U10W5: Colorectal cancer Flashcards

Question

What are the histological features of dysplasia in the colon?

Answer 1

Hyperchromatic nuclei Pseudostratified Loss of goblet cells

Answer 2

Tubulovillous adenoma tubulo on the left Vilous on the right

Answer 3

Increased mucin aand goblet cells Hyperplastic with pseudostratified epithelium Hyperchromatic High grade dysplasia - poorly defined cell borders and poor representation of original cell structure, basal cells replace epithelium , mitotic cells present closer to the epithelium surface.

Answer 4

Nuclei are uniform in size and shape Low mitotic activity Well-formed glandular structures - resembling normal tissue Minimal abnormalities Typically confined to the mucosa or with slight extension into the submucosa

Answer 5

Variation in nucleus shape and colour as variation in chromatin Increased mitotic activity Glandular structures are somewhat displaced Some tissue disorganization and dismoplasma (connective tissue growth) Some clear abnormalities Extend into submucosa or muscularis

Answer 6

High grade cancer Nuclei are very different in size and shape and are often hyperchromatic High mitotic activity Disrupted glandular structures or absence of recognisable glands Architecture is highly distorted Desmosplasia Lumen of cell may contain necrotic depbris Muscularis is fully involved and may be extension in adjacent structures

Answer 7

Grade - degree of dysplasia/differentiation in the tumour itself (more histological) Staging - more focused on tumour size, location and spread

Answer 8

Common pathway 1.Normal epithelium and glandular tissue 2. Loss of APC gene - small adenoma/polyp 3. Oncogenic mutation is Ras gene - large adenoma/polyp 4. Mutation or loss of function in p53 - invasive and malignant colon cancer or adenocarcinoma

Answer 9

Available to all 60-74 year olds, can be requested if older.(expanding to make available from 50yrs) Sent a faecal immunochemical test to collect a small sample of faeces and send it to a lab Positive results - indicates presence of human Hb and further testing recommended Negatove result - no human Hb detected, no need for further testing but screening should be repeated at normal interval.

Answer 10

gFOBT: Guiac reagent and H202 (hydrogen peroxidase) React in the presence of heme Guiac is oxidised resulting product is blue in colour FIT: antibodies against human Hb, exposed to stool mixture** (positive result detected by enzyme reaction??)

Answer 11

Colonoscopy Barium Enema Rectal exam Fecal Occult Blood test Urine dipstick Full blood test - inflammatory markers and pathogen antigens

Answer 12

Light diet - few days before test, low fibre foods only such as clear soups Take laxatives Drink plenty of fluids - encourage stool movements and prevent dehydration

Answer 13

Insoluble fibre, coarse fibre - cause diahorrea Soluble fibre and fine fibre - cause constipation

Answer 14

Haematemesis - Blood in vomit Melena - black stool due to GI bleeding (upper GI) Hematochezia - fresh red blood passage in the stool

Answer 15

In the week before: Meds containing iron - coats GIT makes harder to see Aspirin - risk of GI bleed Meds containing codein phosphate and loperamide - cause constipation 2 days before: reduce meal size, no fibre, no red coloured food or liquids, no alcohol Day of: stop taking bulk forming laxatives. Should not eat from 9am day before until after procedure

Answer 16

2 days before: drink plenty of fluids - aim for 2L a day 1 day before: drink clear fluids only after a light breakfast before 9am Take a bowel prep solution

Answer 17

Sodium picosulphate (picolax) Klean Prep Moviprep

Answer 18

Is a stimulant laxative - cleanse colon to allow better view in a colonoscopy Contains sodium picosulphate - is hydrolysed by colonic bacterial enzyme sulfatase into active compound BHPM. This acts directly on colonic mucosa to stimulate eneteric nervous system hence peristalsis and increase secretion of water. Inhibits absorption of water and electrolytes So increases intestinal content and peristalis leading to defecation Picolax also contains magnesium citrate which acts as an osmotic laxative - to increase water secretion into the bowel lumen.

Answer 19

Is appointment in the morning recommends: original Senna tables with water, 1st sachet of picolax and 2nd sacchet of picolax the day before roughly 2.5 hours apart Is appointment in the morning: Senna tables, with water and first picolax is taken the evening before and second picolax is taken early morning of

Answer 20

May be offered sedation More commonly to have Entonox (gas and air) In complicated or prolonged investigations may be put under general anaesthetic but this is very rare.

