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70 Cards in this Set
- Front
- Back
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What is a polyp?
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epithelium derived mass with protrudes into the gut lumen
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What are two types of polyps?
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pedunculated polyp
sessile polyp |
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What is a non-neoplastic polyp a reslut of?
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abnormal mucosal maturation, inflamation, distorted architecture
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What is a neoplastic polyp the result of?
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proliferation and dysplasia
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What are 4 types of non-neoplastic polyps?
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1. hyperplastic
2. hamartomatous 3. inflammatory 4. lymphoid |
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Where do you find hyperplastic polyps?
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90% io LI
>50% in rectosigmoid |
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Can hyperplastic polyps lead to cancer?
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No malignant potential
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Who do you find hyperplastic polyps in?
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found in more than 1/2 of ppl over 60
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What does a hpyerplastic polyp come from?
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decreased epithelial cell turnover
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What does a hyperplastic polyp look like?
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nipple-like, hemispheric, smooth protrusion of mucosa usually at the tops of mucosal folds
serrated lumina & inc # of goblet cells small |
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What is a harmartoma polyp?
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mass of disorganized but mature specialized cells or tissue indigenous to a particular site
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What causes a harmartoma polyp?
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anomalus development
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What are Juvenile hamaratous polyps?
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<5yo
80% in rectum large lamina propria enclosing abundant cystically dilated glands |
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What is juvenile polyposis syndrome?
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multipe juvenile polyps
autosomal dominant inheretance increased risk of adenomas |
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What does a juvenile polyp look like/made of?
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lamina propria constitutes bulk of polyp enclosing abundant cystically dilated glands with inflammation
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Can peutz-jeghers polyps cause cancer?
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no malignant potential
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What is peutz-jeghers syndrome?
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autosomal dominant
multi GI polyps + melanotic mucosal & cutaneous pigments |
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What are you at increased risk for in peutz-jegher syndrome?
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intussusception
cancers: breast, pancreas, lung, ovary, uterus |
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What does a peutz-jegher polyps look like?
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large & pedunculated
CT & SM extends into polyp abundant glands rich in goblet cells |
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What is cowden syndrome?
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autsomal dominant
hamartomaus GI polyps facial trichilemmomas, oral papillomas, acral keratoses |
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What do you have an increased risk for with cowden syndrome?
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tyroid & breast cancer
polps themselves have no malignant potential |
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What is Cronkhite-Canada?
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non-hereditary
GI hamartomous polpys ectodermal abnormalies |
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What is an inflammtory polyp?
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pseudopolyps - regenernating mucosa adjacent to ulceration (severe IBD)
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What is a lymphoid polyp?
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mucosal bumps caused by intramucosal lyphoid folicles - normal
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What do adenomatous polyps arise from?
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epithelial proliferative dysplasia
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What is an adenoma polyp a precusor for?
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andenocarcinoma
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What are 3 architectural typs of adenocarcinoma?
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1. tubular adenoma
2. villous adenoma 3. tubulovillous adenoma |
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How common are adenomatous polyps?
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40-50% of ppl over 60 and only 20-30% before age 40
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What is the risk associated with adenomatous polyps?
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four fold greater increase risk in developing adenomas among 1st degree relatives
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What sex do you find this in?
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M=F
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What does the tubular adenoma polyp look like?
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tubular glands - small
90% in colon single or multiple |
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What is a tubular adenoma polyp?
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dysplastic epithelium - elongated, pseudostratified, hyperchromatic nuclei with loss of mucin production
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What does a villous adenoma polyp look like?
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large, sessile
rectosigmiod of older ppl |
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What happens with villous adenomas?
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invasive cause there is no stalk to act as a buffer and invades directly into the colon wall
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What is an intramucosal carcinoma?
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invades lamina propria - no metastatic potential
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What is an carcinoma in a pedunculated adenoma?
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goes through that muscularis mucosa
tx with resection |
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What do you do with an invasive carcinoma in sessile polyps?
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partial coletomy
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What happens if you leave and adenomatous epthilium?
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potential for carcinoma
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What gene is involved in familial adenomatous polyposis?
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APC gene 5q21
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What do you get with FAP?
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100% colon adenocarcinoma
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What do you see in FAP?
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carpeting of colon with polyps
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What are the risks associated with hereditary nonpolyposis colorectal cancer?
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inc risk of colorectal cancer & endometrial cancer
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What si seen with HNCC?
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earlier but low # adenomas
multiple colonc carcinomas |
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What type of gene is deficient in HNCC?
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DNA mismatch repair genes leading to microsatelite instability
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80% of colon cancers have what?
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inactivated APC
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50% of cancers without APC mutations have what?
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B-catenin mutations
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Normal functioning APC does what?
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promotes cell adhesion & regulates cell proliferation
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What does the absence of the APC gene cause?
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decreased cell adhesion & increased cellular proliferations
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What other gene is often lost in colon cancer?
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p53
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What is microsatelite instabilty caused by?
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DNA mismatch repair genes
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What does this lead to?
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increased mutation rate & accumulation of mutations but no adenomas
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What does HNPCC look like?
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proximal colonic location
mucionous histology infiltration by lymphocytes |
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what is the most common type of adenocarcinoma?
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98% adenocarcinomas
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What are some dietary practices that predispose us for colorectal cancer?
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excess caloric intake
low fiber refines carbs & red meat obesity & physical inactivity |
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What is the clinical presentation of a right-sided cancer?
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fatigue, weakness, iron deficiency anemia
non-obstructive |
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What is the clinical presentation of left-sided cancer?
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occult bleeding, changes in bowel habits, abdominal pain
napkin ring constrictions more infiltrative & obstructive |
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What clinical pearl did we learn about colorectal cancer?
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iron deficiency anemia in older male signifies colon cancer unless proven otherwise
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What is infiltrative colorectal cancer often assoicated with?
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ulcerative colitis
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How does infiltrave colorectal cancer act?
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aggressive
spread |
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What is important in staging?
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depth of invasion
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What is TIS?
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non- invasive
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What is T1?
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invades into the submucosa
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What is T2?
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invades into but not through muscularis mucosa
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What is T3?
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invades through muscualris mucosa
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What is T4?
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invades through muscualris mucosa and into other tissues
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What is the N is staging for?
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LN involvement
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What is M for in staging?
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mets
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What is the single most important prognositis indicator of colorectal carcinoma?
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stage at time of diagnosis
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Where do the mets go?
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adjacent structures
liver, lungs, bones |
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What pecent of pts have mets at time of presentation?
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25-30%
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