Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Y4 Cancer Care SA > 9 - Colorectal > Flashcards

9 - Colorectal Flashcards

1
Q

What is the epidemiology of colorectal cancer?

A
  • Fourth most common cancer
  • Third most common cancer in both men and women, whilst it is fourth most common overall
  • Peak incidence 85-89
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some risk factors for colorectal cancer?

A

THINK ABOUT MODIFIABLE AND NON-MODIFIABLE

  • Older age
  • Family history
  • Hereditary syndromes
  • Inflammatory bowel disease
  • Caucasian
  • Radiotherapy
  • Obesity
  • Diabetes mellitus
  • Smoking
  • Red meats and processed foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the locations of cancer in colorectal cancer?

A

Most common in rectum then sigmoid

More prevalence in left side of colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What dietary source is protective against colon cancer?

A

Fibre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the hereditary syndromes and the genetic mutations they have that predispose to colorectal cancer?

A

Hereditary nonpolyposis colorectal cancer (Lynch Syndrome) (most common)

  • Autosomal dominant
  • Common mutations include MLH1, MSH2, MSH6 and PMS2
  • DNA mismatch repair genes
  • can also increase womans risk of endometrial cancer

Familial adenomatous polyposis

  • Autosomal dominant
  • Mutations to the adenomatous polyposis coli (APC) gene - tumour suppressor gene
  • Development of numerous adenomatous polyps in the colon and rectum, some of which undergo malignant change
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What other malignancies are those with HNPCC (lynch syndrome) at risk of?

A
  • Endometrial
  • Ovarian
  • Small bowel
  • Gastric
  • Gallbladder
  • Liver
  • Brain
  • Renal tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How many people with FAP get colorectal cancer and how is this risk managed?

A
  • 90% before the age of 45 if not treated
  • Screening commenced at the age of 12-14 with an annual colonoscopy
  • Prophylactic total colectomy with ileo-anal pouch formation may be offered at an appropriate time following discussion with patient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What other malignancies are those with FAP at risk of?

A
  • Duodenal tumours
  • Gardner’s syndrome: osteomas of the skull and mandible, retinal pigmentation, thyroid carcinoma, epidermoid cysts on the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some other syndromes apart from HNPCC and FAP that predispose to bowel cancer?

A
  • Juvenile polyposis
  • Peutz-Jeghers syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the Amsterdam criteria?

A

Way of diagnosing HNPCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the pathophysiology of colorectal cancer?

A

Adenocarcinomas (70% sporadic, inherited 5-10%, familial 20%)

Adenoma-Carcinoma sequence

  • Mutations are accumulated over a number of years leading normal epithelium to develop adenomas, which become progressively more dysplastic and eventually develop into a carcinoma
  • Early mutations to tumour suppressor adenomatous polyposis coli (APC) which leads to the hyperproliferative epithelium
  • Then KRAS, a proto-oncogene, that becomes an oncogene following mutation
  • Further mutations to p53 (tumour suppressor) as well as SMAD4 and others leads to the development of a carcinoma from an adenoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

20-25% of colorectal cancers are metastatic on presentation. Where do they tend to metastasise to?

A
  • Lung (especially rectal as drains into IVC)
  • Liver (as drain into portal system - MOST COMMON)
  • Peritoneum
  • Bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How may colorectal cancer present? (symptoms in history)

A

Change in bowel habit, Anaemia and Weight loss are most common

  • Asymptomatic and found on screening
  • Endoscopy for unexplained iron deficiency anaemia
  • Change in bowel habit e.g constipation or diarrhoea
  • Weight loss
  • Bowel obstruction in ⅓ of presentations
  • Malaise
  • Tenesmus
  • PR bleeding
  • Abdominal pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What signs may you see on examination if somebody has colorectal cancer?

A
  • Pallor
  • Abdominal mass
  • Abnormal PR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How may colorectal cancer present if it has already metastasised?

A

think - colorectal cancer SPREADS to the liver so these will be the knock on effect…..
* Hepatomegaly
* Jaundice
* Abdominal pain
* Lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does right vs left sided colon cancer present differently?

