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Colon Cancer


Colon cancer risk: doubles each decade after 40 yo; M>F; 90% occur after 50; sig higher risk if 1st-degree relative with colon ca
Colon cancer Genl RFs Age; Personal hx colon polyps or ca; FH; inherited syndromes; T2DM; IBD
Colon cancer lifestyle RFs Diet (red meat); physical inactivity; obesity; smoking; heavy alcohol use
2 types of dx criteria for HNPCC Amsterdam; Bethesda
S/S colon cancer Rectal bleeding; Fe def anemia; Fatigue / wt loss; obstruction (left sided tumors); change in stool quality/caliber; abdominal mass or abd pain
Colon cancer: most common metastases are to: liver, then lung (colon); liver or lung (rectal ca)
Colon cancer: gold standard of dx eval: colonoscopy
Colon cancer: other dx eval CT with contrast abd/pelvis (for staging). CXR. Needle bx of suspected mets. PET scan only for suspected mets dz
Colon cancer: labs CBC, chemistry; may check CEA, but not for dx (help w/staging)
Cancer stage is determined from: PE, biopsy, imaging, lymph node dissection
Layers of colon wall Mucosa; muscularis mucosa; submucosa; muscularis propia; subserosa/serosa
Types of ablation of mets Radiofrequency Ablation; Ethanol ablation; Cryosurgery; Hepatic artery embolization
Goal of chemo: Eradicate micrometastasis to increase likelihood of cure; none for stage 0 or I; resected stage II: poss modest survival benefit but not routinely recommended
Indications for radiation tx in colorectal cancer not typically used for colon cancer. Used for rectal cancer
Screening: stool Tests: primarily detect cancer; Guaiac FOBT & immunochemical-based FIT; Stool DNA (sDNA)
Screening: Structural Exams: Detect cancer and polyps; Colonoscopy; CT colonography; Flexible Sigmoidoscopy; Double-contrast barium enema (uncommon)
Best mortality data for CRC screening: Guiac FOBT
Never screen for colon ca with: DRE
Positive FOBT should always be followed by: colonoscopy (and no more FOBTs needed)
Negative FOBT tests should be: repeated annually
Flexible Sigmoidoscopy procedure description Examines left colon; some bowel prep needed; can be performed w/o sedation in Dr’s office. 5-year interval between exams
Patients w/ adenomas found on flex sig should: have a colonoscopy
Colonoscopy: procedure description Direct inspection of entire colon with sedation (usu conscious); thorough bowel prep required
Colonoscopy false negative rates 6-12% miss rates for large adenomas; 5% miss rates for cancer
Most common serious complication of colonoscopy bleeding post-polypectomy; Perforation = 1/1000 and increases with age and diverticular disease
Colon cancer screening FOBT at age 50-75 yrs (alt: colonoscopy or sigmoidoscopy). USPSTF: no screen for >75 y.o.
Colon cancer surveillance once ca/adenomatous polyps are detected, occurs at shorter intervals (usually repeat colonoscopy in 3-5 years); If FH CRC: every 5 yr; IBD: yearly once disease present for more than 15 yr
Colon polyps (types) adenomatous (poss pre-malig: req shorter surveillance colonoscopy interval); hyperplastic (not considered pre-malig)
CT colonography No sedation; req bowel prep; pos result req f/u colonoscopy
Colon polyps: more likely to be malignant if: sessile, >1cm, villous
Colon polyps: less likely to be malignant if: pedunculated, <1cm, tubular
If 2 first-degree relatives have CRC or 1 relative with colon ca or adenomatous polyps: Screen at 40 y.o. (or 10 yrs <earliest family dx)
Created by: Abarnard