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Oncology – Awesome
Colon cancer
| Question | Answer |
|---|---|
| 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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