Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + TEST TAKING TIPS Download Section PDF Listen +++ ++ Test Taking Tips Questions regarding colorectal anatomy, physiology, and pathology are all too common on the ABSITE – while most subjects are fair game there are common themes tested. Comparing and contrasting ulcerative colitis and Crohn disease will always draw a question or two while other benign conditions such as volvulus and diverticulitis will garner questions about nonoperative and operative management. Colorectal cancer is a broad topic with many items, which may be tested. Know the proto-oncogenes and tumor suppressor genes associated with the condition, as well as the eponymous diseases, which are risk factors or markers for the development of malignancy. It is also helpful to know the treatment of the different stages of colorectal cancer in regards to neoadjuvant and adjuvant chemotherapy as well as radiotherapy. + ANATOMY AND PHYSIOLOGY Download Section PDF Listen +++ +++ Where does the hindgut begin and end? ++ Hindgut begins at distal third of the transverse colon and extends to the rectum +++ The hindgut relies on which artery for its blood supply? ++ Inferior mesenteric artery +++ What are the white lines of Toldt? ++ The lateral peritoneal reflections of the ascending and descending colon +++ What parts of the gastrointestinal (GI) tract do not have a serosa? ++ Esophagus, middle, and distal rectum +++ What are the major anatomic differences between the small bowel and colon? ++ The small bowel is smooth, whereas the colon has fat appendages (appendices epiploicae), haustra, and taenia coli +++ What is the arterial blood supply to the rectum? ++ Proximal: superior hemorrhoidal artery (superior rectal artery) from the inferior mesenteric artery Middle: middle hemorrhoidal artery (middle rectal artery) from the hypogastric artery (internal iliac artery) Distal: inferior hemorrhoidal artery (inferior rectal artery) from the pudendal artery, which is a branch of hypogastric artery (internal iliac artery) +++ What is the venous drainage of the rectum? ++ Proximal: inferior mesenteric vein that joins the splenic vein to drain into the portal vein Middle: iliac vein into the inferior vena cava Distal: iliac vein into inferior vena cava ++ FIGURE 20-1. Arterial supply to the rectum and anal canal. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz Principles of Surgery. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ What is the purpose of the colon? ++ Water, sodium, and bile salt absorption and stool storage +++ What is the main nutrient of a colonocyte? ++ Short-chain fatty acids (SCFA) (butyrate) +++ How long is the rectum? ++ 12 to 15 cm +++ What are the approximate proximal and distal extents of the anal canal/rectum/rectosigmoid junction from the anal verge? ++ Anal canal: 0 to 5 cm Rectum: 5 to 15 cm Rectosigmoid junction: 15 to 18 cm +++ What 2 points are considered to mark the location of the rectosigmoid junction? ++ The distal point at which the taeniae converge at the level of the sacral promontory +++ What do anatomists consider the distal extent of the rectum versus what surgeons consider the distal extent of the rectum? ++ Anatomists: dentate line Surgeons: proximal border of the anal sphincter complex +++ What is the eponym for the extension of the peritoneal cavity between the rectum and back wall of the uterus in the female human body? ++ Pouch of Douglas (Ehrhardt-Cole Recess/rectouterine excavation/rectouterine pouch) +++ What is the deepest point of the peritoneal cavity in women? ++ Pouch of Douglas +++ What is another name for the rectovesicular fascia in men/rectovaginal fascia in women? ++ Denonvilliers fascia +++ What is the eponym for a mass that forms in the pelvic cul-de-sac from a drop metastases from a visceral tumor that may be detected by a digital rectal examination? ++ Bloomer shelf +++ What is the thick condensation of endopelvic fascia that connects the presacral fascia to the fascia propria at the level of S4, which then extends to the anorectal ring called? ++ Waldeyer fascia (rectosacral fascia) +++ What artery is contained within the lateral rectal stalks? ++ The middle rectal artery +++ What muscles make up the pelvic floor (pelvic diaphragm)? ++ Pubococcygeus, iliococcygeus, puborectalis (which form the levator ani) +++ Where does the pelvic floor (pelvic diaphragm) lie? ++ Between the pubis, obturator fascia, sacrum, and ischial spines +++ What artery runs close to