Bowel Cancer

Question 1

Describe the epidemiology of colorectal cancer.

Answer 1

• 4th most common cancer in the UK (42000 cases per year; 110 per day).
• Common in people living in the most deprived areas.
• Incidence rates are highest in people ages 85-89.
• >50% are diagnosed at a late stage in England, Scotland and NI.
• Most bowel cancers occur in the rectum.
• More common in White people than Asian or Black people.

Question 2

What is the mortality of colorectal cancer?

Answer 2

• ~16300 bowel cancer deaths in the UK every year (~45 / day).
• 2nd most common cause of cancer death in the UK.
• Since 1970s, bowel cancer mortality rates have decreased, 44% in the UK.
• Mortality rates are projected to fall by 23% between 2014-2035.

Question 3

What are the risk factors for colorectal cancer?

Answer 3

• Age
• Genetics
• Exposure to risk factors
• 54% of cases in the UK are preventable:
  
  • 28% - eating too little fibre
  • 13% - eating processed meat
  • 11% overweight and obesity
  • 6% - Alcohol
  • 7% - Smoking
  • 5% - too little physical activity
  • 2% - ionising radiation
• Specific risks:
  
  • ​Age >50
  • Polyps in the colon: tubulovillous adenoma (TA polyps)
  • FHx <10% (FAP, HNPCC)
  • Ulcerative colitis

Question 4

What are the red flags in colorectal cancer presentation?

Answer 4

• Change in bowel habit (constipation / diarrhoea / alternating).
• PR bleeding.
• Iron deficiency anaemia.
• Weight loss / loss of appetite.
• FHx
• Request colonoscopy - suspicion of cacner referral. Ca until proven otherwise.

Question 5

What are the investigations for colorectal cancer?

Answer 5

• Colonoscopy
• CT colonogram
• Bowel screening programme (BSP)

Question 6

What are the treatments for colorectal cancer?

Answer 6

• Surgery - colectomy
• Chemotherapy
• Radiotherapy (only rectal)
• Palliative: surgery / chemotherapy / radiotherapy