Bowel cancer Flashcards
Risk factors for bowel cancer
Family history Familial adenomatous polyposis (FAP) Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome Inflammatory bowel disease Increased age Diet (high in red and processed meat and low in fibre) Obesity and sedentary lifestyle Smoking Alcohol
What is FAP
Autosomal dominant condition involving malfunctioning of the tumour suppressor genes called adenomatous polyposis coli (APC).
It results in many polyps (adenomas) developing along the large intestine.
Procedure for patients with FAP to prevent bowel cancer
Patients have their entire large intestine removed prophylactically to prevent the development of bowel cancer (panproctocolectomy).
What is HPNCC/Lynch syndrome
Autosomal dominant condition that results from mutations in DNA mismatch repair (MMR) genes.
Patients are at a higher risk of a number of cancers, but particularly colorectal cancer.
Unlikely FAP, it does not cause adenomas and tumours develop in isolation.
Red flags - bowel cancer
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
When do NICE advise two week wait referral for colorectal cancer
Over 40 years with abdominal pain and unexplained weight loss
Over 50 years with unexplained rectal bleeding
Over 60 years with a change in bowel habit or iron deficiency anaemia
Why is unexplained IDA without any other explanation an indication for two week wait
It is an indication for a “two week wait” cancer referral for colonoscopy and gastroscopy (“top and tail”) for GI malignancy.
This is because GI malignancies such as bowel cancer can cause microscopic bleeding (not visible in bowel movements) that eventually lead to iron deficiency anaemia.
What is the FIT test
Faecal immunochemical tests (FIT) look very specifically for the amount of human haemoglobin in the stool
FIT tests can be used as a test in general practice to help assess for bowel cancer in specific patients who do not meet the criteria for a two week wait referral
Age for bowel cancer screening
People aged 60 – 74 years are sent a home FIT test to do every 2 years. If the results come back positive they are sent for a colonoscopy.
Gold standard ix for bowel cancer
Colonoscopy is the gold standard investigation. It involves an endoscopy to visualise the entire large bowel.
Any suspicious lesions can be biopsied to get a histological diagnosis, or tattoo in preparation for surgery.
IX for staging bowel cancer
Staging CT scan involves a full CT thorax, abdomen and pelvis (CT TAP). This is used to look for metastasis and other cancers.
Use of CEA in bowel cancer
Carcinoembryonic antigen (CEA) is a tumour marker blood test for bowel cancer. This is not helpful in screening, but it may be used for predicting relapse in patients previously treated for bowel cancer.
Classification of bowel cancer
Dukes’ classification now replaced by TNM
General options for managing bowel cancer
Surgical resection
Chemotherapy
Radiotherapy
Palliative care
What is a right hemicolectomy
Involves removal of the caecum, ascending and proximal transverse colon
What is a left hemicolectomy
involves removal of the distal transverse and descending colon
What is a high anterior resection
involves removing the sigmoid colon (may be called a sigmoid colectomy).
What is a low anterior resection
involves removing the sigmoid colon and upper rectum but sparing the lower rectum and anus.
What is an abdomino-perineal resection
involves removing the rectum and anus (plus or minus the sigmoid colon) and suturing over the anus. It leaves the patient with a permanent colostomy
What is a hartmann’s procedure
Is usually an emergency procedure that involves the removal of the rectosigmoid colon and creation of an colostomy. The rectal stump is sutured closed. The colostomy may be permanent or reversed at a later date
Common indications for Hartmann’s procedure
Acute obstruction by a tumour, or significant diverticular disease.
Complications of bowel cancer
Bleeding, infection and pain
Damage to nerves, bladder, ureter or bowel
Post-operative ileus
Laparoscopic surgery converted during the operation to open surgery (laparotomy)
Leakage or failure of the anastomosis
Intra-abdominal adhesions
What is low anterior resection syndrome
Low anterior resection syndrome may occur after resection of a portion of bowel from the rectum, with anastomosis between the colon and rectum
Symptoms of low anterior resection syndrome
Urgency and frequency of bowel movements
Faecal incontinence
Difficulty controlling flatulence
Follow-up post surgery for bowel cancer
Patients will be followed up for a period of time (e.g., 3 years) following curative surgery. This includes:
Serum carcinoembryonic antigen (CEA)
CT thorax, abdomen and pelvis
Risk factors for gastric cancer
H pylori Atrophic gastritis Diet Smoking Blood group
Features of gastric cancer
Abdominal pain Weight loss and anorexia Nausea and vomiting Dysphagia Over GI bleeding
Lymphatic spread features of gastric cancer
left supraclavicular lymph node (Virchow's node) periumbilical nodule (Sister Mary Joseph's node)
diagnosis of gastric cancer
endoscopy with biopsy - signet ring cells
Mx of gastric cancer
surgical options depend on the extent and side but include:
endoscopic mucosal resection
partial gastrectomy
total gastrectomy
chemotherapy
Presentation of perianal abscess
Pain around anus, worse on sitting
Pus-like discharge from the anus
Systemic features of abscess
Causes of perianal abscess
gut flora such as E coli
Staph aureus
Gold standard imaging ix for perianal abscess
MRI
Conditions associated with perianal abscess
Underlying IBD(Crohn’s)
Diabetes mellitus is a risk factor
Underlying malignancy
Treatment of perianal abscess
Incision and drainage under local anaesthetic
Abx if systemic upset
