Oncology 3 Colon Cancer

Lecture Outline I. Colon Polyps A. Hyperplastic polyps B. Adenomatous polyps Risk Factors Screening A. Colonoscopy B. Flexible sigmoidoscopy C. Double contrast barium enema D. CT colonography E. Stool testing Clinical Manifestations Diagnosis and Staging Treatment A. Surgical therapy B. Chemotherapy C. Post-treatment surveillance

II. III.

IV. V. VI.

Colon Polyps 1. What type of cancer makes up more than 95% of colon cancers?

2. What are the two most common types of colon polyps?

Risk Factors 3. What are the risk factors for developing colon cancer?

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4. What gene is mutated in patients with familial adenomatous polyposis (FAP)?

5. What two features are more common in patients with colon cancer due to Lynch syndrome (HNPCC)?

Screening 6. What is the standard screening test for colon cancer used in the United States?

7. What is the recommendation to begin screening for colon cancer with a colonoscopy?

8. What other tests are available for colon cancer screening?

Quick Review 9. How long does it take an adenomatous colon polyp to become cancerous?

10. A 50-year-old male undergoes his first screening colonoscopy that reveals an adenomatous polyp. When should you re-check this patients colonoscopy?

11. A 42-year-old African-American patient is worried about his risk of developing colon cancer. His father was diagnosed with colon cancer at 56 years of age, and his fathers brother was diagnosed at 59 years of age. At what age should you recommend this patient begin colon cancer screening?

12. What is Gardner syndrome? What is Turcot syndrome?

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Clinical Manifestations 13. What stool changes can occur in colon cancer?

14. What is the most common finding associated with bleeding from a colon cancer?

15. What type of bacteremia is associated with colon cancer?

Diagnosis and Staging 16. What is a synchronous colon cancer?

17. What is the clinical utility of carcinoembryonic antigen (CEA) in the setting of colon cancer?

18. What is the most important factor for TNM staging of the primary tumor?

Primary Tumor (T) Tis Carcinoma in situ T1 Tumor invades submucosa T2 Tumor invades muscularis propria T3 Tumor invades through the muscularis propria into pericolorectal tissues Regional Lymph Nodes (N) N0 No regional lymph node metastasis N1 Metastasis in 1-3 regional lymph nodes N2 Metastasis in 4 or more regional lymph nodes Distant Metastasis (M) M0 No distant metastasis M1 Distant metastasis M1a Metastasis confined to one organ or site M1b Metastases in more than one organ, or the peritoneum

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American Joint Committee on Cancer (AJCC) Staging of Colon Cancer (2010) Stage I T1-T2 N0 M0 Stage IIA T3 N0 M0 Stage IIB T4a N0 M0 Stage IIC T4b N0 M0 T1-2 N1/N1c M0 Stage IIIA T1 N2a M0 T3-T4a N1/N1c M0 Stage IIIB T2-T3 N2a M0 T1-T2 N2b M0 T4a N2a M0 Stage IIIC T3-T4a N2b M0 T4b N1-N2 M0 Stage IVA Any T Any N M1a Stage IVB Any T Any N M1b

19. How does Dukes classification compare with the stages used by the American Joint Commission on Cancer (AJCC)? Duke Stage AJCC Stage

Treatment 20. What is a colostomy?

21. In general, what treatment modalities are used for each stage of colon cancer? Stage I & II Stage III & IV (resectable) Stage III & IV (unresectable)

22. What drugs are used to treat for non-operable colon cancer?

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End of Session Quiz 1. What is syndrome is associated with the following presentations? Colon cancer plus endometrial cancer Colon cancer plus medulloblastoma Innumerable colon polyps, plus osteoma of the jaw Numerous colon polyps plus hyperpigmented lesions on the oral mucosa

2. What is the difference between adjuvant chemotherapy and neoadjuvant chemotherapy?

3. What practical advantage does colonoscopy have over barium enema and CT colonography, both in terms of screening and diagnosis of colon cancer?

4. You are seeing a new 30-year-old male patient who was diagnosed with ulcerative colitis with pancolitis 5 years ago. When should this patient have a screening colonoscopy?

5. What diseases are commonly associated with pseudopolyps?

6. Where are most colon polyps found?

7. What is the classic appearance of colon cancer on a barium enema?

8. Besides adenocarcinoma, what other primary colon malignancies can occur?

9. A 35-year-old healthy patient asks you if he should begin taking a NSAID or aspirin for the prevention of colorectal cancer. What is the United States Preventive Service Tasks Force (USPSTF) recommendation for the use of NSAIDs and asprin for the prevention of colorectal cancer?

10. What is the mechanism of 5-flurouracil (5-FU)? What are the potential side effects of 5-FU?

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