Week 3: colon polyps and cancer

Question 1

Describe colon epithelium histology

Answer 1

columnar cells that make up the glands

Question 2

Describe colon lamina propria histology

Answer 2

supportive connective tissue which harbors the glands

Question 3

Describe colon muscularis mucosa histology

Answer 3

this superficial layer of smooth muscle

Question 4

Describe colon submucosa histology

Answer 4

connective tissue

Question 5

Describe colon muscularis propria histology

Answer 5

Thick outer layer of smooth muscle responsible for peristalsis

Question 6

Describe colon serosa histology

Answer 6

thin outer lining of mesothelial cells

Question 7

Intestine epithelial crypts

Answer 7

Question 8

Why are the specific layers of the colon important as they pertain to cancer?

Answer 8

Question 9

What is this?

Answer 9

Polyp

Question 10

What is the difference?

Answer 10

Question 11

Describe tubulovillous adenoma

Answer 11

• has at least low grade dysplasia
• can progress to carcinoma

Question 12

Describe the meaning of hyperplastic

Answer 12

• is essentially benign
• will not progress to carcinoma

Question 13

Describe the meaning of serrated

Answer 13

• Histologic deceptive term
• Glands of polyps have undulations (like a serrated knife edge)
• Certain types can progress to carcinoma (more on this later)

Question 14

What are the most common colon polyps

Answer 14

Question 15

What is this?

Answer 15

Hyperplastic colon polyp on the right

Question 16

Describe hyperplastic colon polyps

Answer 16

Question 17

Describe the histologic features of a hyperplastic colon polyp

Answer 17

• surface has irregular tufting of epithelial cells
• superficial serrated architecture and absence of atypia

Question 18

Describe Adenomas properties & screening policies

Answer 18

Question 19

Adenomas Gross histology

Answer 19

3 to 10 mm, pedunculated or sessile, dark red surface that looks velvety or like a raspberry

Question 20

Describe Adenomas histology

Answer 20

• epithelium is dysplastic: nucleui of surface epithelial cells are hyperchromatic, elongated and stratified, reduction of goblet cells
• Tubular rounded glands
• Villous: slender villi
• Tubulovillous: mixed

Question 21

What is the most common preneoplastic polyp screened for?

Answer 21

Tubular adenoma

Question 22

What is this?

Answer 22

Question 23

What is this?

Answer 23

TVA (Tubulovillous adenoma)

Question 24

What are these?

Answer 24

Question 25

Describe Sessile Serrated Adenomas histology

Answer 25

Question 26

Most common location of Sessile Serrated adenomas

Answer 26

precancerous polyps usually found in the right colon

Question 27

Sessile Serrated Adenomas properties

Answer 27

Question 28

What are these?

Answer 28

Question 29

Compare and contrast TA, SSA and HP

Answer 29

Question 30

What are some of the features of a polyp with a higher risk of progressing to cancer?

Answer 30

Question 31

Screening intervals are based on?

Answer 31

Question 32

What is a hamartoma?

Answer 32

An abnormal growth of tissue elements normally found at that site [ie normal tissue for that site just disorganized]

Question 33

Describe what a hamartomatous polyp is

Answer 33

Question 34

Which of the following polyps are dysplastic by definition? * Tubular adenoma * Hyperplastic polyp * Sessile Serrated adenoma * Hamartomatous polyp

Answer 34

Question 35

Describe the risk for adenocarcinoma

Answer 35

Question 36

Describe the prevalence of adenocarcinoma

Answer 36

Question 37

Describe the various locations of adenocarcinoma and location-specific signs and symptoms

Answer 37

Question 38

Describe the histological features of adenocarcinoma

Answer 38

Question 39

How is adenocarcinoma staged?

Answer 39

TNM staging T = depth N = nodes M = distant mets (most common is liver)

Question 40

What are these?

Answer 40

Adenocarcinoma

Question 41

Describe the molecular pathways of colon carcinogenesis

Answer 41

Question 42

Adenoma-Carcinoma pathway

Answer 42

Question 43

Adenoma-Carcinoma pathway figure

Answer 43

Question 44

Serrated pathway AKA

Answer 44

Question 45

Serrated pathway figure

Answer 45

Question 46

Microsatellite instability?

Answer 46

Question 47

MSI example

Answer 47

Question 48

Overview of microsatellite instability

Answer 48

Question 49

Summary of sporadic cancer pathways

Answer 49

Question 50

Hereditary non-hamartomatous polyposis cancer syndromes

Answer 50

* Familial adenomatous polyposis * Lynch syndrome

Question 51

Hereditary hamartomatous polyposis cancer syndromes

Answer 51

* Peutz-Jeghers Syndrome * Juvenile Polyposis Syndrome

Question 52

Familal Adenomatous Polyposis

Answer 52

Question 53

FAP gross histology

Answer 53

Question 54

Describe Lynch Syndrome

Answer 54

Question 55

MSI SSAs not TAs?

Answer 55

Question 56

Confusion

Answer 56

Question 57

Summary of LS vs Sporadic Serrated pathway

Answer 57

Question 58

Question

Answer 58

Got like 10 questions at the end of this lecture was hungover and ran out of fucks to give

Question 59

Peutz-Jeghers Syndrome

Answer 59

Question 60

Peutz-Jeghers Polyp

Answer 60

Question 61

Peutz-Jeghers increased risks

Answer 61

Question 62

Average age of cancer diagnosis with Peutz-Jeghers

Answer 62

46

Question 63

Juvenile Polyposis syndrome

Answer 63

Question 64

Juvenile Polyp

Answer 64

Question 65

Juvenile Polyposis syndrome juvenile reference and location

Answer 65