spread of a colorectal carcinoma; lymphatic spread

A

mesenteric nodes lymph nodes of mesorectum)

31
Q

describe the pattern of spread of a colorectal carcinoma; haematogenous

A

liver (via portal system), distant sites

32
Q

what are the two types of inherited colorectal cancer syndromes

A

heriditary- non polyposis coli (<100 polyps) HNPCC

familial- adenomatous polyposis (>100 polyps) FAP

33
Q

describe HNPCC

A

late onset, autosomal dominant, defect in dna repair, right sided tumours, crohns like inflammatory response

34
Q

descibe FAP

A

early onset, autosomal dominant, defect in tumour supressor, throughout colon, no specific inflammatory response

35
Q

how long does it take polys to turn into cancer

A

3-5 years

36
Q

what is the aeitology of colorectal cancer

A

mutation in APC gene, mutation of p58 gene, autosomal dominant inheritance

predisposing conditions (long standing IBD, adenomatous polyps)

lifestyle factors (red/processed meat, smoking, alcohol, obesity)

37
Q

what are the chronic symptoms pf colorectal cancer

A

change in bowel habit, colicky abdo pain, iron deficiency anaemia, rectal bleeding, weight loss, abdo mass, bowel

emergency symptoms: obstruction/bleeding

38
Q

name a benign colorectal neoplasia

A

adenoma

39
Q

name a malignant colorectal neoplasia

A

adenocarcinoma

40
Q

where is the most common places for a colorectal neoplasia

A

rectum then sigmoid, colon, caecum

41
Q

what are the different types of colorectal polyp

A

inflammatory, hamartomatous (local malformation), metaplastic, neoplastic (adenoma)

42
Q

what genes are assocaited with cancer

A

oncogenes (mutation causes excess growth and division- gain of function)

tumour suppressor genes (mutation allows excess growth and division-loss of function)

HNPCC

43
Q

what is APC

A

a tumour suppressor gene

44
Q

what is kras

A

a mutated gene found in 30-50% of all colorectal cancers

45
Q

what are the macroscopic appearances of colorectal cancer pathology

A

polypoidal, ulcerative, annular

46
Q

describe the histology of adenomas

A

tubular, villous

47
Q

describe the histology of adenocarcinomas

A

have different degrees of differentiation

48
Q

how are cancers pathologically staged

A

dukes (A,B,C,D), TNK

49
Q

what does a stage III cancer mean

A

it has invaded through the muscularis

50
Q

what does the T1,2,3,4 stages mean in TNM colorectal staging mean

A

T1 - submucosa only

T2 - into muscle

T3 - through muscle

T4 - adjacent structures (including peritoneum)

51
Q

what does N means in TNM staging

A

N0- no lymph node involvement

N1 - < 3 nodes involved

N2 - > 3 nodes involved

52
Q

what does M means in TNM staging

A

presence or not of distant metastases

53
Q

how does colorectal cancer spread

A

local, lymphatic, blood, transcoelomic (peritoneal cavity)

54
Q

what lifestyle factors protect you from colorectal cancers

A

vegetables, fibre, exercise

55
Q

what symptoms are likely to arise from cancer in the caecum

A

anaemia

56
Q

what symptoms are likely to arise from cancer in the descending colon

A

pain, change in bowel habit, rectal bleeding

57
Q

what symptoms are likely to arise fro cancer in the rectum

A

rectal bleeding tenesmus

58
Q

what are the general clinical findings of colorectal cancer

A

anaemia, cachexia, lymphadenopathy

59
Q

what clinical signs are found in the abdomen in colorectal cancer

A

mass, hepatomegaly, distension

60
Q

what clinical signs are found in the rectum in colorectal cancer

A

mass, blood

61
Q

what investigations are used to diagnose colorectal cancer

A

barium enema, CT colonography, sigmoidoscopy, colonoscopy

62
Q

what is the benefit of a colonoscopy

A

can do diagnosis and treatment at same time

63
Q

how far do the sigmoidoscopy and colonoscopy reach

A

sigmoidoscopy reaches to splenic flexure

colonoscopy reaches to the caecum

64
Q

what is faecal occult blood testing (FOBT) used for

A

used to detect colon cancer and other disease

65
Q

what are the staging investigations for lung and liver cancer

A

CT scan

66
Q

what is the staging investigation for primary rectal cancer

A

MRI

67
Q

what is the prep for a CT colonscopy

A

bowel prep and faecal tagging (ingestion of a contrast)

68
Q

what is the e,ergency presentation of colorectal cancer

A

obstruction (distention, absolute constipation, pain, vomiting), bleeding, perforation

69
Q

how are obstructions treated

A

colostomy alone, resection + colostomy, resection + anastomoses, stenting

70
Q

what is the treatment for colorectal cancer

A

surgery , radiotherapy, chemotherapy

71
Q

can surgery be done on rectal cancer

A

yes- anterior resection or abdomino-perineal excision

72
Q

when is radiotherapy used in rectal cancer

A

as an adjuvant pre or post op or as a palliative measure

73
Q

when is chemotherapy used in colorectal cancer

A

adjuvamt for stage c

for advance disease

74
Q

what are the new agents for advanced colorectal disease

A

oxaliplatin, irinotecan and biological agents

GI (64 decks)

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