A

Right: usually iron deficiency anaemia

Left: usually develops circumferentially so apple core sign and a change in bowel habit and eventual bowel obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Who is offered screening for bowel cancer on the NHS and what test do they use to screen?

A

Every 2 years to all men and women aged 60 to 74 years (changing to 56). Over 74 can request screeningevery 2 years

Faecal Immunochemical Test (FIT): faecal occult blood test that uses antibodies to determine how much human Hb/blood in a stool sample. Doesn’t pick up animal blood from diet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If patients have a positive result from FIT test what are they then sent for?

A

Colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Who else is eligible for a FIT test apart from 60-74 year olds?

A

Those who have symptoms but do not fit the criteria for a 2 week wait referral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How are those with FAP, HNPCC and IBD screened for colorectal cancer?

A

Annual colonoscopy

21
Q

What is the referral criteria for a 2 week wait for colorectal cancer?

A
  • 54-74
  • patients >= 40 years with unexplained weight loss AND abdominal pain
  • patients >= 50 years with unexplained rectal bleeding
  • patients >= 60 years with iron deficiency anaemia OR change in bowel habit
  • tests show occult blood in their faeces
22
Q

What are red flags for colon cancer?

A
  • Change in bowel habit (usually to more loose and frequent stools)
  • Unexplained weight loss
  • Rectal bleeding
  • Unexplained abdominal pain
  • Iron deficiency anaemia (microcytic anaemia with low ferritin)
  • Abdominal or rectal mass on examination
23
Q

What investigations are done as part of the two week wait for colorectal cancer?

A
  • Colonoscopy: Gold standard. Usually under sedation but a lot cannot tolerate. Can biopsy suspicious lesions
  • Flexible Sigmoidoscopy: if cannot tolerate above
  • CT pneumocolon: if colonoscopy not suitable, use bowel prep and contrast
  • CT TAP: to look for metastases for staging - thorax, abdo, pelvis
24
Q

What are the complications of a colonoscopy?

