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bowel cancer Flashcards

1
Q

bowel cancer development - polyps

A
  • growths in the lining of the colon or rectum that protrude into the intestinal canal
  • They can be benign or adenomatous (benign but may be precancerous)
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2
Q

Bowel cancer signs and symptoms

A
  • A persistent change in bowel habit - emptying bowels more frequently, runner stools
  • Blood in the faeces without other symptoms
  • Abdominal pain, discomfort or bloating always brought on by eating
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3
Q

predisposing factors

A
  • lack of regular physical exercise
  • overweight obese
  • alcohol consumption
  • Tobacco use
  • inflammatory bowel disease such as
    Crohn’s disease or ulcerative colitis
  • A genetic syndrome such as familial adenomatous polyposis
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4
Q

Bowel Cancer- Symptomatic Patient NICE Guidelines NG12

A

Patients are referred by their GP using a suspected cancer pathway referral for an appointment within 2 weeks for colorectal cancer if they have symptoms

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5
Q

Bowel cancer symptomatic patients - symptoms

A
  • pt is 40+ with unexplained weight loss/abdominal pain
  • 50+ and unexplained
  • Aged 60 + with Anaemia, changes in bowel habit
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6
Q

Test taken to assess risk of bowel cancer in symptomatic patients

A

Faecal immunochemical Test (FIT)

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7
Q

NHS England - Faster Diagnosis Standard

A

This standard ensures that people are told whether they have cancer or cancer is excluded within 28 days from referral

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8
Q

The faster diagnosis standard intends to

A
  • reduce time between referral and diagnosis
  • reduce anxiety
  • represents an improvement on the current two-week wait to first appointment target.
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9
Q

Faster Diagnosis Standard 28 days (day 0)

A

Urgent GP referral (after FIT result)

pt information is provided in primary care

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10
Q

Faster Diagnosis Standard 28 days (by day 7)

A

Clinical triage by a suitably experienced clinician. (Possibly clinical nurse specialist)

With telephone consultation

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11
Q

Faster Diagnosis Standard 28 days (7-14 days)

A

straight to test - Colonoscopy or CT colonography

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12
Q

Faster Diagnosis Standard 28 days (14-21 days)

A

straight to imaging
- Contrast CT of CAP

  • MRI of pelvis +/-TRUS (transrectal ultrasound)
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13
Q

Faster Diagnosis Standard 28 days (by day 21)

A

MDT meeting

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14
Q

Faster Diagnosis Standard 28 days (day 28)

A

clinic review with CNS and next of kin support

MDT recommendations, treatment options, personalised care and support are discussed

assess fitness and arrange pre-op assessment

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15
Q

which days is cancer likely to be diagnosed or excluded

A

8-21

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16
Q

After an abnormal Faecal Immunochemical Test (FIT) what is used to examine the bowels

A

Flexible sigmoidoscopy (involving sigmoid colon)

Endoscopic colonoscopy

CT colonography

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17
Q

Endoscopic Colonoscopy compared to CT colonography

A
  • more sensitive for smaller polyps

-tissue samples can be taken

  • polyps can be removed
  • 15-60 minutes
  • However time is required to recover from sedative and there is an increased risk of tearing the abdominal wall
18
Q

CT colonography compared to Endoscopic Colonoscopy

A
  • recovery quickly
  • less risks of tearing abdominal wall
  • takes up to 15 minutes
  • no sedative required
  • However, it is less sensitive to smaller polyps and tissue samples cannot be taken.
19
Q

colonoscopy - pt prep

A

pt receives written instructions in advance

  • pt must empty bowels for colonoscopy
  • a laxative can be taken the day before
  • low fibre diet 1-2 days before the test and drink plenty of fluids
20
Q

colonoscopy procedure

A

ID pt, gain consent and answer questions
- pt wear gown, cannula is inserted for sedation
- pt lies on their left side with knees towards chest
- the colonoscope is inserted via the rectum into the bowel
- CO2 gas is introduced to distend the bowel
- pain relief is administered via cannula or gas and air
- images of bowel are taken
- biopsy samples can be taken and small polyps removal

21
Q

colonoscopy risks

A

abdominal pain due to introduction of CO2

  • pain/tenderness if tissue sample biopsy is performed. bleeding may be present after removal
  • pts require close monitoring in case there are reactions to sedative
  • risk of perforation - this will require surgical repair
22
Q

CT colonography is suitable for

A

pts who cannot undergo colonoscopy

23
Q

CT colonography provides

A

good detail (2D & 3D reconstruction of bowel

24
Q

CT colonography is not suitable for

A

polyp removal or biopsies

25
CT colonography pt prep days prior
2 days before the procedure - pt is given a list of allowed food 7-9am and 12pm. plus no solid food til 7pm. 7pm pt drinks 50ml of gastrografin with water - One day brfore procedure - pt drinks as much clear liquid as possible, no solid food intake and they must consume the 2nd half of the Gastrografin (50ml) with water day of procedure - no food intake and pt must drink clear fluids
26
CT colonography pt prep (within hospital)
- ID check - explanation of procedure to pt - 10 day rule is applied - Hospital gown is worn - cannula is inserted for delivery of drugs e.g. Buscopan and contrast agent to identify nearby structures
27
CT colonography procedure
pt lies on their side with knees drawn up - A thin flexible catheter is inserted into the rectum ( a balloon may be used to keep it in place) - Gas is administered via manual inflation to distend the colon - Supine and prone views. Decubitus position may be used as an alternative for those unable to lie prone - single breath hold acquisition (approx. 15 seconds in prone and supine) - 2D and 3D reconstruction
28
CT colonography risks
pain during air inflation - radiation dose - reaction to contrast - however risks should be addressed before hand - potential perforation (rare)
29
Alternative imaging techniques
MR colonography
30
MR colonography
- does not use ionising radiography - however claustrophobia and other MRI risks need to be considered - it is more useful for ano-rectal cancer diagnosis and inflammatory small bowel disease
31
types of staging systems
TNM and Duke's staging system
32
TNM staging system
used for Tumour Nodes and Metastasis staging
33
Duke's staging system
may be used for bowel cancer staging
34
identifying primary tumor and whether it has spread
contrast of CT CAP MRI of pelvis +/- TRUS if rectum is involved plus histopathology and bloods
35
TNM system
records the anatomical extent of disease such as: Tumour size and invasion (gradedT0-T4) . Number of nodes involved (graded N0-N3). distant metastatic site (graded MO-M1)
36
Primary Tumour (staging )
TX means that main tumour cannot be measured. T0 means that main tumour cannot be found T1,T2,T3,T4 refers to the size of the main tumour. higher the number, the larger the tumour
37
Regional lymph nodes (staging)
NX: cancer in nearby lymph nodes cannot be measured N0: There is no cancer in nearby nodes N1,N2,N3 refer to the number and location of lymph nodes that contain cancer the higher the number, the more lymph nodes that contain cancer.
38
Distant metastasis (staging)
MX: Metastasis cannot be measured. M0: Cancer has not spread to other parts of the body. M1: Cancer has spread to other parts of the body
39
if the FIT test is abnormal...
pt is referred for further imaging
40
if FIT test is normal...
pt is referred for investigation of symptoms or differential diagnosis
41
if there a positive findings on the colonoscopy...
the pt is referred for staging
42
if there are positive findings on CT colonography...
the pt is referred for colonoscopy and staging

CDM (7 decks)

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