Answer 21

Investigate for location of tumours and metastasis. (used to calculate TNM score) Very good for observing bone and soft tissue differences Is cheaper and faster (5 mins) However, can be insensitive to small masses. Also may be used for CT colonoscopy which is minimally invasive (takes images from many angles and combines to produce an image of the bowel)

Answer 22

Identify size, location and metastasis of a tumour Excellenet, very high detail on soft tissue Is more expensive Takes longer (15 minutes to 2 hours) depending on the quality of image desired

Answer 23

Specialist screening practitioner Gastroenterologist MDT (radiologist, radiographer, oncologist, etc) Specialist nurse Surgeon

Answer 24

Give patients information to enable them to make appropriate choices for investigation and screening tests - informed consent Will assess the suitability of patients for investigation Arrange procedures and follow ups Record the outcomes of procedures and explain results to patient. See patients if they receive a positive colorectal cancer screening test

Answer 25

Diagnose, manage and treat gastrointesinal (stomach and intestine) and hepatological diseases (liver, pancreas and billary system)

Answer 26

Provide individualised care Provide support, advice and written information before and after diagnosis Liase with patient GP and other members of the healthcare team. Ensures the patients views and wishes are heard at MDT meetings

Answer 27

Wnt is secreted by stromal cells at the bottom of colonic crypts Acts locally on intestinal stem cells Binds to frizzle transmembrane receptor and recruits co-receptor LRP5/6 Results in activation of Dishevelled protein This acts on the destruction complex

Answer 28

Activated Dishevelled recruits axin to the receptor complex This causes a loss of structure in the diestruction complex so falls apart releases Beta catentin - transloactes to the nucleus and functions as a transcription factor Causes the expression of genes needed for cell proliferation such as c-Myc

Answer 29

Axin not recruited Destruction comples remains intact GSK3 phosphorylates beta catenin so it is targeted for degradation via ubiquitination Unable to act as transcription factor, so genes required for cell proliferation are not expressed

Answer 30

APC is inactivated (often is a non-sense mutation forming truncated proteins) APC inactivation deregulates the destruction complex No longer binds to beta catenin Beta catenin is not degraded and is released from the destruction complex Is free to function as a transcription factor, activating cellular proliferation genes such as c-myc This occurs even in the absence of Wnt signalling.

Answer 31

Used to decrease the size of a tumour before surgery (main treatment) Can help shrink metastasis, ensure better functional outcome after surgery as less tissue needs to be removed Reduce the risk of local reoccurence Chemotherapy - uses drugs, commonly 5-fluuroracil (inhibits thymidilate synthase) Radiatherapy - uses high energy rays, cause oxidative stress damaged DNA or may damage plasma membrane leading to cell death

Answer 32

Local resection - most common, used for small early stage cancers - use a colonscope to identify polyp, cutting instrument then passed down to remove cancer and surrounding normal border - then passed to histpathologist Colectomy - removal of all (total) or part of (partial) the bowel. Ends of bowel may be joined together to form an anastomosis or may be brought outside the body to form a stoma.

Answer 33

Radiofrequency ablation - thin, needle like probe, release radiofrequency waves to heat tumour and destroy cancerous cells Cryoablation: probe attached to argon gas to freeze abnormal cells.

Answer 34

open surgery: large incision made down abdomen Laproscopic surgery: key hole surgery, small incisions made to pass surgical instruments with camera through Robotic surgery: new technique to advance key hole surgery

Answer 35

Fatigue Weakness Nausea and vomitting Diarrhoea Sore skin (around site e.g rectum) Passing more urine (bladder may shrink due to radiotherapy)

Answer 36

Nausea Weight loss Fatgiue Easy bleeding and blood loss Diarrhoea Constipation Hair loss Lower resistance to infection

Answer 37

Anastomotic leak - where the two ends of bowel have been joined together Bowel not functioning - risk of nervous damage or fragment peristalsis INfection Blood clots Leakage

Answer 38

Size, type and stage of cacner Location in colon, rectum or both Metastasis of cancer Genetic changes in cancer Age and general health of patient Other medical conditions Other medications that patient is on Patient preference Risk benefit of all types of treatment

Answer 39

Stoma - opening in the abdmone connected to either the urinary or the digestive system Allos passage of waste out of the body Pink and red in appearance, may bleed slightly especially in the beginning but this is normal Attached to a colostomy bag to collect waste.

