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Flashcards in pathology of tumours of the lower GIT Deck (24):
1

bowel cancer is a disease of older age T or F?

true

2

what intervention has reduced mortality from bowel cancer?

endoscopy

3

At the age of 60, what proportion of people have bowel polyps?

1/3

4

what are the origins of colorectal adenocarcinoma?

Dysplasia of the epithelium - adenoma

5

what hereditary condition predisposes to adenocarcinoma of the bowel?

familial adenomatous polyposis

6

would you need to offer to screen the family if a member had familial adenomatous polyposis?

yes

7

what is the pathophysiology of hereditary nonpolyposis colorectal cancer HNPCC?

mutations occur in genes that code for repair proteins - there are two hits of both genes in a pair before colorectal cancer develops

8

why is it important to identify HNPCC cancers?

there is a risk of further cancers in the index pt and relatives
some chemo will not work on them, eg flurouracil - DNA damage is not recognised and so apoptosis is not activated

9

where do most colorectal cancers occur?

rectum, rectosigmoidal junction and anus - combined = 38%

10

what is resection coding?

gives an indication to a surgeon as to whether the tumour has been completely excised or whether the resection margin still has tumour present on it
R0 - tumour completely excised locally
R1 - microscopic involement of margin by tumours
macroscopic involvement of margin by tumour

11

how does prognosis relate to circumferential resection margin?

there is a higher risk of recurrence if there is a positive CRM (ie cancer is present in the margin of the resection)

12

what is a high tie lymph node?

the lymph node furthest away that was removed by the surgeon

13

a tumour has not yet penetrated the muscularis mucosa from the mucosa, what Dukes' and TNM staging is this?

Dukes' doesn't have anything for carcinoma in situ
pTispN0

14

if the tumour of the bowel has invaded the muscularis mucosa what would be the Dukes' and TNM staging?

Dukes' A
pT1pN0

15

if the tumour of the bowel has invaded the muscularis mucosa and the submucosa what would be the Dukes' and TNM staging?

Dukes' A
pT1pN0

16

if a tumour has invaded the muscularis propria what is its Dukes' and TNM stage?

Dukes' A
pT2pN0

17

if the tumour has gone through the muscularis propria - ie through the bowel wall, what dukes' and TNM stage is it?

Dukes' B
pT3pN0

18

if the tumour has gone to a set of regional lymph nodes, what is the dukes and TNM staging?

Dukes' C1
pT3pN1

19

if the tumour has gone to two sets of lymph nodes, what is the dukes and TNM staging?

Dukes' C2
pT3pN2

20

Summarise the Duke's staging

Dukes A: invasion into but not through the bowel wall (90% 5 year survival)
Dukes B: invasion through the bowel wall but not involving lymph nodes (75% 5 year survival)
Dukes C: involvement of lymph nodes (35% 5 year survival)
Dukes D: widespread metastases (25% 5 yr survival)

21

what is the trend of the five year survival rate of colon caner over the last 40 years?

the five year survival is increasing

22

what is the treatment for adenoma?

endoscopic resection

23

what is the treatment for colorectal adenocarcinoma?

surgical resection

24

What is the treatment for metastatic colorectal adenocarcinoma?

chemo
palliative care