colon and small bowel

this mesorectal envelope is bulky with a smooth surface and no defects greater than 5 mm, no coning and a smooth regular radial margin

complete

this mesorectal envelope has moderate bulk and an irregular surface with defects greater than 5 mm, no visible muscularis mucosa, some coning and a moderately irregular radial margin

nearly complete

this mesorectal envelope has little bulk, irregular surface, coning, defects to the muscularis propria, irregular radial margin

incomplete

what does a better mesolectal envelop provide for the patient

decreased chance of recurrence

what two portions of the GI system have a circumferential margin completely unencased by peritoneum

esophagus and rectum

what is the margin for a left colon specimen and a right colon

retroperitoneal

what is the margin for a transverse colon and sigmoid

mesenteric

this is the most common neoplastic intestinal lesion and a precursor to adenocarcinoma, size correlates with malignancy and villous harbors cancer more often

adenoma

this is the most common malignancy of the GI tract, is polypoid more proximal and annular more distal

adenocarcinoma

this syndrome is from a mutation in the APC gene, at least 100 polyps needed for dx and colorectal cancer develops in 100% of untreated, patients are still at risk in other sites despite total colectomy tho

FAP

if there are multiple nodules/tumors in one specimen, what should you measure?

distance between the two

if there is a right colon specimen, what are two additional sections that might need to be taken

ileocecal valve, appendix

where is peritoneum for the proximal 1/3 rectum

anterior and lateral

where is the peritoneum for the middle third of rectum

anterior

what is an important exterior landmark on rectosigmoid specimens that needs to be mentioned in relationship to the tumor

anterior peritoneal reflection

what are the fat nodules dangling off the colon

epiploic appendices

if a rectal tumor has an epicenter greater than 2 cm proximal to the dentate line, what staging is used

rectal

what staging does a tumor that is less than 2 cm from the dentate line or between dentate and mucocutaneous

anal

what two locations does an APR tumor need to be measured to

anterior peritoneal reflection and dentate line

what pathology should you also look for in a sigmoid colon

diverticula

what are 7 genetic factors ad syndromes associated with colon differential diagnosis

FAP, Lynch, MSI, gardner, turcot, juvenile polyposis, peutz-jeghers

what is the stage for a colon tumor that invades the submucosa through the musclaris mucosae

pt1

what is the stage for a colon tumor that invades the muscularis propria

pt2

what is the stage for a colon tumor that invades through muscularis propria into the pericolorectal tissues

pt3

what is the stage of a colon tumor that invades through the visceral peritoneum, including gross perforation

pt4a

what is the stage of a colon tumor that directly invades or adheres to adjacent organs

pt4b

where do colon tumors metastasize

lungs, liver

what can colon tumors cause in the abdomen

peritoneal carcinomatosis

what therapy does microsattelite instability have better response to

immunotherapy

what therapy does microsattelite stable tumors have better response to

traditional chemo

twhat two factors can be associated with MSS and have the lowest survival

CIMP and BRAF

what pathway do MSS tumors follow

APC and WNT

what is CIMP

genome hypermethylation

if a colon tumor is recurrent, what is the stage?

there is no stage

what is the size of a t1 anal tumor

less than or equal to 2 cm

what is the size of a t2 anal tumor

greater than 2 cm and less than 5 cm

what is the size of a t3 anal tumor

greater than 5 cm

what is the criteria for a t4 anal tumor

any size invading adjacent organs

what can an early polypoid small bowel tumor cause

intussusception

where do neuroendocrine tumors usually reside

intramural or submucosal

what is invaded in a t1a small bowel tumor

laminate propria

what is invaded in a t1b tumor

submucosa

what is invaded in a t2 small bowel tumor

muscularis propria

what is invaded in a t3 small bowel tumor

subserosa or mesentery/retroperitoneum

what is invaded in a t4 small bowel tumor

visceral peritoneum, other organs

where are the common mets for a small bowel

regional lymph nodes, liver, peritoneal cavity, lung

what is one of the most important prognostic factors for small bowel tumors

lymph node mets

what site is worse with small bowel tumors

duodenum

where do GISTs usually mets

liver and intrabdominal tissue

what are three prognostic factors associated with NETS

size, location, ki-67

what are the three forms of appendices adenocarcinoma

mucin, non mucin, goblet cell

where do mucinous adenocarcinoma appendices tumors mets

peritoneal cavity

where do non mucinous adenocarcinomas of the appendix mets

other sites on peritoneum like ovaries

colon resection tumor OR total

88309

colon resection not tumor

88307

colon colostomy. stoma

88304

gallbladder excision

88304

gastrointestinal bypass tissue

88305

peritoneum resection not tumor

88307

peritoneum resection tumor

88309

rectocele

88302

small intestine or stomach for morbid obesity

88305

small intestine not tumor

88307

small intestine tumor

88309

mesentery not tumor

88305

mesentery tumor

88307