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GI 2 > Polyps and Adenocaricnoma > Flashcards

Polyps and Adenocaricnoma Flashcards

1
Q

What is a sessile polyp vs peduncuated?

A
  • Sessile is without a stalk
  • Pedunculated is with a stalk
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2
Q

Where are hyperplastic polyps predominantly found?

A
  • left colon (sigmoid and rectum)
  • usually 6-7th decade
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3
Q

What causes hyperplastic polyps?

A
  • result from decreased epithelial cell turnover and delayed shedding of surface epithelial cells leading to “piling up” of goblet and absorptive cells.
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4
Q

What can a hyperplastic polyp be a clue of?

A

Presence of adjacent clinically important mass or inflammatory lesion

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5
Q

What syndrome can an inflammatory polyp be a part of?

A
  • Solitary rectal ulcer syndrome
    • Rectal bleeding
    • Mucus disscharge
    • Anterior rectal wall location
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6
Q

What type of polyp and its associated syndromes are associated with increased cancer riwsk?

A
  • Hamartomatous polyps
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7
Q

What is a juvenile polyp?

A
  • Sporadic or syndromic
  • Majority occur under 5
  • Rectal location predominates
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8
Q

Juvenile polyp symptomS?

A
  • rectal bleeding
  • Intussusception
  • Intestinal obstruction
  • Polyp prolapse
  • Extraintestinal manifestations
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9
Q

what is Peutz-Jeghers syndrome?

A
  • AD syndrome presenting at 11 yo with multiple GI hamartomatous polyps and mucutaneous hyperpigmentation
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10
Q

Where does Peutz Jeghers syndrome occur?

A

Small intestine

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11
Q

What syndrome is associated with intussusception being fatal and has a LOF mutation in STK11 in ~50% of patients, and increased risk of multiple malignancies?

A

Puetz Jeghers syndrome

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12
Q

What are the most common neoplastic polyps?

A

Adenomatous polyps

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13
Q

What are adenomas?

A

Intraepithelial neoplasm that ranges from small often pedunculated poolyps to large sessile lesions

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14
Q

When do adenomatous polyps develop, who do they occur in more, and what are they precursors to?

A
  • Develop in 30% by 60 yo
  • M>F
  • Precursors to colorectal adenocarcinoma
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15
Q

What are the hallmarks of colorectal adenomas?

A
  • nuclear hyperchromasia
  • elongation
  • stratification
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16
Q

What is sessile serrated polyposis cancer syndrome?

A
  • rare disorder characterized by presencec of multiple serrated polyps in the colon and increased persosnal and familial risk of colorectal cancer
17
Q

What is FAP?

A
  • AD disorder in which patients developnumerous colorectal adenomas as teenagers
  • Caused by somatic mutation in APC gene
18
Q

What is one of the extraintestinal manifestations of FAP?

A

Congenital hypertrophy of the retinal pigment epithelium

19
Q

When does colonic adenocarcinoma peak? What are the risk factors?

A
  • 60-70 yo
  • low fiber, high fat, refined carbs
20
Q

What are the two genetic pathways for colonic adenocarcinoma?

A
  • APC/B-catenin/Wnt path
  • Microsatellite instabililty (MSI) path
21
Q

What is the classic sequence of gene mutations in sporadic colon cancers?

A
  1. APC
  2. APC B-Catenin
  3. K-RAS
  4. TP53
  5. Telomerase
22
Q

How many copies of APC need to be lost for an adenoma to arise?

A

Both, it is a component of the WNT path that controls cell growth and differnetiation

23
Q

What is Lynch syndrome?

A
  • Hereditary non polyposis colorectal cancer
  • caused by inherited mutations in mismatch repair genes that encodes proteins responsible for detection excision and repair
  • Cancers occur at younger age and are often located in ascending colon
24
Q

How are adenocarcinomas located in the colon?

A
  • Usually distributed approximately equally over entire length of colon
    • on proximal colon grow polypoid exophytic mass along one wall-rarely causes obstruction
    • in distal colon they are annular lesions that produce napkin ring constrictions
25
Q

What are the two most immportant prognostic factors of colorectal adenocarcinomas?

A
  • depth of invasion
  • presence of lymph node metastases
26
Q

Describe the differences in symptoms in right sided colon cancers and left sided?

A

Right:

  • fatigue
  • Weakness due to iron deficiency anemia

Left:

  • occult bleeding
  • changes in bowel habits
  • cramping
  • LLQ discomfort/cramping

GI 2 (19 decks)

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