Bowel Cancer

Question 1

Bowel cancer

Causes

Answer 1

Adenoma (rapidly dividing groups of cells but asymptomatic with malignant potential) then gene hits causing carcinoma

Risk factors:
Genetics - FAP, HNPCC
Inflammatory bowel disease

Question 2

Bowel cancer

Clinical Features

Answer 2

Altered bowel habit

Anaemia

Weight loss

Pr bleeding

Question 3

Bowel cancer

Complications

Answer 3

Bowel obstruction

Question 4

Bowel Cancer

Investigations

Answer 4

Bloods: FBC for anaemia and CEA (cancer marker)

CT Staging

Endoscopy + biopsy for grading

TNM and dukes staging

Question 5

Colon cancer

Management

Screening
Medical
Surgery

Answer 5

Conservative: screening

1. Faecal immune chemical test - to look for blood in faeces in 60 years or older every 2 years
   - is positive you do endoscopy
2. Flex sigmoidoscopy
   - 55-60 years old once
   - look for polyps and biopsy
   - if malignancy then surgery

Medical
- chemotherapy +/- radiotherapy

Surgery
- Bowel resection

• T1-T3 = resection
• t4 beyond = chemo or radiotherapy
  Plus node involvement = need adjuvant chemo

Question 6

Genetic types of colorectal cancer

Answer 6

Sporadic (most common)

Hereditary non-polyposis colorectal carcinoma (or lynch syndrome)

• Autosomal dominant syndrome
• Associated with highly aggressive proximal colorectal cancer and endometrial cancer
• most commonly affected gene is MSH2

Familial Adenomatous Polyposis

• rare autosomal dominant syndrome
• leads to formation of hundreds of polyps by the age of 30-40
• APC gene mutation
• Patients usually have total colectomy with ileoanal pouch in their 20s
• Associated with colorectal and duodenal cancer