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Pathology- Colorectal Carcinoma Flashcards

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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
what can the presenting complaints of a right sided colorectal carcinoma be
anaemia, weight loss- not obstruction as in caecum tumour has large area to grow
26
describe the gross appearance of a colorectal carcinoma
varied- polypoid, stricturing, ulcerating raised rolled edges
27
what happens when a tumour occludes the bowl
constipation and diarrhoea and bowl pushes through liquid material only
28
what can a caecal mass breach
mesenteric fat
29
describe the pattern of spread of a colorectal carcinoma; local invasion
mesorectum, oeritoneum, other organs
30
describe the pattern of spread of a colorectal carcinoma; lymphatic spread
mesenteric nodes lymph nodes of mesorectum)
31
describe the pattern of spread of a colorectal carcinoma; haematogenous
liver (via portal system), distant sites
32
what are the two types of inherited colorectal cancer syndromes
heriditary- non polyposis coli (<100 polyps) HNPCC familial- adenomatous polyposis (>100 polyps) FAP
33
describe HNPCC
late onset, autosomal dominant, defect in dna repair, right sided tumours, crohns like inflammatory response
34
descibe FAP
early onset, autosomal dominant, defect in tumour supressor, throughout colon, no specific inflammatory response
35
how long does it take polys to turn into cancer
3-5 years
36
what is the aeitology of colorectal cancer
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
what are the chronic symptoms pf colorectal cancer
change in bowel habit, colicky abdo pain, iron deficiency anaemia, rectal bleeding, weight loss, abdo mass, bowel emergency symptoms: obstruction/bleeding
38
name a benign colorectal neoplasia
adenoma
39
name a malignant colorectal neoplasia
adenocarcinoma
40
where is the most common places for a colorectal neoplasia
rectum then sigmoid, colon, caecum
41
what are the different types of colorectal polyp
inflammatory, hamartomatous (local malformation), metaplastic, neoplastic (adenoma)
42
what genes are assocaited with cancer
oncogenes (mutation causes excess growth and division- gain of function) tumour suppressor genes (mutation allows excess growth and division-loss of function) HNPCC
43
what is APC
a tumour suppressor gene
44
what is kras
a mutated gene found in 30-50% of all colorectal cancers
45
what are the macroscopic appearances of colorectal cancer pathology
polypoidal, ulcerative, annular
46
describe the histology of adenomas
tubular, villous
47
describe the histology of adenocarcinomas
have different degrees of differentiation
48
how are cancers pathologically staged
dukes (A,B,C,D), TNK
49
what does a stage III cancer mean
it has invaded through the muscularis
50
what does the T1,2,3,4 stages mean in TNM colorectal staging mean
T1 - submucosa only T2 - into muscle T3 - through muscle T4 - adjacent structures (including peritoneum)
51
what does N means in TNM staging
N0- no lymph node involvement N1 - < 3 nodes involved N2 - > 3 nodes involved
52
what does M means in TNM staging
presence or not of distant metastases
53
how does colorectal cancer spread
local, lymphatic, blood, transcoelomic (peritoneal cavity)
54
what lifestyle factors protect you from colorectal cancers
vegetables, fibre, exercise
55
what symptoms are likely to arise from cancer in the caecum
anaemia
56
what symptoms are likely to arise from cancer in the descending colon
pain, change in bowel habit, rectal bleeding
57
what symptoms are likely to arise fro cancer in the rectum
rectal bleeding tenesmus
58
what are the general clinical findings of colorectal cancer
anaemia, cachexia, lymphadenopathy
59
what clinical signs are found in the abdomen in colorectal cancer
mass, hepatomegaly, distension
60
what clinical signs are found in the rectum in colorectal cancer
mass, blood
61
what investigations are used to diagnose colorectal cancer
barium enema, CT colonography, sigmoidoscopy, colonoscopy
62
what is the benefit of a colonoscopy
can do diagnosis and treatment at same time
63
how far do the sigmoidoscopy and colonoscopy reach
sigmoidoscopy reaches to splenic flexure colonoscopy reaches to the caecum
64
what is faecal occult blood testing (FOBT) used for
used to detect colon cancer and other disease
65
what are the staging investigations for lung and liver cancer
CT scan
66
what is the staging investigation for primary rectal cancer
MRI
67
what is the prep for a CT colonscopy
bowel prep and faecal tagging (ingestion of a contrast)
68
what is the e,ergency presentation of colorectal cancer
obstruction (distention, absolute constipation, pain, vomiting), bleeding, perforation
69
how are obstructions treated
colostomy alone, resection + colostomy, resection + anastomoses, stenting
70
what is the treatment for colorectal cancer
surgery , radiotherapy, chemotherapy
71
can surgery be done on rectal cancer
yes- anterior resection or abdomino-perineal excision
72
when is radiotherapy used in rectal cancer
as an adjuvant pre or post op or as a palliative measure
73
when is chemotherapy used in colorectal cancer
adjuvamt for stage c for advance disease
74
what are the new agents for advanced colorectal disease
oxaliplatin, irinotecan and biological agents

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