Bowel Cancer

Question 1

Risk factors for bowel cancer

Answer 1

Fhx, FAP, HNPCC, IBD, increased age, diet high in red and processed meat and low in fibre, obesity, sedentary lifestyle, smoking alcohol

Question 2

What is familial adenomatous polyposis

Answer 2

Autosomal dominant condition involving malfunctioning of the tumour suppressor genes adenomatous polyposis coli (APC)

Question 3

What is the result of FAP

Answer 3

Many polyps (adenomas) develop along the large intestine, which have the potential to become cancerous

Question 4

When do FAP patient typically get bowel cancer

Answer 4

Before age of 40

Question 5

What prophylactic treatment are FAP patients given

Answer 5

Panproctocolectomy - entire large intestine removed

Question 6

What is hereditary nonpolyposis colorectal cancer

Answer 6

Lynch syndrome, autosomal dominant condition that results from mutations in DNA mismatch repair genes

Question 7

Presentation of bowel cancer

Answer 7

Change in bowel habit, unexplained weight loss, iron deficiency anaemia, abdominal or rectal mass on examination, rectal bleeding, abdominal pain

Question 8

What symptom can patients present with acutely

Answer 8

Obstruction if the tumour blocks the passage through the bowel

Question 9

How can GI cancers cause iron deficiency anaemia

Answer 9

They can cause microscopic bleeding

Question 10

What is the faecal immunochemical test (FIT)

Answer 10

Looks at the amount of human haemoglobin in the stool.

Question 11

Gold standard investigation

Answer 11

Colonoscopy - Involves endoscopy to visualise entire large bowel, can then biopsy or tattoo bowel

Question 12

What is sigmoidoscopy

Answer 12

Involves endoscopy of rectum and sigmoid colon only, for cases of rectal bleeding

Question 13

What is a CT colongraphy

Answer 13

CT scan with bowel prep and contrast to visualise the colon in more detail

Question 14

Tumour marker for bowel cancer

Answer 14

Carcinoembryonic antigen (CEA).

Question 15

Factors which change the choice of management

Answer 15

Clinical condition, general health, stage, histology and patient wishes

Question 16

Operation options for surgical resection

Answer 16

Right hemicolectomy, left hemicolectomy, high anterior resection, low anterior resection, abdomino-perineal resection (ARP), Hartmann’s procedure

Question 17

What does a right hemicolectomy involve

Answer 17

Removal of caecum, ascending and proximal transverse colon

Question 18

What does a left hemicolectomy involve

Answer 18

Removal of distal transverse and descending colon

Question 19

What does a high anterior resection involve

Answer 19

Removal of the sigmoid colon (sigmoid colectomy)

Question 20

What does a low anterior resection involve

Answer 20

Removal of sigmoid colon and upper rectum but sparing the lower rectum and anus

Question 21

What does APR involve

Answer 21

Removal of rectum and anus and suturing over the anus leaving patient with permanent colostomy

Question 22

What does Hartmann’s procedure involve

Answer 22

Removal of rectosigmoid colon and creation of colostomy, rectal stump is sutured closed.

Question 23

Indication for Hartmann’s procedure

Answer 23

Obstruction by tumour or significant diverticular disease

Question 24

Complications of bowel surgery

Answer 24

Post op ileus, leakage or failure of anastomosis, requriement for stoma, failure to remove tumour, change in bowel habit, incisional hernias, intra-abdominal adhesions

Question 25

What is low anterior resection syndrome

Answer 25

Urgency and frequency of bowel movements, daecal incontinence, difficulty controlling flatulence

Question 26

What is included in patient follow ups

Answer 26

CEA testing and CT thorax, abdomen and pelvis