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31 Cards in this Set
- Front
- Back
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1. Abdominoperineal resection?
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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. |
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2. Low anterior resection?
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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.
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3. Bowel preparation for elective colon surgery?
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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. |
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4. How common is colorectal cancer?
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a. 4th most common internal malignancy in US
b. 2nd most common cause of death. |
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5. What should screening for colon cancer consist of?
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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. |
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6. Symptoms of colorectal cancer?
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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%. |
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7. How are right-sided colon cancers more likely to present?
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a. Anaemia is a more common.
b. Less likely to cause obstructive sx until late in the course of the disease. |
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8. Tx of colonic polyps?
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a. Can be treated w/endoscopic resection. Considered definitive when resection of the polyps is complete.
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9. When is polypectomy considered curative?
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a. Polypectomy alone is considered curative if tumour has not penetrated the submucosa, whereas submucosal penetration increases the likelihood of regional LN mets.
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10. What should preop metastatic workup include in a pt w/a reasonable life expectancy?
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a. Chest radiograph
b. Abdominal and pelvic CT. |
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11. What is the amount of colon resected based upon?
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a. Blood supply and regional lymphatic drainage.
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12. Following recover from colon resection in pts w/LN involvement (stage III disease), what improves their survival and reduces possibility of recurrence?
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a. Adjuvant chemotherapy.
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13. Current standard chemotherapy for colon cancer?!?
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a. FOLFOX4-regimens
1. (Folinic acid) Leucovorin 2. 5-FU 3. Oxaliplatin |
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14. Rectum?
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a. Lowest 15 cm of GI tract.
b. Cancer of rectum accounts for 30% of all colorectal carcinomas. |
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15. Why is rectal cancer more dismal?
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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.
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16. What should preop eval of pts w/rectal cancer include?
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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. |
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17. Tx options for rectal cancer?
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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. |
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18. Tx of rectal cancer for pts w/deeper invasion (T2 and T3)?
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a. Surgical resection of the involved rectum and surrounding lymph nodes is necessary.
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19. What is performed in rectal cancers above the anal sphincter complex?
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a. A low anterior resection.
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20. What is performed for cancers near the sphincter complex?
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a. Abdominoperineal resection (APR) w/permanent colostomy is usually necessary.
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21. Benefit of neoadjuvant therapy for Stage III (locally invasive rectal cancer)?
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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. |
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22. Post-op surveillance of colorectal cancer?
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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. |
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23. Screening rec for children of persons w/FAP?
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a. Flex sig every 1-2 yrs beginning when they are 10-12 yrs of age.
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24. Screening for people w/ a strong family hx of colorectal cancer?
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a. Should have an initial colonoscopy at 40 or 10 yrs younger than the age at which the relative was diagnosed, whichever comes first.
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25. Screening rec for pts w/HNPCC?
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a. Initial colonoscopy at 25 yrs of age, followed by yearly fecal occult blood testing and colonoscopy every 3 yrs
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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.
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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.
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27. Recommended screening and surveillance guidelines for Sporadic Adenomatous Polyposis?
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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. |
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28. Recommended screening and surveillance guidelines for Familial adenomatous polyposis?
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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. |
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29. Which BRCA confers increased risk of colon cancer?
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a. BRCA2
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30. What is indicated for pt w/stage III colon cancer in ascending colon?
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a. Right hemicolectomy w/postop adjuvant therapy using FOLFOX.
b. Radiation therapy is generally indicated for rectal carcinoma. |
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31. Complete.
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31. Complete.
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