the bowel in the mesentery as part of a vascular arcade that connects the superior mesenteric artery and inferior mesenteric artery? ++ The marginal artery of Drummond +++ What artery found low in the mesentery, near the root, is part of a vascular arcade that connects the proximal middle colic artery to the proximal inferior mesenteric artery? ++ The arc of Riolan (meandering mesenteric artery) +++ What is the most proximal branch of the inferior mesenteric artery? ++ Left colic artery +++ Describe the venous drainage of the colon and rectum? ++ Right and proximal transverse colon drain into the superior mesenteric vein, which joins with the splenic vein to become the portal vein Distal transverse colon, descending colon, sigmoid, and most of the rectum drain into the inferior mesenteric vein, which drains into the splenic vein that joins with the superior mesenteric vein to become the portal vein Anal canal drains by way of the middle and inferior rectal veins into the internal iliac veins, which drain into the inferior vena cava +++ What nodal chain do lymphatics from the colon and proximal two-thirds of the rectum drain into? ++ Para-aortic nodal chain +++ What nodal chains do lymphatics from the distal rectum and anal canal drain into? ++ Para-aortic nodal chain or superficial inguinal nodal chain +++ What kind of neurologic injury after rectal surgery generally results in sympathetic dysfunction characterized by retrograde ejaculation and bladder dysfunction? ++ Severing of the hypogastric nerves near the sacral promontory +++ What kind of neurologic injury after rectal surgery generally results in impotence and atonic bladder? ++ Injury to the mixed parasympathetic and sympathetic periprostatic plexus +++ What is the most prevalent species of bacteria in the colon? ++ Bacteroides species +++ What is the most common aerobe in the colon? ++ Escherichia coli +++ In what colonic segment are bacteria the most metabolically active? ++ The cecum +++ How is diarrhea defined? ++ >3 loose stools/d +++ How is constipation defined? ++ <3 stools/wk +++ What are absolute contraindications to bowel preparation? ++ Complete bowel obstruction, free perforation + DIVERTICULITIS Download Section PDF Listen +++ +++ How are the diverticula with colonic diverticulosis formed? ++ Mucosa herniates through the colon at sites of penetration of the muscular wall by arterioles on the side of the antimesenteric taeniae +++ What area of the colon is most commonly affected by diverticula? ++ Sigmoid colon (80%) +++ What segment of the colon has the smallest intraluminal diameter? ++ Sigmoid colon +++ What is the treatment for uncomplicated diverticulitis? ++ Antibiotics on an outpatient basis; if patient has significant pain (localized peritonitis), admit to the hospital and give intravenous (IV) antibiotics for ~48 hours +++ How should patients be followed after an episode of uncomplicated diverticulitis? ++ After symptoms have subsided for at least 3 weeks, a colonoscopic examination should be performed to establish the presence/location of the diverticula and to exclude cancer (mimic diverticulitis) +++ What is the approximate chance of a patient who recovered from an initial episode of uncomplicated diverticulitis developing a second attack of diverticulitis? ++ <25% +++ What is the estimated percentage of patients who recovered from an initial episode of uncomplicated diverticulitis requiring a subsequent emergency colectomy or colostomy? ++ ~5% +++ Although controversial, what types of patients might you offer an elective sigmoid colectomy? ++ Young patients with an episode of diverticulitis (<45 years old), patients with 2 episodes of diverticulitis, and immunocompromised patients +++ What is the treatment for an abscess complicating diverticulitis? ++ The preferred treatment is computed tomography (CT) or ultrasound-guided percutaneous drainage or drainage of a pelvic abscess into the rectum through a transanal approach followed by elective surgery ~6 weeks after drainage of the abscess when the patient has completely recovered from the infection versus a more undesirable transabdominal approach by laparotomy +++ What are the 2 causes of generalized peritonitis resulting from diverticulitis? ++ A perforated diverticulum into the peritoneal cavity that is not sealed by the body's normal defenses; an initially localized abscess that expands and suddenly bursts into the peritoneal cavity +++ What procedure would you perform for generalized peritonitis from