3- colorectal cancer diagnosis & therapy Flashcards
what are some epidemiology facts about colon cancer?
- 2nd most common cause of cancer death
- most common in people over 65 but now getting more common for people who are younger
- 5 year survival 50%
- most arise on left side
- we think they arise from a polyp
what are risk factors for colon cancer?
- Older age
- Low intake of fibre
- High intake of fat, sugar, alcohol, red meat, processed meats
- Obesity
- Smoking
- Lack of physical exercise
what are ways cancer can spread?
- directly
- through lymphatics
- hematologically (in blood)
what are different ways colon cancer can be found?
- bowel screening programmes
- urgent endoscopy (referred by GP for red flag symptoms)
- emergency presentations (hopefully less due to screening programme but still see some)→obstructions, rectal bleeding, palpable mass, perforation etc
what is right sided colon cancer signs and symptoms?
(more difficult to identify as blood changed colour by poo)
- Unexplained Iron deficiency anaemia (important symptom for right sided colon cancer)
- Persistent tiredness
- A persistent and unexplained change in bowel habit
- Unexplained weight loss (late feature)
- Abdominal pain (colicky in nature)
- Lump in the abdomen
what is left sided colon cancer signs and symptoms?
- Rectal bleeding
- Feeling of incomplete emptying
- Worsening constipation
what are important questions to ask about colon cancer?
- Any recent change in the bowel habit?
- Any bleeding from the back passage? -Dark?, Bright red? Mixed with stool or separate?
- Any recent weight loss?
- Any abdominal pain?
- Have you noticed any swelling in your abdomen?
- Any family history of bowel problems?
- Any previous operations?
what investigations can be done for colorectal cancer?
- sigmoidoscopy vs colonoscopy (sigmoidoscopy just shorter version)
- CT colonography
→both cases need to clear bowel with bowel presentation (something to clear it)
what is done after colon cancer diagnosis?
- Histopathology confirmation
- Cancer staging (want find level so find if spread)
- CT chest/abdo/pelvis
- MRI for rectal cancers
- MDT
- Surgery/ palliation
- FOU
what are treatment options for colon cancer?
- surgery
- palliation
what are surgery types for colon cancer? like not the surgery but how you perform it
- open surgery
- laparoscopic surgery (keyhole)
- robotic surgery (still keyhole surgery but using robot to control)
what are options of surgery types for colon cancer on right?
- right hemicolectomy = ascending (right) colon removed and anastomose with transverse colon + ileum
- extended right hemicolectomy = right colon & portion of transverse colon removed, then anastomosis between ileum and what’s left of transverse
- transverse colectomy = remove part of transverse colon with tumour and anastomose what’s left
what are options of surgery types for colon cancer on left?
- sigmoid colectomy = remove sigmoid colon and anastomose descending and rectum
- anterior resection = pretty much remove rectum and put colon to anus making J pouch
- APR = remove rectum and colostomy
what can occur post-op for colon cancer?
- Chemotherapy / radiotherapy depending of staging (if still cancer after)
- follow up scans = CT, CEA (carcinoembryonic antigen - tumour marker often elevated in colorectal cancer), Colonoscopy
what is HIPEC (hyperemic intraperitoneal chemotherapy)?
management of mesothelioma, pseudomyxoma peritonei and peritoneal metastasis = heated chemo delivered into abdominal cavity
