Colorectal Polyps Overview

Questions and Answers

What age should first degree relatives undergo colorectal cancer screening if a family member was diagnosed at age 48?

38 (correct)

What was the estimated decrease in colorectal cancer screening during the COVID-19 pandemic?

50-60%

80-90% (correct)

70-80%

30-40%

Which type of tests are recommended for average-risk individuals in detecting colorectal cancer?

MRI screening

CT colonography

Colonoscopy

Stool-based tests (correct)

What is the possible increase in colorectal cancer mortality linked to delays longer than 9 months in screening high risk individuals?

10-15% Signup and view all the answers

What should be the next step if symptoms persist despite adequate treatment for hemorrhoids?

Advise a colonoscopy Signup and view all the answers

What was the impact of the COVID-19 pandemic on non-urgent medical care?

Interruption of care Signup and view all the answers

Which test is commonly associated with anemia diagnosis in females more than in males for colorectal cancer screening?

Complete Blood Count (CBC) Signup and view all the answers

What is the typical timeframe for colonic polyp progression to malignancy?

10 years Signup and view all the answers

Which genetic change is the first step in the development of colorectal adenomas?

Inactivation of APC gene Signup and view all the answers

What is the role of KRAS proto-oncogene in the development of colorectal polyps?

It leads to the expansion of adenoma Signup and view all the answers

What is the effect of mutations in the TP53 gene in the context of colorectal cancer?

They lead to invasion and carcinoma development Signup and view all the answers

Which of the following describes the gross appearance of colonic polyps?

Visibly protruding structures from the colorectal mucosa Signup and view all the answers

Which factor is NOT considered a risk factor for colorectal polyps?

Frequent consumption of dairy products Signup and view all the answers

What is a key recommendation for colorectal cancer prevention?

Screening for colorectal cancer Signup and view all the answers

What specific patient group is prioritized for colorectal cancer screening?

Individuals over the age of 45 Signup and view all the answers

What impact did the COVID-19 pandemic have on colorectal health screenings?

Delays and decreased screening rates Signup and view all the answers

Which type of colorectal polyp is classified as non-neoplastic?

Juvenile polyp Signup and view all the answers

What is the recommended follow-up for patients with Tubular Adenomas?

Repeat colonoscopy every 3-5 years Signup and view all the answers

What risk factor significantly increases the chance of finding colorectal polyps?

Age over 50 Signup and view all the answers

Which type of adenomatous polyp is associated with the highest potential to develop into adenocarcinoma?

Villous adenoma Signup and view all the answers

At what age are polyps typically detected, according to general screening recommendations?

Age 50 years Signup and view all the answers

What histologic feature is characteristic of hyperplastic polyps?

Non-malignant growth Signup and view all the answers

What is the expected timeframe for a benign adenomatous polyp to progress to carcinoma?

5-10 years Signup and view all the answers

In terms of gross description, which polyp type has a higher risk of developing into invasive cancer?

Sessile polyp Signup and view all the answers

What is the primary advantage of using a snare polypectomy during a colonoscopy?

It cuts through the base of the polyp while cauterizing concurrently. Signup and view all the answers

What is the recommended action if a suspicious polypoid lesion is detected?

Conduct a colonoscopy for visualization and potential polypectomy. Signup and view all the answers

Which imaging technique is specifically mentioned for the initial assessment of polyps?

CT Colonography Signup and view all the answers

Which of the following statements reflects the cost-effectiveness of colorectal cancer screening in the Philippines?

The interventions that save more lives are situated closer to the top left corner of the analysis. Signup and view all the answers

What is a prerequisite for performing a colonoscopy?

Sedation of the patient is necessary. Signup and view all the answers

What role do laxatives play prior to a colonoscopy?

They cleanse the bowel for clearer visualization. Signup and view all the answers

What can be inferred about insurance coverage for screening colonoscopy in the current context?

Patients may incur out-of-pocket expenses for the procedure. Signup and view all the answers

What does the surface pattern of a large polyp likely indicate?

It may warrant additional diagnostic procedures like biopsy. Signup and view all the answers

What screening test would be recommended for a 48 y/o male exhibiting changes in bowel movement and a history of smoking?

Colonoscopy every 10 years Signup and view all the answers

If a 45 y/o male is diagnosed with colorectal cancer, what screening should his children consider, based on risk factors?

Colonoscopy as early as age 35 Signup and view all the answers

Which of the following factors is a strong indicator for beginning colorectal cancer screening?

Experiencing changes in bowel movement Signup and view all the answers

Which of the following statements regarding colorectal adenomatous polyps is accurate?

They are pre-malignant lesions. Signup and view all the answers

What is the primary benefit of early detection of colorectal cancer through recommended screenings?

Can prevent the development of colorectal cancer. Signup and view all the answers

For individuals at average risk for colorectal cancer, what is the recommended approach to screening?

Colonoscopy every 10 years. Signup and view all the answers

What characteristic of colorectal cancer screening is emphasized in the case?

Colonoscopy is cost effective for high-risk individuals. Signup and view all the answers

What is a recommended colon cancer screening approach for patients under 50 years with a family history of colorectal cancer?