perforated diverticulitis? ++ A Hartmann procedure: resection of the diseased sigmoid colon; creation of a descending colostomy using noninflamed tissue; closure of the divided end of the rectum with suture/staples +++ What is the usual time period to wait before restoring intestinal continuity by reversing a Hartmann procedure for perforated diverticulitis? ++ At least 10 weeks (when patient has completely recovered from their illness) +++ What is the Hinchey classification grading system for diverticulitis? ++ Stage I Diverticulitis with associated pericolic abscess Stage II Diverticulitis associated with distant abscess (retroperitoneal or pelvic) Stage III Diverticulitis associated with purulent peritonitis Stage IV Diverticulitis associated with fecal peritonitis + VOLVULUS Download Section PDF Listen +++ +++ What is the most common colonic segment to be involved in a volvulus? ++ Sigmoid colon +++ What is the least common colonic segment to be involved in a volvulus? ++ Transverse colon +++ What is a cecal bascule? ++ The cecum folds anteromedial to the ascending colon from the presence of a constricting band across the ascending colon +++ What findings might you see on plain film, CT scan, and barium enema with a sigmoid volvulus? ++ Plain film: bent inner tube with apex in the right upper quadrant CT scan: mesenteric whorl Barium enema: bird's beak deformity +++ What is the treatment for sigmoid volvulus? ++ Appropriate resuscitation; decompression with placement of a soft rectal tube through the proctoscope past the twist of the volvulus and leaving the rectal tube in place If a rectal tube cannot be passed, detorsion of the volvulus with a colonoscope If unable to detorse volvulus by rectal tube or colonoscopy, perform Hartmann operation procedure Confirm the reduction with an abdominal radiograph, attempt a full colonoscopic examination after cleansing the bowel with cathartics, perform an elective sigmoid colon resection +++ What is the recurrence rate for sigmoid volvulus without surgical intervention? ++ ~50% +++ What is a cecal (cecocolic) volvulus? ++ An axial rotation of the terminal ileum, cecum, and ascending colon with concomitant twisting of the associated mesentery from a lack of fixation of the cecum to the retroperitoneum +++ What might you see on plain abdominal radiographs with a cecal volvulus? ++ A gas-filled comma shape with the concavity facing inferiorly and to the right (upside down comma sign), a circular shape with a narrow, triangular density pointing to the right and superiorly, a dilated cecum displaced to the left side of the abdomen +++ What is the treatment for a cecal volvulus? ++ The procedure of choice is a right colectomy with primary anastomosis; if frankly gangrenous bowel, resect right colon and create an ileostomy; cecopexy is another option (higher recurrence rates) + OBSTRUCTION Download Section PDF Listen +++ +++ What is the most common cause of large intestinal obstruction in the United States? ++ Colorectal cancer +++ What is the most common cause of large intestinal obstruction in Russia, Eastern Europe, and Africa? ++ Colonic volvulus (high-fiber diets) +++ What is a closed loop obstruction? ++ An obstruction featuring the occlusion of the proximal and distal parts of the bowel ++ FIGURE 20-2. Acute colonic pseudo-obstruction, with a markedly dilated proximal colon; endoscopy confirmed no distal obstruction. (Zinner MJ, Ashley SW. Maingot's Abdominal Operations. 11th ed. http://www.accesssurgery.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.) Graphic Jump LocationView Full Size||Download Slide (.ppt) +++ What is pseudo-obstruction of the colon otherwise known as? ++ Ogilvie syndrome +++ What study should be performed in all stable patients with a suspected diagnosis of colonic pseudo-obstruction? ++ Water-soluble contrast enema can reliably differentiate between mechanical obstruction and pseudo-obstruction; can consider colonoscopy +++ What is the treatment for Ogilvie syndrome? ++ Initial treatment with nasogastric decompression, fluid replacement, correction electrolyte abnormalities, discontinuation of all medications that inhibit bowel motility, serial abdominal examinations and radiographs; consider administration of 2.5 mg of neostigmine given intravenously over 3 minutes after ruling out distal obstruction with water-soluble contrast enema or colonoscopy (do not give to patients with significant cardiac history and watch for bradycardia by monitoring patient with