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Flashcards in Oncology Deck (321)
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1

Colon CA

MCC gastrointestinal CA - 60K deaths/yr
Age>50
Diet rich in fat, red meat, sucrose, born in west
Pelvic irradiation
UC/Crohns >8yr (colonoscopy now then q 2yr)
1st deg relative with colon CA
h/o other CA (breast, ovarian, endometrial)
Familial polyposis (gardners, familiar adenomatous polyposis)
Hereditary non plyposis colono CA (HNPCC - lynch)
Adenomas - colon CA (hyperplastic polyp no malignant potential)

2

Decreased r/o colon CA

non-smoker
NSAID
ASA >20yr
Celecoxib/sulindac
Ca, folate, estrogens

3

Familial Adenomatous polyposis

Fhx adenomatous polyposis and CA
Mut of APC gene 5q
hundreds polyps before age 16
95% cancer
colectomy indicated before malignancy begins
Sigmoidoscopy age 12-16 then colonoscopy q yearly - if any polyps - colectomy

4

Gardner syndrome

Adenomatous polyps invovling colon
95% cancer
extraintestinal manifestation - osteomas mandible , skull, soft tissue, thyroid adrenal
Colectomy before malignancy begins
Sigmoidoscopy age 12-16 then colonoscopy q yearly - if any polyps - colectomy

5

HNPCC (lynch syndrome)

3 relatives with Cancer related to HNPCC
one 1st deg
2 generations
1 extracolon CA
FAP excluded

6

Adenoma Colonoscopy screening

Hyperplastic polyp - q10yr
Adenoma < 1cm x1 - q5-10yr
Adenoma <1cm 3 Q3yr
Villous adenoma - regardless of size q3yr

7

Colon CA screening

1st deg relative colon CA age 10
colonoscopy standard time (age 50 then q10yr
Two 1st deg relatives colon CA
colonscopy now then q5yr

8

Peutz-Jeghar's syndrome

hemartomas of small intestine
Pigmented lesions on skin, lips, mouth
Juventile polypossi: hyperpalstic polyps in colons - p./w GI bleed or inussusception
Tx: colonoscopy

9

HNPCC (hereditary non-poyposis colon CA - Lynch syndrome

Automsomal dominant
At least 3 relative with colon CA
One 1st deg relative
2 generations with colon CA
May have extracolonic CA
At least one relative <50yo with colon CA

10

50yo F with HNPCC had colon CA done - adenomatous polyps - wtd?

TV US for uterine CA (extracolonic CA)

11

55yo M asx for routine checkup - fecal occult blood test neg (FIT) - signmoidoscopy => polyp

If bx= hyperplastic polyp wtd?
FIT 1yr, sigmoidoscopy q3-5yr, or double contrast barium enema q5yr
If bx=adenoma wtd>?
Full Colonoscopy
If bx=AdenoCA wtd?
Full colonoscopy

12

55yo asx M routine checkup - sigmoidoscopy - neg - FIT +

Full colonoscopy

13

Male or postmenopausal femail with unexplained IDA - wtd?

Colonoscopy

14

Elderly pt with hematochezia, h/o hemorrohids wtd?

Colonoscopy

15

Pt on routine health maintenance exam FIT 1 out of 6 cards + occult blood - pt takes high doses of vit C

Colonoscopy

16

55yo F screening colonoscopy done - 2 polyps removed - both hyperplastic - when next colonoscopy

10 years

17

Pt with 2 adenomas <1cm removed when repeat colonscopy?

colonoscopy q5-10yrs

18

Pt with tubular adenoma 1cm - next colonoscopy?

3 years

19

Pt tubular adenoma 2.5 cm next colonoscopy?

3 years

20

Pt with 3-10 tubular aenoma <1cm next colonoscopy

3 years

21

Pt wit h1 villosu adenoma <1cm next colonscopy

3 years

22

Pt with obstructive colon CA with colonic resection wtd?

Full colonoscopy to r.o other concomitant lesions

23

Pre-op colonscopy with no other lesions

colonoscopy 1 yr then 3 years then q5yrs
measure CEA q3 to 6 mo for 2 years then q 1yr x 5 years

24

Best dx test r/o colon CA?

Colonoscopy with bx

25

When to stop colonoscopy screening?

75yo
D/c mammo 75yo
D/C pap smears - 65
Hep C screening 1945 to 1965
LDCT screen for smokers up to age 79

26

Familial Adenomatous Polyposis (FAP)

Sigmoidoscopy q1-2 yrs starting at age 12

27

HNPCC

start colonoscopy 25yr or 10 years younger than youngest affected relative with HNPCC - then q2yr up to age 40 then q1yr

28

If 2 first deg relatives or 1 first deg relative with colon CA before age 60 when to screen?

40 years or 10 yrs younger than youngest affected relative (whichever younger) then q5 yrs

29

If 1 first deg relative with colon CA after age 50 or 2 2nd deg relative - when to screen?

40 years FIT + sigmoid q3 to 5 years starting at 40yo or colonoscopy at least at age 40 then q10 years

30

General population colon CA screening

50 yo (AA 45yo) - FIT/signmoidoscopy q3-5 yr or colonoscopy at 50 then q10 yrs