CM Colon Cancer
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| 95% of primary colon cancers are | adenocarcinomas
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| _____ is the greatest risk factor for colon cancer | age. Risk doubles each decade of life after age 40.
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| Lifestyle Risk factors | diets high in red meat and processed meats, physical inactivity, obesity, smoking, heavy alcohol use
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| Familial Adenomatous Polyposis Facts | APC gene mutation, autosomal dominant, hundred of colon polyps in teenage years.
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| Hereditary Non-Polyposis Colorectal Cancer or Lynch syndrome | Autosomal dominant, 1:2,000 incidence, Microsatellite instability -->Frame shift mutations--problems wiht mismatch repair. Associated with lots of cancers, eg endometrial
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| Up to _____ percent of colorectal cancers have some familial component | 30%
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| Signs and symptoms of colon cancer | rectal bleeding, iron deficiency anemia, fatigue and weight loss, obstruction (left sided tumors), change in stool quality/caliber, abdominal mass/pain
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| 50% of colorectal cancers occur | in the rectum (30%) and the sigmoid colon (20%)
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| unusual presentations of colon cancers | fistulas, fever or unknown origin or abscesses. Streptococcus bovis bacteremia and Clostridium septicum sepsis
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| ___ % of patients have metastatic dz at time of diagnosis | 22%
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| Common places of mets | colon cancer: liver then lung; Rectal cancer: liver or lung
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| Diagnostic Evaluation of Colon Cancers | Colonoscopy (gold standard), CT abd/pelvis for staging, CXR, Needle biopsy of suspected metastatic dz, Labs, PET only for suspected mets
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| CEA is used to | track someone's tumor over time, not to make a diagnosis
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| Colectomy | hemicolectomy with lymph node dissection (usually 1/4th the colon is removed)
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| radiation is used for | rectal cancer, not colon cancer (colon is too mobile)
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| Role of Vitamin D and Calcium | Possibly protective against Colon cancer
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| For the average patient, colonoscopy starts at | age 50. If a family history of CRC, repeat every 5 years.
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| If a pateint has a first degree family relative or multiple second degree relatives, screening begins | starting 10 years younger than youngest affected family member
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| Gold standard of colon cancer screening | colonoscopy
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| Guaiac-based FOBT | has the best mortality data for CRC screening. Never screen with DRE. Three cards sent home with patient
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| FOBT's must be repeated | every year
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| a positive FOBT must be followed by | a colonoscopy
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| What is the time interval allowed between flex sigmoidoscopies? | 5 year interval between exams
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| What is the colonoscopy miss rate for cancer | 5%
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| Name the most serious complication of colonoscopy | bleeding post-polypectomy
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| How often are colonoscopies performed? | Every 10 years, unless cancer or adenomatous polyps are detected (then 3-5 years). Family hx with CRC (every 5 years). IBD (every 15 years)
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| CT colonography facts | no sedation, bowel prep required, great pictures. Positive results require follow-up colonoscopy
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| Hyperplastic polyps are not considered | pre-malignant. A person with only hyperplastic polyps does not need a shortened interval between screening exams
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