Bowel Cancer Flashcards
Risk factors for bowel cancer
Fhx, FAP, HNPCC, IBD, increased age, diet high in red and processed meat and low in fibre, obesity, sedentary lifestyle, smoking alcohol
What is familial adenomatous polyposis
Autosomal dominant condition involving malfunctioning of the tumour suppressor genes adenomatous polyposis coli (APC)
What is the result of FAP
Many polyps (adenomas) develop along the large intestine, which have the potential to become cancerous
When do FAP patient typically get bowel cancer
Before age of 40
What prophylactic treatment are FAP patients given
Panproctocolectomy - entire large intestine removed
What is hereditary nonpolyposis colorectal cancer
Lynch syndrome, autosomal dominant condition that results from mutations in DNA mismatch repair genes
Presentation of bowel cancer
Change in bowel habit, unexplained weight loss, iron deficiency anaemia, abdominal or rectal mass on examination, rectal bleeding, abdominal pain
What symptom can patients present with acutely
Obstruction if the tumour blocks the passage through the bowel
How can GI cancers cause iron deficiency anaemia
They can cause microscopic bleeding
What is the faecal immunochemical test (FIT)
Looks at the amount of human haemoglobin in the stool.
Gold standard investigation
Colonoscopy - Involves endoscopy to visualise entire large bowel, can then biopsy or tattoo bowel
What is sigmoidoscopy
Involves endoscopy of rectum and sigmoid colon only, for cases of rectal bleeding
What is a CT colongraphy
CT scan with bowel prep and contrast to visualise the colon in more detail
Tumour marker for bowel cancer
Carcinoembryonic antigen (CEA).
Factors which change the choice of management
Clinical condition, general health, stage, histology and patient wishes
Operation options for surgical resection
Right hemicolectomy, left hemicolectomy, high anterior resection, low anterior resection, abdomino-perineal resection (ARP), Hartmann’s procedure
What does a right hemicolectomy involve
Removal of caecum, ascending and proximal transverse colon
What does a left hemicolectomy involve
Removal of distal transverse and descending colon
What does a high anterior resection involve
Removal of the sigmoid colon (sigmoid colectomy)
What does a low anterior resection involve
Removal of sigmoid colon and upper rectum but sparing the lower rectum and anus
What does APR involve
Removal of rectum and anus and suturing over the anus leaving patient with permanent colostomy
What does Hartmann’s procedure involve
Removal of rectosigmoid colon and creation of colostomy, rectal stump is sutured closed.
Indication for Hartmann’s procedure
Obstruction by tumour or significant diverticular disease
Complications of bowel surgery
Post op ileus, leakage or failure of anastomosis, requriement for stoma, failure to remove tumour, change in bowel habit, incisional hernias, intra-abdominal adhesions
What is low anterior resection syndrome
Urgency and frequency of bowel movements, daecal incontinence, difficulty controlling flatulence
What is included in patient follow ups
CEA testing and CT thorax, abdomen and pelvis
