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Gastroentrology > 1: Colorectal Cancer > Flashcards

1: Colorectal Cancer Flashcards

1
Q

How common is colorectal cancer

A

Third most common UK cancer

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2
Q

How does incidence of colorectal cancer change

A

Increases with age.

Familial associated colorectal cancer may occur at a younger age.

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3
Q

How do the majority of colorectal cancers develop

A

adenoma-carcinoma sequence

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4
Q

Explain adenoma-carcinoma sequence

A

normal mucosa evolves to colonic adenoma (polyp) then progresses to invasive adenocarcinoma

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5
Q

what percentage of adenomas progress to adenocarcinomas

A

10%

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6
Q

What are two genetic syndromes that lead to colorectal cancer

A

HNPCC (Lynch)

Familial Adenomatous Polyposis

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7
Q

What gene is mutated in familial adenomatous polyposis

A

APC

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8
Q

What type of gene is APC

A

Tumour suppressor gene

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9
Q

What is Lynch syndrome also called

A

HNPCC

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10
Q

What genes are mutated in Lynch syndrome

A

DNA mismatch repair genes: MLH1 and MSH2

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11
Q

In HNPCC which side of the colon are tumours more likely to be

A

Right

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12
Q

What criteria is used to diagnose to identify lynch syndrome

A

Amsterdam

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13
Q

What is the amsterdam criteria for Lynch syndrome

A

3 Family members (one first generation)

2 Successive generations

1 Family member under 50-years

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14
Q

What are 5 risk factors for colorectal cancer

A 
Age 
FH
IBD
Low Fibre Diet 
High processed meat intake 
Smoking 
Alcohol
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15
Q

How do symptoms of colorectal cancer vary

A

Depending on location

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16
Q

What are 5 symptoms of left-sided colorectal cancer

A
  • Change bowel habbit
  • Rectal bleeding
  • Tenesmus
  • Mass LIF
  • Mass on PR
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17
Q

What are 3 symptoms of right-sided colorectal cancer

A
  • Abdominal pain
  • Occult bleed
  • Mass in RIF
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18
Q

How may colorectal bleeding on either side present

A
  • Change bowel habit
  • Rectal bleed
  • Weight loss
  • Abdominal pain
  • IDA
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19
Q

When should individuals >40y be sent for urgent investigation for bowel cancer

A

Unexplained weight loss

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20
Q

When should individuals >50y be sent for urgent investigation for bowel cancer

A

Rectal Bleeding

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21
Q

When should individuals >60y be sent for urgent investigation for bowel cancer

A

IDA

Or, change bowel habit

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22
Q

When should any individual be sent for bowel cancer assessment

A

+ve faecal occult blood test

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23
Q

When should a 2W referral for bowel cancer be made

A

If individuals have

  1. Abdominal mass
  2. Or, anal mass
  3. Or, <50 with rectal bleeding

AND one of:

a. abdominal pain
b. change bowel habit
c. weight loss
d. IDA

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24
Q

What type of cancer are colorectal cancers

A

adenocarcinomas

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25
Q

Where do 40% of colorectal cancers arise

A

rectum

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26
Q

Where do 30% of colorectal cancers arise

A

sigmoid colon

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27
Q

What stool test is ordered for colorectal cancer and what will it show

A

Faecal occult blood test - shows presence blood in stool

28
Q

What blood tests are ordered in colorectal cancer

A

FBC

CEA

29
Q

What will FBC show in colorectal cancer

A

microcytic anaemia (IDA) - especially if right-sided

30
Q

What is CEA used for in colorectal cancer

A

it is not diagnostic! but used to monitor response to treatment

31
Q

What is first-line imaging for colorectal cancer

A

colonoscopy and biopsy = gold-standard

32
Q

If a patient has several co-morbidities what is used as an alternative to colonoscopy

A

flexible sigmoidoscopy and barium enema

33
Q

What sign will be present on barium enema in colorectal cancer

A

apple core sign = construction lumen due to colorectal cancer

34
Q

What imaging is used to stage the disease

A

CT CAP

35
Q

Why may MRI be used in colorectal cancer

A

Assess risk of local recurrence

36
Q

When is endo-anal US used in colorectal cancer

A

Asses depth invasion of rectal cancers

37
Q

How is colorectal cancer staged

A

TNM Staging

38
Q

What was used previously to stage colorectal cancer

A

Duke’s staging

39
Q

What is Duke’s stage A

A

Confined to mucosa

40
Q

What is Duke’s stage B1

A

Extending to muscularis propria

No node involvement

41
Q

What is Duke’s stage B2

A

Penetrating through muscularis propria

No node involvement

42
Q

What is Duke’s stage C1

A

Extending to muscularis propria

Node involvement

43
Q

What is Duke’s stage C2

A

Penetrating through muscularis propria

Node involvement

44
Q

What is Duke’s stage D

A

Metastses

45
Q

What is the survival rate of Duke’s stage A

A

90

46
Q

What is the survival rate of Duke’s stage B

A

65

47
Q

What is the survival rate of Duke’s stage C

A

30

48
Q

What is the survival rate of Duke’s stage D

A

10

49
Q

Explain screening for bowel cancer

A
  • 55y = offered one-off flexible sigmoidoscopy
  • 65-74 = offered FIT every 2-years
  • > 75 = can request FIT every 2-years
50
Q

If faecal immunochemical testing is positive what are individuals offered

A

Colonoscope

51
Q

What is the aim of surgical intervention for bowel cancer

A

To remove location where tumour is (regional colectomy)

52
Q

What surgery will someone with ascending or caecal tumour receive

A

Right hemi-colectomy

53
Q

What surgery will someone with tumour in transverse colon receive

A

Extended right hemi-colectomy

54
Q

What surgery will someone with descending colon cancer receive

A

Left hemicolectomy

55
Q

What surgery will someone with sigmoid tumour receive

A

Sigmoidectomy

56
Q

What are indications for anterior resection

A

High anal tumour:

- >5cm from anal sphincter

57
Q

What is the advantage of anterior resection over AP resection

A

Anal sphincter remains intact

58
Q

When is abdominalperineal resection indicated

A

Low anal tumour:

<5cm from anus

59
Q

What does AP resection involve

A

Remove:
Distal colon
Rectum
Anal sphincter

60
Q

What does AP resection result in

A

Removal anal sphincter and permanent colostomy

61
Q

What is a Hartmann procedure indicated for

A

Emergency bowel obstruction

62
Q

What does a Hartmann procedure involve

A

Remove recto-sigmoid junction. Attach a colostomy and form a rectal stump.

63
Q

When is chemotherapy indicated for colorectal cancer

A

metastatic disease

64
Q

Why is radiotherapy not used for colon cancer

A

Damages the small bowel

65
Q

When may radiotherapy be used

A

Adjuvant rectal cancers

66
Q

What is used for palliation of colorectal cancer

A
  • Endoluminal stenting = if obstruction - often left-side

- Stoma formation

Gastroentrology (18 decks)

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