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Oncology – Awesome

Colon cancer

QuestionAnswer
What genetic abnormality associated with FAP? APC gene on Chromosome 5q
If pt with family h/o familial adenomatous polyposis, when you start screening and what's the interval? start with sigmoidoscopies at age 12 q1-2y, colonoscopy annually at 16, colectomy in their 20's
physical findings that would make you want to do a colonoscopy strep bovis, hyperpigmented lesion on lower lip (consider Peutz-Jegher)
things that would make you do a TVUS woman with fam h/o HNPCC who has adenomas on colonoscopy (associated with endometrial CA)
Things that would make you do a pelvic or abd US choreoform movements in someone with NMDA receptor meningitis (think ovarian teratoma)
pt with hyper plastic polyp on colonoscopy f/u in 10 years, no malignancy potential
<40 and Fe def - wtd EGD
> 40 and L supraclavicular LN EGD for stomach cancer
adenoma < 1cm on colonoscopy f/u colonoscopy 5-10 years
villous adenoma < 1 cm on colonoscopy f/u colonoscopy q3y
any tubular adenoma on colonoscopy f/u colonoscopy q3y
pt with fam h/o HNPCC - how to screen start colonoscopies at 25 or 10 year younger than youngest affected relative; colonoscopy q2y until 40, after which q1yr
pt with 2 FIRST degree relatives with h/o colon CA start at age 40 or 10 years younger than the youngest affected family member, colonoscopy q5years (5 years with first degree)
pt with 1 FIRST degree relative with colon CA < 60 start at age 40 or 10 years younger than the youngest affected family member, colonoscopy q5years (5 years with first degree)
pt with 2 SECOND degree relatives with h/o colon CA start at age 40 or 10 years younger than the youngest affected family member, colonoscopy q10years (10 years with second degree)
pt with 1 FIRST degree relative with colon CA after the age of 60 start at age 50 or 10 years younger than the youngest affected family member, colonoscopy q5years (5 years with first degree)
no fam h/o colon cancer stage at age 50, colonoscopy every 10 years
Monitoring post colon resection for colon CA colonoscopy at 1y --> 3y --> 5y; abdomen and pelvis CT each year for five years; history and physical with CEA every 3 to 6 months for five years
if have UC or Crohn's, when colonoscopy? 8 years after diagnosis, then every 1-2 years
when to stop colon cancer screening 75, unless super healthy and will live more than 10 years. All should stop at age 85
when to start colonoscopy in African Americans age 45 because African-Americans are at a greater risk for colon cancer and they are being diagnosed at a younger age than other groups
resection only for colon cancer if which layers affected mucosa, submucosa (Duke A); muscularis (Duke B1)
what to treat colon cancer with when you have serosal involvement or LNs resection + FOLFOX (5 FU + leucovorin + oxaliplatin) or CAPOX
what to treat colon cancer with when you have distant mets palliative resection + FOLFOX (leucovorin, 5-FU, oxaliplatin) or CAPOX (capecitabine, oxaliplatin)
how to treat if you have cancer of the anal margin local excision
how to treat if you have cancer of the anal canal mucosa external beam radiation + 5FU + mitocytin
What is the genetic abnormality in HNPCC? DNA mismatch repair causing microsatellite instability
What genetic testing do you do in colorectal CA and why? K-ras and N-ras are resistant to EGFR-targeted meds such as cetuximab and panitumumab. If pt has these genes, we can't use those meds for them.
For those who are diagnosed with Lynch syndrome, what should they get in terms of yearly surveillance? 1. Colonoscopy q 1 to 2 y, 2. Annual US of GU tract, 3. women annual TVUS and annual endometrial biopsy, 4. EGD every 2 to 3 years starting at age 30, 5. Urinalysis annually starting at age 30 due to increased transitional cell carcinoma
What are the genes associated with juvenile polyposis syndrome? SMAD4 & BMPR1A
What are the three criteria to diagnose juvenile polyposis syndrome? 1. Four or greater juvenile polyps in colon, 2. Juvenile polyps throughout the G.I. tract, 3. 1-3 juvenile polyps with a family history of juvenile polyposis syndrome
When to start screening for polyps in juvenile polyposis syndrome? What screening modality and frequency? 15 years old or 10 years younger than the youngest family member affected. Screen with colonoscopy and EGD every 2 to 3 years.
How to treat high risk localized G.I. stromal tumors? Imatinib
When to repeat colonoscopy if 1 to 2 adenomas less than 1 cm are found? Five years
When to repeat colonoscopy if 1 to 2 sessile serrated polyps less than 1 cm are found? 5 y
When to repeat colonoscopy if 3 to 10 adenomas less than 1 cm are found? 3 years
When to repeat colonoscopy if an adenoma more than 1 cm is found? 3 y. The Big.
When to repeat colonoscopy if a sessile serrated polyp more than 1 cm is found? 3 y. The Big.
When to repeat colonoscopy if a traditional serrated polyp is found? 3 y. The Bad.
When to repeat colonoscopy if a villous adenoma is found? 3 y. The Bad.
When to repeat colonoscopy if a hi grade adenomatous dysplastic polyp is found? 3y. The Ugly.
When to repeat colonoscopy if a sessile serrated dysplastic polyp is found? 3y. The Ugly.
When to repeat colonoscopy if >10 denomas are found? 1 y, check genetics or fam hx
When to repeat colonoscopy if patient is diagnosed with sessile polyposis syndrome? 1 y, check genetics or fam hx
Created by: christinapham
 

 



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