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Flashcards in 03a: Colon Deck (62)
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1

Lifetime risk of colon cancer is (X)%

X = 5

2

Lifetime risk of colon adenoma is (X)%

X = 60

3

Which behavioral trends have led to the (increase/decrease) in colon cancer (incidence/mortality)?

Decrease; both

1. Decrease smoking
2. Improved diet/exercise
3. NSAIDs

4

T/F: an emigrating population acquires the colon cancer risk of the new environment

True - variation in geographic incidence may be related to diet

5

List the modifiable factors that increase risk for colorectal cancer

1. Red and processed meat intake
2. Obesity
3. Smoking and EtOH
4. DM II

6

List the modifiable factors that decrease risk for colorectal cancer

1. Physical activity
2. NSAIDs
3. Hormone replacement Rx
4. Dairy/Ca, folate

7

T/F: about 35-40% of colorectal cancer cases are sporadic

False - 75%

8

Classic Familial Adenomatous Polyposis: risk of colorectal cancer approaches 100% by age (X). Caused by (Y) gene mutation.

X = 40
Y = APC (chrom 5)

9

Patient is 25 years old with multiple (over 100) colorectal adenomas. Which genetic disease is he likely to have? What’s the mode of inheritance?

Classic FAP; autosomal dominant

10

(FAP/AFAP) presents with adenomas that are predominantly right-sided. What’s the mean age at which these polyps are seen?

AFAP

44

11

T/F: both FAP and AFAP are cause by genetic mutation in APC

True

12

MUTYH-associated polyposis mimics (X) disease phenotypically but has mutation in (Y)

X = FAP
Y = MUTYH (base-excision repair)

13

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) aka (X) Syndrome: which age of onset? And predominance of cancer at which site?

X = Lynch

40 yo or under
Proximal colon

14

T/F: HNPCC results in multiple primary cancers (colorectal and extracolonic).

True

15

HNPCC: mutation in which genes?

DNA mismatch repair (MLH1,2, MSH6, PMS2)

16

List the two sequences of natural progression to colorectal cancer. What percent of CRC has followed each of these paths?

1. Adenoma-Carcinoma sequence (80%)
2. Serrated Adenoma Path (20%)

17

How long (timeline) is the Adenoma-Carcinoma sequence for colorectal cancer? List the steps

10y

Small adenoma, large adenoma, HG dysplasia, invasive cancer, metastasis

18

How long (timeline) is the Serrated Adenoma pathway for colorectal cancer? List the steps

15y

Microvesicular Hyperplasia, sessile/serrated adenoma/polyp, serrated adenoma, serrated cancer, metastasis

19

Individuals with one first-degree relative affected by CRC before age 60 have an (X)-fold increased lifetime risk of developing CRC. The risk applies/begins when they’re (older/younger/same age) as relative.

X = 2-3
Younger (10 y younger)

20

List the Amsterdam II criteria for (X) disease.

X = HNPCC

1. 3+ relatives with HNPCC associated cancer
2. 2+ generations of CRC
3. 1+ case before age 50

21

T/F: 95% of colorectal cancers are adenocarcinomas

True

22

Diagnostic method of choice for CRC

Colonoscopy

23

How might a CBC be helpful in diagnosing or verifying CRC?

Fe deficiency anemia (Sx of CRC in cecum)

24

CRC: best imaging study for detecting intra-abdominal spread ​of disease

Abdominal CT

25

CRC: Endoscopic ultrasound useful in assessing

depth of invasion and local lymph node status for rectal cancers

26

Carcinoembryonic antigen (CEA) serum levels can be used to monitor recurrence of (X) cancer after curative surgery

X = colorectal

27

T/F: Chemotherapy for advanced colorectal cancer (Stage IV) has proven incredibly successful.

False - v disappointing

28

Which type of therapy is recommended for Dukes’ C (node-positive) colon cancers?

Adjuvant Rx
Chemo (alone or with radiation) given post-op after curative resection

29

Which type of therapy is recommended for Dukes’ B2 and C rectal cancers?

Adjuvant Rx
1. Curative surgery
2. Chemo with high dose pre- and/or post-op radiation

30

Pt with no FHx of CRC: when do you start screening and how often by colonoscopy?

Age 50
Every 10y