Colonoscopy starting at age 35 Signup and view all the answers

Which type of adenoma has the lowest potential to develop adenocarcinoma?

Tubular Adenoma Signup and view all the answers

Which type of adenoma advises repeat colonoscopy after 1 year?

Villous Adenoma Signup and view all the answers

Tubulo-villous Adenoma has the highest potential to develop adenocarcinoma.

False Signup and view all the answers

Which statement accurately describes a difference between FOBT and FIT?

FOBT detects peroxidase activity from all GI tract sources. Signup and view all the answers

What dietary consideration must be taken into account when using FOBT?

Limiting intake of red meat and vitamin C. Signup and view all the answers

Which of the following is true about FIT in comparison to FOBT?

FOBT is less specific for colon bleeding. Signup and view all the answers

What is a primary advantage of using FIT over FOBT?

FIT does not require dietary modifications. Signup and view all the answers

Which characteristic distinguishes FOBT from FIT?

FOBT can be affected by dietary intake. Signup and view all the answers

Study Notes

Colonic Polyps Overview

Colorectal polyps are grossly visible protrusions from the colorectal mucosa.
Prevalence: 30% of middle-aged individuals and over 50% of the elderly population have colorectal polyps.
Histopathologic classification includes non-neoplastic hamartoma, hyperplastic polyps, and adenomatous polyps (pre-malignant).

Pathophysiology

Inactivation of the APC gene initiates early adenoma development.
Activation of KRAS proto-oncogene leads to loss of DNA and adenoma expansion.
Mutations in TP53 (tumor suppressor gene) facilitate invasion and colorectal carcinoma development.

Colorectal Adenomatous Polyps

Classified into tubular adenomas (lowest cancer risk), tubulo-villous adenomas (intermediate risk), and villous adenomas (highest risk, recommend colonoscopy every year).
Average malignant transformation timeline: 5-10 years.

Risk Factors

Polyps are typically detected around age 50; screening age may be lowered to 45 in some regions.
Significant risk factor includes age, with over 50% of elderly individuals found to have polyps upon autopsy.
Family history of colorectal cancer necessitates early screening in first-degree relatives (e.g., if diagnosed at 48, screen relatives starting at 38).

Effects of COVID-19 Pandemic

During the pandemic, screening for colorectal cancer dropped by 80-90%, leading to an increase in missed colorectal cancer diagnoses.
Non-urgent medical care interruptions delayed essential screenings.

Detection and Screening

Recommended for high-risk individuals to undergo screening without delay; those with a history of symptoms should consider colonoscopy.
Common stool-based tests for average-risk individuals: FOBT (fecal occult blood test) and FIT (fecal immunochemical test).
Imaging tests such as CT colonography can assist but are not replacements for colonoscopy if abnormalities are suspected.

Screening Recommendations

Snare polypectomy is a common minimally invasive procedure used during colonoscopy to remove polyps.
Colonoscopy is ideal for patients with concerning symptoms, especially those above age 50 or with a history of smoking.

Cost Utility Analysis in the Philippines

Colorectal cancer screening is considered cost-effective as it saves lives.
Current barriers include lack of insurance coverage for screening colonoscopy.
Importance of follow-up screening for individuals with past bowel changes or family history of colorectal conditions.

Summary

Colorectal adenomatous polyps are pre-malignant lesions, necessitating early detection to prevent cancer.
Screening strategies are crucial, especially for high-risk individuals and those showing symptoms, with colonoscopy being the preferred diagnostic tool.

Histologic Classification of Adenomas

Tubular Adenoma
- Lowest risk of progressing to adenocarcinoma.
- Recommended to repeat colonoscopy every 3-5 years for monitoring.
Tubulo-villous Adenoma
- Intermediate risk of evolving into adenocarcinoma.
- Requires regular surveillance but with less frequency than the highest-risk type.
Villous Adenoma
- Highest risk of developing adenocarcinoma.
- Strong recommendation for repeat colonoscopy within 1 year to detect any changes early.

Stool-based Tests Overview

Two prominent stool-based tests for detecting gastrointestinal bleeding: FOBT (Fecal Occult Blood Test) and FIT (Fecal Immunochemical Test).

FOBT (Fecal Occult Blood Test)

Detects peroxidase activity, indicating potential blood in stool.
Results can be influenced by dietary factors:
- Plant peroxidases, such as those in cauliflower, may produce false positives.
- Consumption of red meat and vitamin C can alter accuracy, necessitating dietary restrictions prior to testing.
Capable of detecting bleeding from the entire gastrointestinal tract.

FIT (Fecal Immunochemical Test)

Utilizes antibodies to specifically detect globin, a component of hemoglobin.
Does not require any dietary modifications, simplifying patient preparation.
More focused than FOBT, as it detects colonic bleeding specifically, making it a more targeted test for colorectal issues.

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Description

This quiz covers the essential aspects of colorectal polyps, including their prevalence, classification, and pathophysiology. Learn about the risk factors and malignant transformation timelines associated with different types of adenomatous polyps. Ideal for students studying gastroenterology or related health sciences.