telemetry during administration of the drug with atropine immediately available); can consider colonoscopic decompression but high recurrence +++ What is the Law of Laplace? ++ Tension is directly proportional to increased pressure times radius. Stated differently, for a given pressure, increased radius requires increased wall thickness to accommodate a stable wall tension; also, increased pressure requires increased thickness to maintain a stable wall tension. It is remembered by the following equation: T = ½ (P × R)/t (T = wall tension, P = pressure, R = radius, T = wall thickness) The law explains why the cecum, with its largest diameter, is the most common site of colonic rupture secondary to distal obstruction or increased pressure (eg, overzealous insufflations with excessive air during colonoscopy). + ULCERATIVE COLITIS Download Section PDF Listen +++ +++ What layers of the bowel wall are affected by ulcerative colitis? ++ Mucosa and submucosa +++ What is the sine qua non of ulcerative colitis? ++ Rectal involvement (proctitis) +++ What diagnostic characteristics of ulcerative colitis help differentiate it from Crohn disease? ++ Continuous, uninterrupted inflammation of the colonic mucosa beginning in the distal rectum and extending proximally (Crohn disease features normal segments of colon [skipped areas] interspersed between distinct segments of colonic inflammation), ulcerative colitis does not involve the terminal ileum, except with backwash ileitis; ulcerative colitis affects the mucosa and submucosa where Crohn can have transmural involvement +++ What 3 features are suggestive of a malignant stricture in the setting of ulcerative colitis? ++ Stricture appears later in the course of ulcerative colitis; stricture is proximal to the splenic flexure and causes large bowel obstruction +++ What are the extraintestinal manifestations of ulcerative colitis? ++ Arthritis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, primary sclerosing cholangitis +++ What extraintestinal manifestation of ulcerative colitis does not improve with colectomy? ++ Primary sclerosing cholangitis, ankylosing spondylitis +++ What are the American Cancer Society guidelines regarding surveillance colonoscopy for ulcerative colitis patients? ++ Colonoscopy every 1 to 2 years beginning 8 years after the onset of pancolitis 12 to 15 years after the onset of left-sided colitis +++ What classes of drugs are used in the treatment of ulcerative colitis? ++ Aminosalicylates (sulfasalazine, mesalamine) Corticosteroids (prednisone) Immunosuppressive agents (azathioprine, cyclosporine) +++ What are indications for surgery in a patient with ulcerative colitis? ++ Dysplasia-carcinoma, longstanding disease, intractability, massive colonic bleeding, toxic megacolon (may consider surgery for malnutrition/growth retardation in pediatric/adolescent patients), persistent obstruction or stricture, perforation +++ What is the treatment for toxic megacolon? ++ Nasogastric decompression; IV hydration (with consideration given to IV hyperalimentation depending on length of illness before fulminant episode and patient's nutritional status); broad-spectrum IV antibiotics; high-dose IV steroids if patient is steroid-dependent; follow with serial abdominal exams and leukocyte counts, if deteriorates or if lack of improvement with medical therapy for 24–48 hours, perform an urgent procedure +++ What is the preferred operation for toxic megacolon? ++ Total abdominal colectomy with ileostomy and preservation of the rectum +++ What is the procedure of choice in a patient with massive hemorrhage from ulcerative colitis? ++ Subtotal colectomy; if severe bleeding from rectal mucosa, may also require emergency proctectomy +++ What are your options for elective surgery in patients with ulcerative colitis? ++ Total proctocolectomy with ileostomy; restorative proctocolectomy with ileal pouch anal anastomosis; total proctocolectomy with a continent ileal reservoir (Kock pouch) + CROHN DISEASE Download Section PDF Listen +++ +++ What are indications for surgery in a patient with Crohn disease? ++ Cancer Fistula Fulminant colitis Growth retardation Intra-abdominal abscess Intractability Toxic megacolon Massive bleeding Intestinal obstruction +++ What operation would you perform for massive bleeding from Crohn disease? ++ Abdominal colectomy and ileostomy versus ileorectal anastomosis if the rectum is not inflamed + INFECTIOUS AND ISCHEMIC COLITIS Download Section PDF Listen +++ +++ What