Bowel Cancer

Question 1

What increases the risk of colorectal cancer?

Answer 1

Family history

Familial adenomatous polyposis

Hereditary nonpolyposis colorectal cancer (Lynch syndrome)

IBD

Age

Smoking

Alcohol

Obesity

Diet

Question 2

What is familial adenomatous polyposis?

Answer 2

Autosomal dominant

Tumour suppressor genes malfunction- adenomatous polyposis coli

Causes multiple polyps along large intestine

Polyps have potential to become cancerous usually before 40

Question 3

What surgery do patients have prophylactically if they have FAP?

Answer 3

Panproctocolectomy

Question 4

What is hereditary nonpolyposis colorectal cancer?

Answer 4

AKA Lynch syndrome

Autosomal dominant

Mutations in DNA mismatch repair genes (MMR genes)

Question 5

What type of family history can lead to increased suspicion of Lynch syndrome?

Answer 5

Ovarian or endometrial cancer

Germline mutation in Mismatch repair genes

Question 6

What are the red flags of bowel cancer?

Answer 6

Change in bowel habit
Weight loss
Rectal bleeding
Unexplained abdominal pain
Microcytic anaemia with low ferritin
Abdominal or rectal mass

Question 7

What are the NICE guidelines for bowel cancer?

Answer 7

2 week urgent referral if:
- Over 40 with abdominal pain and unexplained weight loss
- Over 50 with unexplained rectal bleeding
- Over 60 with changed bowel habits or iron deficiency anaemia

Question 8

How can patients present acutely with bowel cancer?

Answer 8

Obstruction causes blocked bowels leading to vomiting, abdominal pain and absolute constipation

Question 9

What is a faecal immunochemical test for?

Answer 9

Looks for human Hb in stool to help assess for bowel cancer

Question 10

Why is faecal occult blood test no longer used?

Answer 10

False positives due to detecting blood from food e.g. red meat

Question 11

What is Dukes’ classification?

Answer 11

Bowel cancer staging system

Question 12

What is the ideal treatment of bowel cancer?

Answer 12

Surgically remove entire tumour

Question 13

What operations are available for bowel cancer?

Answer 13

Right hemicolectomy
Removal of caecum, ascending and proximal transverse colon

Left hemicolectomy
Removal of distal transverse and descending colon

High anterior resection Removing sigmoid

Low anterior resection Removing sigmoid colon and upper rectum

Abdomino-perineal resection (APR)
Removal of rectum and anus (plus or minus the sigmoid colon) and suturing over the anus

Patient left with permanent colostomy

Hartmann’s procedure
Emergency procedure that involves removal of the rectosigmoid colon and creation of an colostomy

Rectal stump sutured closed

Colostomy may be permanent or reversed at a later date

Question 14

Why is Hartmann’s procedure carried out?

Answer 14

Acute obstruction by a tumour, or significant diverticular disease

Question 15

What are some complications of bowel cancer surgery?

Answer 15

• Bleeding, infection and pain
• Nerve, bladder, ureter or bowel damage
• Ileus
• Anaesthetic
• Anastomotic failure
• Stoma
• Failure
• VTE
• Incisional hernias
• Intra-abdominal adhesions

Question 16

What is low anterior resection syndrome?

Answer 16

Portion of bowel is removed causing:
- Urgency and frequency of bowel movements
- Faecal incontinence
- Difficulty controlling flatulence

Question 17

What is done in follow-up after bowel cancer surgery?

Answer 17

Serum carcinoembryonic antigen (CEA)

CT thorax, abdomen and pelvis