bowel cancer

Question 1

risk factors

Answer 1

FHx
familial adenomatomous polyposis 
HNPCC
IBD 
inc age 
diet - processed meat, low fibre
obesity 
smoking 
alcohol

Question 2

what is familial adenomatous polyposis

Answer 2

autosomal dominant condition, malfunction of tumour suppressor genes called adenomatous polyposis coli

many polyps develop with potential to become cancerous

Question 3

HNPCC

Answer 3

autosomal dominant condition, mutations in DNA mismatch repair

higher risk of cancers

Question 4

red flags to make you consider bowel cancer

Answer 4

• change in bowel habit
• unexplained weight loss
• rectal bleeding
• unexplained abdo pain
• iron deficiency anaemia
• abdo/rectal mass

Question 5

what are indications for 2 week wait cancer referral

Answer 5

• 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

Question 6

Faecal immunochemical tests

Answer 6

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

Question 7

Ix

Answer 7

colonoscopy***
staging CT
carcinoembryoonic antigen

Question 8

carcinoembryonic antigin

Answer 8

tumour marker for bowel cancer

useful for predicting relapse

Question 9

Dukes A

Answer 9

confined to mucosa + part of muscle of bowel wall

Question 10

Dukes B

Answer 10

extending through muscle of bowel wall

Question 11

Dukes C

Answer 11

lymph node involvement

Question 12

Dukes D

Answer 12

metastatic disease

Question 13

T1

Answer 13

submucosa involvement

Question 14

T2

Answer 14

involvement of muscularis propria (muscle layer)

Question 15

T3

Answer 15

involvement of subserosa and serosa but not through serosa

Question 16

T4

Answer 16

spread through serosa (4a)

reaching other tissues/organs (4b)

Question 17

N1

Answer 17

spread to 1-3 nodes

Question 18

N2

Answer 18

spread to 3+ nodws

Question 19

options for managing bowel cancer

Answer 19

surgical resection
chemo
radio
palliation

Question 20

right hemicolectomy

Answer 20

removal of

• caecum
• ascending colon
• proximal transverse colon

Question 21

left hemicolectomy

Answer 21

removal of

• distal transverse colon
• descending colon

Question 22

high anterior resection

Answer 22

removal sigmoid colon

aka sigmoid colectomy

Question 23

low anterior resection

Answer 23

remove sigmoid colon + upper rectum

spare lower rectum and anus

Question 24

abdomino-perineal resection

Answer 24

remove rectum and anus +/- sigmoid colon

Question 25

Hartmann’s procedure

Answer 25

removal of rectosigmoid colon and creation of colostomy

Question 26

complications of surgery for bowel cancer

Answer 26

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

Question 27

lower anterior resection syndrome

Answer 27

• urgency and frequency bowel movements
• faecal incontinence
• difficulty controlling flactulance

Question 28

follow up

Answer 28

pt will be followed up for a period of time following curative surgery

serum carcinoembryonic antigen
CT TAP

Question 29

R sided cancer presentation

Answer 29

unexplained fe def anaemia
abdo pain
mild diarrhoea

Question 30

L sided cancer presentation

Answer 30

change bowel habit
abdo pain
passing blood/mucous

Question 31

rectal cancer presentation

Answer 31

fresh blood
incomplete evacuation
tenesmus