Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

304: GI > Bowel cancer > Flashcards

Bowel cancer Flashcards

1
Q

Colorectal cancer epidemiology

  • Prevalence
  • Mortality
  • Prognosis
  • Age
  • Sex
A

Prevalence+ mortality: 4th most common in UK
- 2nd most common death.

Prognosis: 60% survival with surgery.

Age: 70+ (60%)

Sex
- M> F, 3:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Colorectal cancer risk factors (9)

A
  • Male (3:1)
  • Increasing age
  • Smoking
  • Family history
  • Polyps
  • Alcohol
  • Obesity
  • IBD
  • Polyposis syndromes: FAP, HNPCC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Two-week referral criteria

A

40 + with unexplained weight loss

50+ with rectal bleeding

60+ with iron deficiency anaemia

60+ with change in bowel habit

Rectal/ abdominal palpable mass.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Colorectal cancer diagnosis

A

Luminal:

  • Gold standard- colonoscopy
  • Flexible sigmoidoscopy: sigmoid most common area of pathology
  • Obstructive symptoms/ Fe def anaemia= OGD

Radiological Imaging:

  • CT/MRI/ USS/ PET CT
  • CT Colonography (risk of perforation): false positives, not interventional
  • CT CAP for staging
  • Rectal staging= MRI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Colonoscopy and flexi sigmoid complications

A 
Bleeding
Perforation
Missed pathology
AKI
Risk of sedation.

Flexi Gives limited study. - Can miss pathology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Duke staging of colorectal cancer

  • Method of staging
  • Stages
A

Gold standard= thoracoabdominoplevic CT

Local cancer

  • Colon= CT
  • Rectal, pelvic= MRI

With 5 year survival:
A- Penetration into submucosa.

B- 1. Penetration into propia (>90)
2. Penetration through bowel wall (80-85%)

C- 1. Into propia, LN metastasis. (50-65%)
2. Through bowel wall, LN Mets (>90%)

D- Distant mets: lung, liver, bone, skin. (<5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Rectal cancer surgery indication

A

Stage 3

  • T1-2, N1-2, M0
  • T3-4, N, M0
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risks of surgery treatment in colorectal cancer

A
  • Infection, bleeding
  • DVT/PE
  • Injuries to other structures: bowel, bladder, ureter, vessels, pelvic nerves
  • Anastomotic leak.
  • MI/CVA/ Resp/ AKI
  • Recurrence
  • Chronic pain
  • Lower anterior resection syndrome: incontinence, faecal urgency, diarrhoea, flatulence, abdominal pain.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Chemo and radiotherapy for colorectal cancer

A

Can be neoadjuvant/ adjuvant. 3 months/ 6 months.

  • Drugs: FOLFOX/ FOLFIRI.;
  • Only offered in rectal cancer stages (stage 3): T1-2, N1-2, M0 or T3-4, N, M0.
  • Offered in colon stages(preoperative): T4
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Advantages of CT colonoscopy

A

Not invasive

Can look outside the bowel

  • Look at the distant disease
  • I.e lymphadenopathy and metastasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CEA test

  • Descripton
  • Causes of raised CEA
A

Blood test that is a tumour marker
- Used to monitor disease prolapse

CarinoEmbryonicAntigen

Non specific, raised in

  • Smokers
  • Ca prostate, ovary, lung, thyroid, liver cirrhosis.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FOB

- Collecting samples

A

faecal occult blood test

  • Gold standard
  • Picks up any blood in faeces
  • Needs 3 separate samples from separate bowel movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FIT test

A

Faecal immunochemical test

Picks up HUMAn blood in faeces
- More specific than FOB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Polyps

  • Description
  • Types (morphology)
  • Malignancy tendency
  • Management
A

Benign adenomas
- Excess growth of epithelium

Types

  • Villous
  • Tubular
  • Tubulovillous

if >2cm= 40% chance of malignancy

<1cm= 1% chance of malignancy.

