19. Tumors of the large bowel (symptoms, diagnosis, treatment)

Question 1

Most common colorectal cancers

Answer 1

Colorectal carcinoma – 3rd most common cancer,

>60 y.o., adenocarcinoma

Question 2

Predisposing factors

Answer 2

Neoplastic polyps, IBD, genetics, diet, alcohol, smoking

Question 3

Presentation, left sided

Answer 3

• rectal bleeding/mucus
• altered bowel habits
• obstruction
• rectal mass/tenesmus (need to pass stool)

Question 4

Presentation, right sided

Answer 4

• weight loss
• Hb decrease
• abdominal pain

Question 5

Presentation on both sides

Answer 5

• abdominal mass
• perforation
• hemorrhage
• fistula

Question 6

Tests

Answer 6

• CBC
• fecal occult blood
• sigmoidoscopy/colonoscopy
• LFT
• CEA

Question 7

Spread

Answer 7

• local
• lymphatic
• hematogenous (liver, lung, bone)
• transcoelomic

Question 8

Surgery

Answer 8

Laparascopic

Question 9

Surgical treatment: Cecal, ascending or proximal transversal

Answer 9

Right hemicolectomy

Question 10

Surgical treatment: Distal transverse or ascending

Answer 10

Left hemicolectomy

Question 11

Surgical treatment: Sigmoid

Answer 11

Sigmoid colectomy

Question 12

Surgical treatment: Low sigmoid/high rectal

Answer 12

Anterior resection

Question 13

Surgical treatment: Low rectum (max. 8cm from anus)

Answer 13

Abdominoperineal resection: permanent

colostomy and removal of rectum and anus

Question 14

Surgical treatment: Emergency bowel obstruction, palliation or perforation

Answer 14

Hartmann’s procedure

Question 15

Surgical treatment: Localized rectal disease

Answer 15

Transanal endoscopic microsurgery

Question 16

palliative treatment in malignant obstruction

Answer 16

Endoscopic stenting

Question 17

If tumor causes obstruction

Answer 17

can make temporary stoma, remove the tumor and close the stoma after healing = Stoma reversal

Question 18

Radiotherapy

Answer 18

mostly palliative, occasionally preoperatively to allow resection, only postop. if high recurrence risk

Question 19

Chemotherapy

Answer 19

beneficial for stage 3 (and somewhat stage 2), FOLFOX regimen (5FU,folinic acid, oxaliplatin)