organisms should be evaluated for in a stool sample from a patient with suspected infectious colitis? ++ Campylobacter jejuni, Yersinia enterocolitica, Salmonella typhi, Clostridium difficile +++ What is the most common form of intestinal ischemia? ++ Colonic ischemia +++ What sign may be seen on radiographic imaging with intestinal wall edema or submucosal hemorrhage? ++ Thumb printing +++ Which colonic segment is the most prone to ischemia? ++ Splenic flexure and rectosigmoid junction (Griffith and Sudeck point) +++ What are indications for surgery with acute colonic ischemia? ++ Peritoneal signs, massive bleeding, universal fulminant colitis with or without toxic megacolon + LYNCH SYNDROMES (HEREDITARY NONPOLYPOSIS COLON CANCER) Download Section PDF Listen +++ +++ What are the Amsterdam criteria for Hereditary Nonpolyposis Colorectal Cancer (HNPCC)? ++ "3,2,1" At least 3 first-degree relatives with colon cancer and all of the following: 2 successive generations affected At least 1 case of colon cancer diagnosed before age 50 years; familial adenomatous polyposis excluded +++ What is the difference between the Amsterdam criteria and the modified Amsterdam criteria? ++ The modified Amsterdam criteria is almost the same as the Amsterdam criteria, except that with the modified Amsterdam criteria the cancer must be associated with HNPCC (colon, endometrium, small bowel, ureter, renal pelvis) instead of specifically colon cancer +++ What are the screening recommendations for patients with HNPCC? ++ Colonoscopy at age 20 to 25 years and repeat every 1 to 3 years Transvaginal ultrasound or endometrial aspirate at age 20 to 25 years and repeat annually +++ What is the mainstay of the diagnosis of HNPCC? ++ A detailed family history +++ What is the procedure of choice when colon cancer is detected in a patient with HNPCC? ++ Abdominal colectomy with ileorectal anastomosis If the patient is female with no further plans for childbearing, prophylactic total abdominal hysterectomy and bilateral salpingo-oophorectomy are recommended + FAMILIAL ADENOMATOUS POLYPOSIS Download Section PDF Listen +++ +++ What are the screening recommendations for patients with familial adenomatous polyposis(FAP)/Gardner syndrome? ++ Flexible proctosigmoidoscopy at age 10 to 12 years and repeat every 1 to 2 years until age 35, after age 35 repeat every 3 years Upper GI endoscopy every 1 to 3 years starting when polyps are first identified +++ What is the most commonly recommended procedure for the treatment of FAP syndrome? ++ Restorative proctocolectomy with ileal pouch anal anastomosis with distal rectal mucosectomy Alternative includes total abdominal colectomy with ileorectal anastomosis +++ What percentage of patients with the adenomatous polyposis coli (APC) mutation express the gene? ++ 100% +++ Do you have to worry about duodenal and ampullary polyps found in a patient with FAP syndrome? ++ Yes, because the duodenal and ampullary polyps are usually neoplastic All large polyps should be removed with endoscopic polypectomy, and pancreatoduodenectomy (Whipple procedure) is indicated with ampullary cancer discovered at an early stage +++ How many juvenile polyps need to be present to make the diagnosis of familial juvenile polyposis? ++ 10 juvenile polyps + POLYPS AND COLON CANCER Download Section PDF Listen +++ +++ What are the most common colonic polyps? ++ Hyperplastic polyps +++ Are hyperplastic polyps considered to have malignant potential? ++ No, but adenomatous changes can be found in hyperplastic polyps +++ What autosomal dominant syndrome is characterized by a combination of hamartomatous polyps of the intestinal tract and hyperpigmentation of the buccal mucosa, lips, and digits? ++ Peutz-Jeghers syndrome +++ T or F: patients with Peutz-Jeghers syndrome are not at increased risk for the development of cancer? ++ False; Peutz-Jeghers syndrome is associated with an increased risk for cancer throughout the intestinal tract, from the stomach to the rectum and extraintestinal malignancies (breast, ovary, cervix, fallopian tubes, thyroid, lung, gallbladder, bile ducts, pancreas, testicles) +++ What is the approximate lifetime risk of colon cancer in the general US population? ++ 6% +++ The APC gene is located on what chromosome? ++ Chromosome 5q21 +++ What kind of gene is the APC gene? ++ Tumor suppressor gene +++ What is the most frequently mutated tumor suppressor gene in human neoplasia? ++ p53 +++ On what chromosome can p53 be found? ++ Chromosome 17p +++ On which