Colorectal Cancer Quiz

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Created by Connor Bohlken and Chris Galbraith
Edited by Dr. Paris Ingledew

You are a student with a keen interest in histology. Sadly, not many of your colleagues share the same passion. Of course, this doesn’t stop you from asking everyone to name the five layers of the bowel wall from the lumen outward. When they get the answer wrong, a slight smirk forms as you state:

1 point

Submucosa, Mucosa, Muscularis Propria, Serosa, Subserosa

Submucosa, Mucosa, Muscularis Propria, Subserosa, Serosa

Subserosa, Serosa, Submucosa, Mucosa, Muscularis Propria

Mucosa, Submucosa, Muscularis Propria, Subserosa, Serosa

Muscularis Propria, Mucosa, Submucosa, Serosa, Subserosa

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You are a R2 Family Practice Resident working in clinic with Dr. Notazebra. Dr. Notazebra is a big fan of the phrase “common is common” and she is known for stressing the importance of having a handle on common pathologies. One of her passions is cancer. She asks you, amongst the different forms of cancer, do you know how common colorectal cancer is in the general population? You answer:

1 point

Colorectal cancer is estimated to be the 3rd most common cancer, the lifetime incidence is approximately 7%.

Colorectal cancer is the most common cancer, the lifetime incidence is approximately 15%.

Colorectal cancer is a relatively rare form of cancer, the lifetime incidence is approximately 0.5%.

Colorectal cancer is the 2nd most common cancer, the lifetime incidence is approximately 10%.

Colorectal cancer is amongst the rarest forms of cancer, the incidence of which is only 5-10 cases / 1,000,000 annually.

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You are working in the emergency department and have just picked up a new chart. The patient is Mr. Cole Lawn, a 64 year sedentary male with a past medical history of inflammatory bowel disease who is presenting with weight loss, bowel changes, and bright red blood per rectum. You really don’t feel like doing a DRE this morning so hand the case off to your student. Your student reports back and says that Mr. Lawn also endorses alcohol use, and interestingly hereditary nonpolyposis colorectal cancer syndrome (HNPCC). Physical exam is largely non-contributory but the student indicates there was some blood on DRE. You note that this patient has many risk factors for colorectal cancer. You proceed to ask your student: amongst the general population, what is the most important risk factor for colorectal cancer?

1 point

Age

Inflammatory Bowel Disease

Sedentary Lifestyle

Alcohol Use

HNPCC

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You are working in an outpatient clinic, and your next patient is Mr. Fit. He is a 50 year old otherwise healthy gentleman whose passion is preventative health measures. He read online that 50 is the age to begin screening for colorectal cancer, and has come to get it started. Which of the following is an appropriate screening regimen for this patient?

1 point

DRE annually from 50-74

FIT q2 years from 50-74

Barium Enema q3 years from 50-74

Colonoscopy q5 years from 50-74

Sigmoidoscopy q5 years from 50-74

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You are a fourth year medical student on a family practice elective. You are working with Dr. Inhairatid. Today you are seeing Alina-paige Chevalier, a 15 year old patient of his known to have Familial Adenomatous Polyposis (FAP). Dr. Inhairatid did his undergraduate degree in molecular genetics and has a special place in his heart for genetics. He asks you, how often should this patient be screened for colorectal cancer?

1 point

Starting at the age of 50, choose between FIT every 2 years or flexible sigmoidoscopy every 10 years.

Starting at the age of 40, colonoscopy every 5 to 10 years.

Starting at the age of puberty, flexible sigmoidoscopy every year.

Starting at the age of 40, FIT every 1 to 2 years.

This patient’s condition confers a resistance to colorectal cancer, they do not need to be screened!

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You are on the final week of your surgery rotation. Your colleague lucked out and is second assist on a Whipple. You did not luck out, and have a slate of 15 colonoscopies. You are with Dr. Noscope, an aspiring artist who paints pictures of polyps. Somehow they sell for 200$ a piece at the local market. After freezing the screen on what seems like the millionth polyp Dr. Noscope says “Ahhh, I’m no pathologist but I’ll bet we got a high risk polyp here. Can you tell me a feature that makes a polyp high risk”? You answer:

1 point

Tubular Adenoma > 0.5cm

Hamartoma

Pedunculated Adenoma

Sessile Serrated Adenoma > 0.5cm

Villous Adenoma

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You are working in a family practice clinic. Your patient is Mr. Spread, a 74 year old male who was originally presented with bright red blood per rectum (BRBPR) and a change in his bowel habits. He had stat colonoscopy and was found to have an extensive Adenocarinoma in his left colon. Unfortunately he was determined to not be a candidate for surgery. He is a lifetime non-drinker or smoker and otherwise has no known medical conditions. He is now presenting with a three day history of dyspnea and a feeling of abdominal distention. His wife also commented to him the other day that he was looking a bit yellow. He wants to know what is going on with him, he tells you “Give it to me straight doc, you know me, what do you think might be going on. You answer:

1 point

Your presentation is suspicious for congestive heart failure (CHF).

Your presentation is suspicious for cirrhosis.

Your presentation is suspicious for metastasis to your liver.

Your presentation is suspicious for hemolytic anemia secondary to infection with Malaria.

Your presentation is suspicious for crohn's disease.

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You have just finished seeing Mr. Wrek Tul a 73 year male who presented with fatigue, abdominal pain, weight loss, and bright red blood per rectum. You are worried that this might be colorectal cancer, and report back to your attending. You would like to order a CBC, electrolytes, creatinine, urea, a CT abdo / pelvis, and refer the patient to gastrology for a colonoscopy. Your attending is impressed with your workup, but asks if there are any tumor markers you would like to consider. You answer:

1 point

AFP

CA 19-9

CA-125

CEA

PSA

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You are a third year medical student who has just started their third year clinical rotation in Oncology. Today you will be working with Dr. Terhd, who primarily treats colorectal cancers. You begin the day with a quick review of TNM staging. To gauge your knowledge he asks the following: If you have a patient with a known colorectal cancer that has the following characteristics: The tumor invades through the muscularis propria, there is 1 regional lymph node, and metastasis confined to the liver, what TNM stage would it be?

1 point

T2, N1c, M0

T3, N0, M0

T1, N1a, M1a

T3, N1a, M1a

T2, N1a, M1a

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You are a third year medical student on your general surgery rotation. You have just seen the following patient in the clinic. Mrs. Whatchagonnado, who has known colorectal cancer with the following characteristics: It is a T2,N0,M0, 5 cm adenocarcinoma in the right colon. She would like definitive treatment and has no medical comorbidities that would make her a poor candidate for any treatments.. Your attending, Dr. Healwithsteel, asks: “So…. How are we going to treat this patient?”

1 point

Local Excision

Bowel Resection

Radiation

Chemotherapy

Targeted Therapy

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Which of the following are components of the routine follow-up for those who have undergone primary treatment for colorectal cancer?

1 point

Colonoscopy, Imaging, Laboratory work, and physical exam / history, with different schedules based on the stage of the cancer.

Serum CEA exclusively, if you get a single low value you can be certain there has been no recurrence.

Colonoscopy annually for three years as the most important phase of follow-up is the first three years.

No follow-up is necessary as treatment for colorectal cancer is typically definitive.

Monitor clinically based on signs and symptoms.

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