What is the second leading cause of death among men and women in the United States?
Colorectal cancer
Colorectal cancer is a significant health concern, ranking second in mortality rates.
What is the 5-Year Overall Survival (OS) rate for colorectal cancer?
67%
This statistic highlights the prognosis for patients diagnosed with colorectal cancer.
What is the lifetime risk of developing colorectal cancer?
1 in 20 (5%)
This statistic indicates the prevalence of colorectal cancer in the population.
List some risk factors for colorectal cancer.
- Increasing age
- Familial syndromes (FAP, HNPCC, Peutz-Jeghers syndrome, juvenile polyposis)
- Inflammatory bowel disease
- Personal or family history of polyps
- Obesity
- Sedentary lifestyle
- Ethanol consumption
- Tobacco use
- Low-fiber diet
- Western diet
Understanding these risk factors can aid in prevention and early detection strategies.
What percentage of colorectal cancers are identified as hypermutated according to TCGA genomic profiling?
~16%
Hypermutation can influence treatment responses and prognosis.
Which genes are frequently mutated in colorectal cancer?
- APC (FAP)
- MLH1/MSH2/MSH6/PMS2 (HNPCC)
- TP53
- SMAD4 (juvenile polyposis)
- PIK3CA
- BRAF
- KRAS
These mutations play a critical role in the pathogenesis of colorectal cancer.
What type of tumors predominantly make up colorectal cancer pathology?
Adenocarcinomas (>90%)
Other tumor types include neuroendocrine, mesenchymal tumors, or lymphomas.
What is the significance of IHC testing for mismatch repair proteins in colorectal cancer?
It is predictive of response to immunotherapy
IHC testing can guide treatment decisions.
What imaging modality is typically used for local staging of colorectal cancer?
MRI
MRI is effective for assessing pelvic lymphadenopathy.
Where does the rectum begin anatomically?
At the rectosigmoid junction at the level of S3
This anatomical landmark is critical for surgical planning.
What is the total length of the rectum?
12 to 15 cm
Understanding the anatomy aids in surgical approaches.
What is the primary site of metastatic disease in colorectal cancer?
Liver
Rectal cancer has a higher propensity for lung metastasis compared to colon cancer.
What is the standard age to begin screening for colorectal cancer?
50 years of age
Screening protocols can vary based on individual risk factors.
What is the most common presenting symptom in rectal and lower sigmoid cancers?
Hematochezia
Other symptoms may include abdominal pain, constipation, and diarrhea.
What does Tis stage indicate in colorectal cancer staging?
Carcinoma in situ: intramucosal carcinoma
This stage signifies early-stage cancer confined to the mucosa.
What is the significance of the circumferential resection margin (CRM) in rectal cancer?
It predicts local recurrence and overall survival
CRM measurement is crucial in surgical pathology.
What is the recommended treatment for Stage I colorectal cancer?
- Transanal excision (TAE)
- Total mesorectal excision (TME)
Observation or adjuvant treatment may follow depending on pathology results.
What chemotherapy regimens are commonly used in conjunction with radiation for rectal cancer?
- Capecitabine
- Continuous infusion 5-FU
- FOLFOX
- CAPOX
These regimens may be utilized in neoadjuvant or adjuvant settings.
What is the first-line treatment for nausea in patients undergoing chemotherapy?
Zofran (8 mg q8h PRN)
Managing side effects is crucial for patient quality of life.
True or False: Long-course chemoRT improves overall survival compared to short-course RT.
False
Oncologic outcomes are similar between immediate and delayed surgery after short-course RT.
What is the first-line treatment for diarrhea?
Imodium titrating to a max of 8 pills/day
If the first-line treatment is insufficient, second-line treatment involves alternating Lomotil 2 pills and Imodium 2 pills every 3 hours.
What symptoms are associated with cystitis?
Urgency, frequency, and dysuria
A urinalysis (UA) is performed to rule out a urinary tract infection (UTI), and treatment is initiated if positive.
What is the first-line skin care treatment?
Sitz baths, Aquaphor, and Domeboro powder
If these are ineffective, second-line options include Silvadene cream and hydrogel dressings (Cool Magic).
What are the symptoms of proctitis?
Diarrhea and abdominal pain
The first-line treatment involves alternating Lomotil and Imodium.
