Bowel Cancer

Question 1

What is an acute anal fissure?

Answer 1

A break or tear in the skin of the anal canal. Associated with sever pain and anal bleeding on toilet paper.

Question 2

What are clinical features of left colon cancer?

Answer 2

fresh rectal bleeding, obstruction

Question 3

What are clinical features of right colon cancer?

Answer 3

Anaemia with occult bleeding or with altered bowel habit

Question 4

What are the clinical features of rectal cancer?

Answer 4

early bleeding, mucus discharge, tenesmus. O/E palpable masses, signs of anaemia or hepatomegaly.

Question 5

What are the red flags for CRC and grounds for suspected cancer two week referral?

Answer 5

• Aged 40 and over with unexplained weight loss
• Aged 50 and over with unexplained rectal bleeding
• > 60 with Iron-deficiency anaemia, changes in their bowel habit, occult blood in their faeces
• consider with rectal or abdominal mass
• Under 50 with rectal bleed + abdo pain/change in bowel habit/weight loss/IDA

Question 6

What is first line diagnostic investigation?

Answer 6

Colonoscopy ± biopsy

Question 7

What is 2nd line diagnostic investigation?

Answer 7

flexible sigmoidoscopy and barium enema

Question 8

What imaging is used to stage colon cancer?

Answer 8

CT TAP

Question 9

What imaging is used to stage rectal cancer?

Answer 9

Pelvic MRI

Question 10

What is Carcinoembryonic Antigen (CEA) used for?

Answer 10

testing can be helpful during follow-up to monitor for presence of recurrence.

Question 11

What is staging system used?

Answer 11

TNM staging and Dukes A-D

Question 12

How is it managed?

Answer 12

• Discussed at the MDT
• Discuss stomas with patient
• locally advanced - adjuvant radio/chemo-therapy + surgical resection
• tumour should be removed, along with adequate resection margins and pericolic lymph nodes.
• metastatic disease to liver/lung - mesatectomy –> curative