Answer 40

Colostomy - opening in large intestine Ileostomy - opening in the small intestine Urostomy - bypass the bladder, often connect ureters to a section of small intestine then out the abdominal wall

Answer 41

Colostomy - easier to manage, reduced skin excoriation, harder to reverse, likely permanent, thicker effluent, left illiac fossa location Ileostomy - harder to manage, skin irrtation (more pancreatic enzymes), reversible, temporarily, liquid effluent located in right iliac fossa.

Answer 42

End stoma - one bowel opening - when other section of bowel has been removed completely or stitched shut (e,g no distal bowel remains in body) Loop stoma - when a loop of the bowel is pulled outside the body then cut a proximal and distal bowel section remain, two ends used to make stoma

Answer 43

Bowel cancer Chrons disease Diverticulitis Bowel incontinence Hisrchsprung disease Obestruction Bowel polyps Megacolon

Answer 44

Complete Cancer remission achieved - no signs or symptoms or detectable signs of cancer. Recommend continue monitoring and observing the patient If this is true for five years some doctors might say you are cured.

Answer 45

Symptom perception - high risk illness Sanctioning of either Timing - if still ill on monday then ill go or Social pressure - such as such made me come Occurence of an interpersonal crisis (no longer able to cope Interference with social or personal activities Interference with vocational or physical activity

Answer 46

Lack of time Lack of access to healthcare service Embarrassment or stigma around health conditions Lack of knowledge around own health and symptoms Fear of outcome Fear or dislike of interaction with medical staff - often associated with a poor previous experience.

Answer 47

Discrediting Discreditable Enacted Felt

Answer 48

Stigma that is based on a clearly known or visible condition For example - worried people will think they are unhygienic because of stoma bag

Answer 49

Stimga against something that can be concealable e.g sexual orientation, hidden disability Stigma against patients with cancer, assume tired or smoker etc

Answer 50

The experience of unfair treatment by others. E.g not being invited to friends pool party because they don't want to see your stoma bag.

Answer 51

The expectation of discrimination that prevents people from talking about their experience and stops them from seeking help Often feel shame about themselves

Answer 52

Do not be embarrassed or nervous yourself - emotion transfer Signpost in conversation - make the patient aware and let them prepare for more personal questions Reflect patients own language - e,g bum, backpassage, rear end etc Gain an understanding of what the patient already knows and expects to find out Use a suitable location and atmosphere - e.g quite room, no interruption, maintain eye contact. Offer suitable support - e.g opportunity to ask questions, provide more resources (website or paper)

Answer 53

Inability to control gas - due to loss or distrubance to GIT bacteria Foul smell Parastromal hernia ( intestines push through muscle around the atoma resulting in a noticeable bulge around the skin) Stoma prolapse - may require further surgery Stoma blockage - blockage from food, should call GP or stoma nurse immediately, or call 111 is there's a risk colon could burst Rectal discharge - mucus from rectum is bowel still intact Skin problems - irritated, sore, infected Leakage - try different bags

Answer 54

Unable to particpate in certain sports - swimming and weight lifting due to risk of damage to stoma orconcern that people may see it Difficulties in sex life/intimacy Change in body image Depression and anxiety Low self esteem Loss of independence - need help changing bag or first, or unable to be away from bathroom/home for long. Diet restrictions - tend to follow normal diet - some people may avoid too much fibre, alcohol or spicy foods to avoid diahorrea.

Answer 55

Depression, anxiety Low self esteem Change in body image Strain of relationships Lack of hope in health, disengage in treatment Lack of interest in everyday activity Some people see a new meaning of life - clarifies what is important to them and decide to reach out to old friends and family. The grief of a future that they do not get to have.

Answer 56

Increased energy expenditure - from inflammation demand, tumour metabolism, cytokines may also increase basal metabolic rate leading to futile cycling Decreased energy intake - nausea, vomiting, bowel habit changes/pain, fatigue Leads to a negative energy balance that promotes muscle catabolism over anabolism causing weight loss.

Answer 57

Colonscope inserted up rectum used to identify polyp Solution usually sodium hyaluronate is injected into submucosal layer under lesion to elevate it - less likely to remove underlying health tissue 1. Endscopic mural resection - remove polyp using a snare . 2. Endoscopic submucosal dissection - submucosa and overlying removed using a needle knife Mrgins will be examined histologically to ensure no cancerous close to edge - that may indicate same cancer cells remain so risk of spread

U10W5: Colorectal cancer Flashcards

(81 cards)