chromosome can the ras proto-oncogene be found? ++ Chromosome 12 +++ What do right-sided colon cancers tend to do? ++ Bleed +++ What do left-sided colon cancers tend to do? ++ Obstruct +++ What is the gold standard for establishing the diagnosis of colon cancer? ++ Colonoscopy +++ In patients with colon cancers causing a complete obstruction, what study can you order to establish the anatomic level of the obstruction when colonoscopy cannot be performed? ++ A water-soluble contrast enema +++ What is the treatment for an obstructing cancer of the proximal colon? ++ Right colectomy with primary anastomosis between the ileum and the transverse colon +++ What is the procedure of choice for a colon tumor involving the cecum, ascending colon, or the hepatic flexure? ++ Right hemicolectomy +++ What is the procedure of choice for most transverse colon tumors? ++ Extended right hemicolectomy +++ What is the procedure of choice for a descending colon tumor? ++ Left hemicolectomy +++ What is the procedure of choice for a sigmoid colon tumor? ++ Sigmoidectomy +++ When is abdominal colectomy for colon cancer indicated? ++ Patients with multiple primary tumors Individuals with HNPCC Occasionally for patients with completely obstructing sigmoid cancers + AJCC TNM STAGING Download Section PDF Listen +++ +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a Tis lesion? ++ Carcinoma in situ: intraepithelial or invasion of lamina propria +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a T1 lesion? ++ Tumor invades submucosa +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a T2 lesion? ++ Tumor invades muscularis propria +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a T3 lesion? ++ Tumor invades through the muscularis propria into the subserosa, or into nonperitonealized pericolic or perirectal tissues +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a T4 lesion? ++ Tumor directly invades other organs or structures and/or perforates visceral peritoneum +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is N0 nodal status? ++ No regional lymph node metastasis +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is N1 nodal status? ++ Metastasis in 1 to 3 regional lymph nodes +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is N2 nodal status? ++ Metastasis in 4 or more regional lymph nodes +++ According to the AJCC TNM Staging System for Colorectal Cancer, what does M0 mean? ++ No distant metastasis +++ According to the AJCC TNM Staging System for Colorectal Cancer, what does M1 mean? ++ Distant metastasis +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage 0 colon cancer? ++ Tis, N0, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage I colon cancer? ++ T1, N0, M0; T2, N0, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IIA colon cancer? ++ T3, N0, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IIB colon cancer? ++ T4, N0, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IIIA colon cancer? ++ T1-2, N1, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IIIB colon cancer? ++ T3-4, N1, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IIIC colon cancer? ++ Any T, N2, M0 +++ According to the AJCC TNM Staging System for Colorectal Cancer, what is a stage IV colon cancer? ++ Any T, Any N, M1 +++ What is the 5-year survival rate for patients who undergo appropriate resection of a T stage 1 colon cancer? ++ ~95% +++ What is the 5-year survival rate for a patient with stage II colon cancer treated by appropriate surgical resection? ++ ~80% +++ What is the survival rate for stage III cancer treated by surgery alone? ++ ~65% +++ What is the 5-year survival rate for a patient with colon cancer with distant metastatic disease (stage IV)? ++ <10% +++ What would you do if you found an isolated hepatic or pulmonary lesion while performing a right colectomy for colon cancer? ++ Attempt to resect the isolated hepatic/pulmonary metastasis +++ What stage of colon cancer shows a clear benefit with chemotherapy? ++ Stage III colon cancer +++ What is FOLFOX? ++ Oxaliplatin, 5-fluorouracil, leucovorin regimen +++ What is Xeloda? ++ Capecitabine (an oral fluoropyrimidine) +++ What is bevacizumab (Avastin)? ++ A monoclonal antibody that is a vascular endothelial growth factor inhibitor +++ What is cetuximab (Erbitux)? ++ A monoclonal antibody that binds to and inhibits the epidermal growth factor receptor (EGFR) +++ What percentage of colon cancer recurrences is detected within 2 years of the time of resection? ++ ~85%