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10 Cards in this Set
- Front
- Back
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*What are the ACS screening recommendations for colon cancer?
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patients >50yo have the option:
yearly fecal occult blood test (FOBT) and 5-yr sigmoidoscopy 5-year flex sigmoidoscopy annual FOBT 10-yearly colonoscopy 5-yearly double contrast barium enema high risk (genetic syndrome, hx of polyps/ cancer, IBD, Fhx of tumors/polyps < 60yo): more regular, younger screenings |
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*FAP
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AD, hundreds of polyps in teenage years, 100% risk of colon cancer.
chr 5, can be detected on a blood test |
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*HNPCC (types A and B, Amsterdam criteria)
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AD
type A: primary colon tumors type B: colon, breast, endometrial, ovarian and gastric cancers Amsterdam criteria: >3 family members with colon cancer (two must be first-relatives), 2 generations involved, at least 1 <50yo. microsatellite instability of the tumor can be found by genetic testing of the tumor (important because may respond differently to chemo) |
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*What's the work up to stage a lower GI malignancy?
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CBC, LFTs, CEA, CXR, CT (abd and pelvis)
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What's the epidemiology and risk factors for colon cancer?
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risk: high fat diet, cigarettes, EtOH, IBD (UC --> 3% 10yr risk, 30% 30yr risk). hx of colon, breast, endometrial or ovarian cancers. adenomatous polyps (5% malignant, esp villous and tubulovillous).
colorectal cancer: 3rd leading cancer, 2nd leading cancer death |
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How do you diagnose colon cancer?
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sxs: abd pain, change in bowel habits, bleeding, N/V, anorexia, wt loss, weakness
exam: heme positive stool, pallor, abd/rectal masses, hepatomegaly, jaundice |
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What's the management for colon cancer, based on the stage?
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stage 1: surgery and surveillance
stage 2: tricky, not on test (chemoRx after surgery is controversial. indicated at least for obstruction, perforation, T4 tumor, lymphovascular invasion, insufficient nodal harvest) stage 3: surgery with adjuvant chemoRx stage 4: chemoRx upfront unless it's resectable or imminent obstruction/perforation/uncontrolled bleeding --> do surgery first. monoclonal Ab (bevacizumab (Ab for VEGF), cetuximab (Ab for EGF)). surgery: take adjacent mesentery and draining lymph nodes, wide margins |
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What's the management for rectal cancer?
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higher risk for local recurrence than colon cancer.
stage 1: surgery and surveillance stage 2: adjuvant chemo and radiation (fewer micromets and increased sphincter preservation) surveillance is crucial: 3/4 of relapses are w/in 3 years. Do CBC, LFTs, CEA, colonoscopy within 1 yr then q 3-5 years |
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Anal cancer
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risks: receptive anal sex, genital warts, HPV
sxs: bleeding, pain mass usually squamous cell carcinoma on bx staging: CXR, pelvic CT, LFTs, FNA of palpable inguinal lymph nodes tx: chemoRx and radiation for six weeks, surgery only if there's a residual mass afterwards. 70% are disease free and colostomy free after 4 years |
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Basic staging of colorectal cancer
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stage 0: in situ
stage 1: tumor, no spread (T1/T2) stage 2: muscle invasion (T3/T4) stage 3: node invasion (N1) stage 4: metastases (M1) |
