bowel cancer Flashcards
risk factors
FHx familial adenomatomous polyposis HNPCC IBD inc age diet - processed meat, low fibre obesity smoking alcohol
what is familial adenomatous polyposis
autosomal dominant condition, malfunction of tumour suppressor genes called adenomatous polyposis coli
many polyps develop with potential to become cancerous
HNPCC
autosomal dominant condition, mutations in DNA mismatch repair
higher risk of cancers
red flags to make you consider bowel cancer
- change in bowel habit
- unexplained weight loss
- rectal bleeding
- unexplained abdo pain
- iron deficiency anaemia
- abdo/rectal mass
what are indications for 2 week wait cancer referral
- over 40 with abdo pain and weight loss
- over 50 w rectal bleeding
- over 6o with change bowel habit or Fe def anaemia
Fe def anaemia on its own without explanatoin
Faecal immunochemical tests
looks specifically for amount of human haemoglobin in the stool
used in GP to assess bowel cancer in pt who do not meet criteria for 2 wk referaal
Ix
colonoscopy***
staging CT
carcinoembryoonic antigen
carcinoembryonic antigin
tumour marker for bowel cancer
useful for predicting relapse
Dukes A
confined to mucosa + part of muscle of bowel wall
Dukes B
extending through muscle of bowel wall
Dukes C
lymph node involvement
Dukes D
metastatic disease
T1
submucosa involvement
T2
involvement of muscularis propria (muscle layer)
T3
involvement of subserosa and serosa but not through serosa
T4
spread through serosa (4a)
reaching other tissues/organs (4b)
N1
spread to 1-3 nodes
N2
spread to 3+ nodws
options for managing bowel cancer
surgical resection
chemo
radio
palliation
right hemicolectomy
removal of
- caecum
- ascending colon
- proximal transverse colon
left hemicolectomy
removal of
- distal transverse colon
- descending colon
high anterior resection
removal sigmoid colon
aka sigmoid colectomy
low anterior resection
remove sigmoid colon + upper rectum
spare lower rectum and anus
abdomino-perineal resection
remove rectum and anus +/- sigmoid colon
Hartmann’s procedure
removal of rectosigmoid colon and creation of colostomy
complications of surgery for bowel cancer
bleeding, infection, pain damage to nerves, bladder, ureter, bowel post-op ileus anaesthetic risks leakage anatomosis failure stoma failure to remove tumour change in bowel habit VTE incisional hernia Intra abdo adhesions
lower anterior resection syndrome
- urgency and frequency bowel movements
- faecal incontinence
- difficulty controlling flactulance
follow up
pt will be followed up for a period of time following curative surgery
serum carcinoembryonic antigen
CT TAP
R sided cancer presentation
unexplained fe def anaemia
abdo pain
mild diarrhoea
L sided cancer presentation
change bowel habit
abdo pain
passing blood/mucous
rectal cancer presentation
fresh blood
incomplete evacuation
tenesmus
