Gen Surgery > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

(44 cards)

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1
Q

Describe the adenoma- carcinoma sequence

A

Sequence of changes from normal mucosa to hyper- proliferative mucosa to adenoma and eventually to carcinoma

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2
Q

Incidence of adenomatous polyps and colorectal cancer in the general population

A

Polyps: 20 % in post mortem studies

Colorectal cancer: 5%

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3
Q

Which polyps are high risk

A
  • Large polyps > 1 cm
  • villous lesions
  • sessile lesions
  • high grade dysplasia
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4
Q

Most common region for polyps

A

Recto sigmoid colon

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5
Q

What parameters are used for the aetiology of colorectal cancer

A
  • dietary parameters
  • physical parameters
  • inflammatory bowel disease
  • familial risks
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6
Q

What diets are associated with increased risk of colorectal cancer

A
  • high amounts of animal fat and meat
  • substitution of fish and poultry is thought to reduce risk
  • high intake of dietary fiber has been associated with a reduction in risk of colorectal cancer, maximum benefit is from wheat bran and cellulose
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7
Q

Physical parameters increasing the risk of colorectal cancer

A
  • obesity –> increased insulin and insulin growth factor –> adenoma formation
  • exercise is thought to be protective
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8
Q

Which are the hereditary cancers

A
  • familial adenomatous polyposis
  • attenuated FAP
  • Lynch syndrome
  • MUYTH associated polyposis
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9
Q

FAP is an autosomal dominant condition, where is the genetic defect

A
  • chromosome 5 (APC gene)
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10
Q

When do patients with FAP manifest with disease

A
  • manifest with polyps on teenage years

- Onset of cancer in fourth decade

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11
Q

What is Gardener’s syndrome (FAP)

A

Patients afflicted with colonic polyposis and extra intestinal manifestations

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12
Q

What is turcot’s syndrome

A
  • polyposis in combination with brain tumor
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13
Q

When do patients with attenuated FAP present

A
  • most patients present with polyps in the 4th to 5th decade
  • cancer diagnosed after 6th decade
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14
Q

What is the lifetime risk of colorectal cancer in a patient with Lynch syndrome? What criteria are used to identify those at risk

A
  • 80%

- Amsterdam criteria

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15
Q

Is MUYTH associated polyposis autosomal dominant or recessive

A

Recessive

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16
Q

What is the risk of colorectal cancer in a patient with IBD before and after 20 years duration of the condition

A
  • less than 20: 5 %

- at 20 years: 10%

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17
Q

What are additional risk factors for colorectal cancer in patients with IBD

A
  • greater extent of the disease
  • evidence of mucosal dysplasia
  • sclerosing cholangitis family history of cancer
  • early onset IBD
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18
Q

If blood in the stool is found what is usually the next investigation

19
Q

When should first degree relatives of cancer patients have a colonoscopy

Study These Flashcards
A

10 years prior to the age of onset of disease in the affected relative

20
Q

What percentage of colorectal cancers are recto sigmoid tumours

21
Q

Presentation of rectal tumour?

Study These Flashcards
A
  • bloody or mucoid discharge from the anus, alteration in bowel habit with/out tenesmus
  • if presentation was delayed: features of obstructive symptoms and perianal pain
  • discrete mass palpable on digital rectal exam
22
Q

How do left sided colonic tumours present

Study These Flashcards
A
  • Intermittent constipation or diarrhea or both
  • passage of blood per rectum may be reported
  • weight loss
  • delayed presentation: palpable mass or symptoms and signs of large bowel obstruction
23
Q

How do right sided colonic tumours present

Study These Flashcards
A
  • unexplained anaemia and/or weight loss
  • occult faecal blood
  • advanced: abdominal mass
  • non specific pain
24
Q

What is the gold standard test for diagnosing colorectal carcinoma

25
What information can a barium enema give when investigating colon cancer
- characterize tumour somewhat | - rule out synchronous lesions
26
Which is the most frequently involved organ in metastatic colon cancer
Liver
27
What is the gold standard investigation for staging of colorectal cancers
CT scan (chest, abdomen and pelvis)
28
What local features is one looking for on CT scan
- size and location of primary tumour and depth of invasion - involvement of any adjacent organs or structures - presence of any surrounding lymph nodes
29
Metastatic features on CT scan
- Opacities in liver, lung or bone - ascites - pleural effusion
30
Which cancer is MRI scan reserved for
Assessment of rectal tumours
31
If CT scans are inconclusive which investigation should be done to look for metastases
PET scanning
32
What is the management of metastatic disease
Chemotherapeutic and or radiotherapy with surgery being reserved for emergency situations (impending or established obstruction, perforation)
33
Management of tumour that is locally advanced and not amenable to curative resection
Neoadjuvant chemotherapy and or radiotherapy can be considered to help downstage the tumour rendering it resectable
34
Post resection what factors need to be assessed
- completeness of surgical excision - adequateness of resection: lymph node yield - features of advanced disease/ spread - tumour characteristics - depth of invasion
35
What are surgical options for colorectal cancer
- right hemi colectomy - left Hemi colectomy - sigmoid colectomy - anterior resection and abdomino- perineal resection
36
What is removed in a right hemicolectomy
- removal of the caecum, ascending colon, proximal transverse colon and includes the iliocaecal valve with short segment of terminal ileum - extent of resection is determined by blood supply of the right colic artery
37
What is removed in a left hemi- colectomy
- removal of distal transverse colon down to the end of the descending colon - extent determined by blood supply of left colic artery
38
Alternative ls to anastomosis in left hemi colectomy
- end to end anastomosis with a diverting atoms proximal to anastomostic site - Hartmanns colostomy: proximal stoma --> end stoma
39
What is an anterior resection
Removal of upper part of the rectum for tumours involving the upper and middle thirds of the rectum. Preservation of the anal sphincter complex
40
What is stage one colorectal disease
- tumours classified as T1 or T2 with no evidence of lymph node involvement
41
What is stage two colorectal cancer
Correlates with T3 or T4 with no lymph node involvement
42
What is stage 3 colorectal cancer
Highlights involvement of lymph nodes
43
Factors which confer a poorer prognosis to patients post surgery for colorectal cancer
- tumor present at surgical margins - obstructed tumor at presentation - poorly differentiated tumour - inadequate lymph node yield - perineural invasion - peritoneal deposits/ micrometastases
44
What investigation is done for surveillance/ follow up of patients after treatment of colorectal cancer
- Serial carcino embryonic antigen measurements | - colonoscopy at 6m, 1 yr, 3 yrs and 5 yrs following surgery and at 5 - 10 year intervals thereafter
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