Management

  • Medical: regular OGD and surveillance
  • Surgical: protocolectomy/ colectomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Symptoms of big colonic polyps

A

Bowel changes

  • Constipation/ Bowel obstruction
  • Watery faeces

Feeling of Incomplete evacuation (tenesmus)

  • Esp if in rectrum
  • Can present with haemorrhoids

PR bleed

Prolapse
- If the poly is low in rectum and pedunculated.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treatment of big colonic polyps

A

Transanal endoscopic microsurgery (TEMS)

Transanal minimally invasive surgery (TAMIS)

Open/ Lap/ robotic

Colonoscopic endoscopic surgery

  • Endoscopic mucosal resection (EMR)
  • If polyp is confined to mucosa
  • ESD- if polyp extends to sumucosa
17
Q

Complications of laparoscopic surgery

A

Perforation
- Especially when putting in the first port

Organ injury
- i.e liver, vascular

18
Q

Risks of surgery

A

Infection
Bleeding

DVT/ PE

Injury to bowel/ bladder/ nerves/ vessels

Anastomotic leak

Recurrence

19
Q

Bowel ischaemia

  • Presentation
  • Causes
  • Diagnosis
A

Presents

  • Severe abdominal pain
  • Nausea, vomitting

Causes
- Clot (from AF, from other areas)

Diagnosis
- CT angiogram

20
Q

Colonic adenoma

  • Description
  • Classifications
  • Presentation
  • Malignant potential
A

Benign precursor of cororectal caricinoma
- Dysplastic epithelium

Classification

  • Tubular: tubular glands
  • Villous
  • Tubulovillous (mixture)

Presentation

  • Mainly asymptomatic
  • If large, can bleed= Fe def anaemia
  • Villous= hypoK, Hypoproteinaemia

Malignant potential

  • Increases with size
  • Increased dysplasia
21
Q

APC

  • Function
  • Mutation
A

Tumour suppressor protein

  • Degrades beta-catenin
  • Prevents overstimulation of cell division

Mutation

  • Causes increase in beta-catenin= increased transcription of genes that promote cell proliferation
  • Associated with FAP and also in non-inherited colorectal cancer ( Caricnoma sequence)
22
Q

Colorectal cancer types

- Pathology

A

Adenocarcinoma

  • Mucinous
  • Signet ring cell
  • Anaplastic
23
Q

Cancer morphology

A

Majority on left side of colon/ rectum.

  • Rectum= most common
  • Descending sigmoid (next common)
24
Q

Clinical presentation

A

PR bleeding

  • Deep red, on the surface of stools= rectal
  • Dark red, mixed with stool= descending sigmoid

Iron-deficiency anaemia
- Right sided colon

Change in bowel habit

25
Q

Emergency presentation of CRCa

A

Large bowel obstruction

  • Colicky pain
  • No BO
  • Bloating

Perforation, peritonitis

Acute PR bleed

26
Q

Curative treatment for CRCa

A

Surgical resection (with lymphadenectomy)

  • Hemicolectomy
  • High/ low anterior resection
  • Anorectal resection
27
Q

Low anterior resection

  • Description
  • Complications
  • Indications
A

Removal of all/part of the rectum

  • Anal-lower colon anastomosis (ultra-low, no remaining rectum) or
  • Anal- rectum anastomosis

The lower the anastomosis, the higher risk of complications

  • Anastomosis leakage
  • Can be avoided via loop ileostomy

Indications

  • Rectal carcinoma
  • Rectal adenoma
  • Sever anorectal sepsis
28
Q

Ileoanal pouch

  • Description
  • Types
  • Indication
A

Formation of a pouch from ileum when colon+rectum are removed but anus is preserved
- Allows rectal function to be retained.

Types

  • J pouch (2 folds)
  • W pouch (3 folds)

Indications

  • Refractory UC
  • FAP/ multiple colorectal polyposis
  • Multiple colonic tumours including the rectum.
29
Q

Complications of pelvic anastomosis (4)

A

Leakage
- Higher in lower anastomosis

Ischaemia
- Proximal bowel in anastomosis becomes ischaemic

Stenosis

  • Later complication
  • Treated with dilation under anaesthetic

Bleeding

30
Q

Familial adenomatous polyposis

  • Genetics
  • Features
A

Autosomal dominant defect in APC gene
- Causes dozens-thousands of adenomatous polyps in colorectum

  • Increased overall risk of colorectal cancer due to the number of polyps present.
31
Q

Hereditary non-polyposis colorectal cancer (HNPCC)
- Genetics
-

A

Cancer syndrome also known as Lynch Syndrome

Autosomal dominant
- High risk of colon cancer (as well as ovary, stomach, brain, skin, hepatobillary)

  • Mutations in DNA mismatch repair genes (MMR)
  • Predisposes to adenoma
  • Microsatellite instability
32
Q

Staging investigations

  • Local
  • Metastasis
  • Synchronous tumour
A

Local

  • CT
  • Rectal (Pelvic MRI)

Mets
- TAP CT

Syndronous tumour
- Colonoscopy, barium enema

304: GI (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions