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31 Cards in this Set

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1. Abdominoperineal resection?
a. Resection of the rectum and anal canal including anal sphincter complex for a low-lying rectal carcinoma.
b. The procedure leaves the pt w/a permanent colostomy.
2. Low anterior resection?
a. Resection of the rectum to the level of the levator ani muscles leaving the anal canal and anal sphincter muscles intact so that a stapled or hand-sewn anastomosis can be performed.
3. Bowel preparation for elective colon surgery?
a. A mechanical preparation consisting of a large volume of polyethylene glycol solution or a smaller volume of phosphosoda and a broad-spectrum IV and/or oral nonabsorbable abx.
b. The goal is to decrease the bacterial count in the event of spillage contents.
4. How common is colorectal cancer?
a. 4th most common internal malignancy in US
b. 2nd most common cause of death.
5. What should screening for colon cancer consist of?
a. Colonoscopy every 10 yrs beginning at 50 yrs.
b. If an adenomatous polyp larger than 1 cm is identified and removed, repeat colonoscopy should be done in 3 yrs.
c. When the colon is clear of polyps, colonoscopy can be done every 5 yrs.
6. Symptoms of colorectal cancer?
a. Bleeding most common (occult or gross)
b. Chronic changes in bowel habits in 77-92% of pts
i. Changes in the calibre of stools and diarrhea.
ii. These are more commonly seen w/left sided tumours.
c. Obstruction in 6-16^ of pts
d. Perforation w/peritonitis in 2-7%.
7. How are right-sided colon cancers more likely to present?
a. Anaemia is a more common.
b. Less likely to cause obstructive sx until late in the course of the disease.
8. Tx of colonic polyps?
a. Can be treated w/endoscopic resection. Considered definitive when resection of the polyps is complete.
9. When is polypectomy considered curative?
a. Polypectomy alone is considered curative if tumour has not penetrated the submucosa, whereas submucosal penetration increases the likelihood of regional LN mets.
10. What should preop metastatic workup include in a pt w/a reasonable life expectancy?
a. Chest radiograph
b. Abdominal and pelvic CT.
11. What is the amount of colon resected based upon?
a. Blood supply and regional lymphatic drainage.
12. Following recover from colon resection in pts w/LN involvement (stage III disease), what improves their survival and reduces possibility of recurrence?
a. Adjuvant chemotherapy.
13. Current standard chemotherapy for colon cancer?!?
a. FOLFOX4-regimens
1. (Folinic acid) Leucovorin
2. 5-FU
3. Oxaliplatin
14. Rectum?
a. Lowest 15 cm of GI tract.
b. Cancer of rectum accounts for 30% of all colorectal carcinomas.
15. Why is rectal cancer more dismal?
a. Bc of the close proximity of the rectum to the surrounding structures, pts w/rectal cancer are not only at risk for distant mets but also for local tumour recurrence.
16. What should preop eval of pts w/rectal cancer include?
a. CXR
b. CT abdomen and pelvis.
c. Also, endoscopic U/S should be performed to determine the depth of tumour invasion and status of the perirectal LNs.
17. Tx options for rectal cancer?
a. Depend on location in rectum and depth of invasion.
b. For most pts w/superficial invasion (T1), the risk of LN mets is low.
c. If the tumour is low in the rectum, a transanal resection of the tumour w/tumour-free margins is the standard therapy.
d. For maximal benefit from this approach, pts generally should have a tumour involving less than 1/3 of the rectal circumference, less than transmural involvement, a well to moderately differentiated histological grade, and unaffected rectal lymph nodes.
18. Tx of rectal cancer for pts w/deeper invasion (T2 and T3)?
a. Surgical resection of the involved rectum and surrounding lymph nodes is necessary.
19. What is performed in rectal cancers above the anal sphincter complex?
a. A low anterior resection.
20. What is performed for cancers near the sphincter complex?
a. Abdominoperineal resection (APR) w/permanent colostomy is usually necessary.
21. Benefit of neoadjuvant therapy for Stage III (locally invasive rectal cancer)?
a. These pts experience a reduction in pelvic tumour recurrence when they complete a course of chemoradiation therapy prior to surgical resection (neoadjuvant therapy).
b. Neoadjuvant therapy appears to have additional benefits over postop chemoradiation therapy in rectal carcinoma in preventing local recurrence.
22. Post-op surveillance of colorectal cancer?
a. Initial colonoscopy at 6 months
b. Intervals up to one year
c. Followed by yearly colonoscopy for 2 yrs, and subsequent surveillance colonoscopy every 3 yrs.
d. In addition, pts would undergo regular evaluation involving H&P and serial CEA measurements.
23. Screening rec for children of persons w/FAP?
a. Flex sig every 1-2 yrs beginning when they are 10-12 yrs of age.
24. Screening for people w/ a strong family hx of colorectal cancer?
a. Should have an initial colonoscopy at 40 or 10 yrs younger than the age at which the relative was diagnosed, whichever comes first.
25. Screening rec for pts w/HNPCC?
a. Initial colonoscopy at 25 yrs of age, followed by yearly fecal occult blood testing and colonoscopy every 3 yrs
26. Screening rec for pts w/hx of ulcerative colitis of more than 7-8 yrs should have a colonoscopy w/biopsies every 1-2 yrs.
26. Screening rec for pts w/hx of ulcerative colitis of more than 7-8 yrs should have a colonoscopy w/biopsies every 1-2 yrs.
27. Recommended screening and surveillance guidelines for Sporadic Adenomatous Polyposis?
a. Complete colonoscopy and clearance of all polyps along w/index polyp.
b. Repeat colonoscopy in 3 y (selectively-pts w/tubular adenoma <1 cm may not require long-term f/u).
c. If initial exam and clearance are suboptimal, initial f/u colonoscopy should be at 1 yr.
28. Recommended screening and surveillance guidelines for Familial adenomatous polyposis?
a. Flex sig for all first-degree relatives to FAP, Gardner syndrome, and Turcot syndromes pts.
b. Screening colonoscopy should being w/known FAP at age 10-12 yrs and performed every 1-2 yrs until age 40, then every 3 yrs thereafter.
c. Initial upper endoscopy at age 20 or at age of prophylactic colectomy.
i. For mild duodenal disease, upper endoscopy every 2-3 yrs.
ii. For severe duodenal disease, upper endoscopy every 6 months to 1 yr.
d. Surveilleince for all first-degree relatives of FAP pts w/abdominal CT for desmoid tumours.
e. Surveillance for 1st degree relatives of Turcot syndrome pts w/CT scan of the brain.
29. Which BRCA confers increased risk of colon cancer?
a. BRCA2
30. What is indicated for pt w/stage III colon cancer in ascending colon?
a. Right hemicolectomy w/postop adjuvant therapy using FOLFOX.
b. Radiation therapy is generally indicated for rectal carcinoma.
31. Complete.
31. Complete.