A
  • Patients cannot tolerate just under sedation so may not view full colon
  • Risk of perforation especially in diverticular disease
  • Must be able to comply with Moviprep bowel preparation
25
Apart from imaging what are some other investigations done in the workup for colon cancer?
**Bloods** * FBC * Serum iron, transferrin saturation, TIBC * Renal function * LFT * Clotting screen **Carcinoembryonic antigen (CEA)** * Tumour marker that can help monitor treatment and recurrence **MRI Rectum** * If tumour sits below peritoneal reflection
26
How is colon cancer staged?
Used to be Duke's criteria, now TNM
27
What is Duke's classification?
* Dukes A – confined to mucosa and part of the muscle of the bowel wall * Dukes B – extending through the muscle of the bowel wall * Dukes C – lymph node involvement * Dukes D – metastatic disease
28
What management is available for colon cancer and what does it depend on?
* Surgical resection * Chemotherapy * Radiotherapy * Palliative care Most treatment is surgery whether curative or palliative e.g stents
29
How is colorectal cancer treated with surgery? (including different procedures)
* ***Stage I-III disease*****:** surgical resection ± post-operative chemotherapy. The type of surgery depends on the tumour site * **Patients with** ***stage III disease*** **(lymph node involvement):** post-operative adjuvant chemotherapy * **For** ***stage IV disease*** **(metastases)**: treatment as above, but pre-operative chemotherapy
30
How do you decide whether to create a stoma or anastomosis after surgical resection for colon cancer?
**For an anastomosis to heal need:** adequate blood supply (the close contact or joining of the mucosal layers of tissues), mucosal apposition and no tissue tension Surrounding sepsis, unstable patients and inexperienced surgeons may compromise these key principles and in such circumstances it may be safer to construct an end stoma rather than attempting an anastomosis Can always reverse stoma later
31
How is rectal cancer treated surgically?
* **Anterior resection** if the proximal 2/3 of the rectum * **Abdomino-perineal (AP) resection** if distal 1/3 of the rectum * **TME:** clearance of fat and lymph nodes **_Early Rectal Cancer_** * **Transanal excision** * **Endoscopic submucosal dissection** * **Total mesorectal excision (TME)** **_Advanced Rectal Cancer_** * **Total mesorectal excision (TME)** with anterior resection or AP resection * **Pre-operative radiotherapy** or chemoradiotherapy
32
What emergency surgical procedure is done for a colorectal cancer causing bowel obstruction?
**Hartmann's Procedure** Rectosigmoidcolectomy with end colostomy and closure of rectal stump
33
What are the complications of surgery for bowel cancer?
* Bleeding, infection and pain * Damage to nerves, bladder, ureter or bowel * Post-op ileus * Anaesthetic risks * Laparoscopic surgery converted during the operation to open surgery * Leakage or failure of the anastomosis * Requirement for a stoma * Failure to remove the tumour * Change in bowel habit * Sexual dysfunction * Venous thromboembolism (DVT and PE) * Incisional hernias * Intra-abdominal adhesions
34
What stoma is made in rectal cancer surgery?
Loop ileostomy as high risk of anastomotic leak
35
How can you estimate the risk of death with colon cancer surgery?
SORT score
36
What is low anterior resection syndrome?
May occur after resection of a portion of bowel from the rectum, with anastomosis between the colon and rectum * Urgency and frequency of bowel movements * Faecal incontinence * Difficulty controlling flatulence
37
What is some adjuvant and neo-adjuvant treatment for colon cancer and when is it given?
**_Neoadjuvant therapy_** * **Rectal cancer** cT1-T2, cN1-N2, M0, or cT3-T4, any cN, M0 should be offered neoadjuvant radiotherapy or chemoradiotherapy * **Colonic cancer** with cT4 disease. Consider the use of chemotherapy **_Adjuvant therapy_** * **FOLFOX** (**FOL**inic acid, **F**luorouracil and **OX**aliplatin) * **CAPOX** (**CAP**ecitabine and **OX**aliplatin)
38
How are those with metastatic colon disease managed?
Metastasectomy or other local therapies to target metastatic deposits as well as systemic anti-cancer therapy May surgically resect tumour **_Liver metastasis_** * **Simultaneously:** Removed at the same time as the primary tumour * **Sequentially:** Removed in a separate procedure either before or after the primary tumour. For those that are not resectable, local ablative techniques and chemotherapy may be considered **_Lung metastasis_** Metastasectomy, ablation and stereotactic body radiation therapy. **_Peritoneal metastasis_** Systemic anti-cancer therapy. At specialist centres cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) may be considered
39
What monoclonal antibodies are offered in metastatic colon cancer?
Cetuximab (anti-EGFR) or Bevacizumab (anti-VEGF) in combination with chemotherapy
40
How are patients followed up after their curative surgery?
Set period of time (e.g., 3 years): * Serum carcinoembryonic antigen (CEA) * CT thorax, abdomen and pelvis
41
How can colon cancer be prevented?
* Patients should be encouraged to maintain a healthy balanced diet * Cut down on processed meats * Smoking cessation * Healthy weight * Daily aspirin for at least 2 years in Lynch syndrome * it inhibits inflammation and potentially promotes cell death,
42
What is the prognosis with colon cancer?
43
How does Peutz-Jeghers syndrome present?
* Mutation in the STK11 gene * Autosomal dominant * In teens with mucocutaneous pigmentaiton and hamartomatous polyps. Risk of neoplastic transformation of hamartomatous polyps is low, but many polyps are present so patients are at increased risk of developing colorectal cancer. They are managed with regular endoscopic surveillance
44
What is iron deficiency anaemia until proven otherwise?
Colon caner
45
What are the long term side effects of bowel cancer treatment?
Don't forget mental health and sexual issues!
46
What are some GI side effects of bowel cancer treatment?
* rectal bleeding * faecal incontinence * urgency * diarrhoea * constipation * flatulence * abdominal pain * painful bowel movements
47
How can we improve the long term side effects that patients have after bowel cancer treatment?
Refer to community nurse clinic!
48
What questions can you ask to see if patient is having late GI side effects?
* Are you woken at night to have a bowel movement? * Do you need to rush to the toilet to have a bowel movement? * Do you ever have bowel leakage, soiling or a loss of control over your bowels? * Do you have any bowel symptoms preventing you from living a full life?

Y4 Cancer Care SA (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions