Bowel Cancer Flashcards
Description
Cancer of the colon or rectum
Epidemiology
One of the most common types of cancer
-most commonly diagnosed at 60+
Aetiology and risk factors
Increasing age
Diet high in red/processed meats, low in fibre
Overweight/obese
Sedentary lifestyle
Alcohol, smoking
Personal history of polyps, colorectal cancer
IBD
Genetics
-familial adenomatous polyposis => almost guaranteed to develop colorectal cancer at a younger age
Pathology
Disease results from accumulation of alterations in genes that drive the formation of neoplasm
Symptoms
MAIN 3
- persistent blood in stool
- persistent change in bowel habit (runnier, but may be constipated if mass causing obstruction0
- persistent lower abdo pain, bloating, discomfort, mass (feeling of fullness despite not eating)
Other systemic symptoms
- unexplained weight loss
- fatigue
- night sweats
- fever
- back pain
Differential diagnoses
Want to rule out neoplastic causes first especially without other symptoms
Infection/inflammatory
- appendicitis, diverticulitis
- cystitis
Autoimmune
-IBD
Neoplastic
-other carcinomas
Degenerative
- benign colon polyps
- hernias
Signs
Abdo exam
- abdominal/rectal mass => potential bowel obstruction?
- melena without anal symptoms
DRE => any anal, rectal masses
-frank haematuria on finger
Investigations
2ww form
- FIT testing for occult blood
- 40+ with unexplained weight loss, abdo pain
- 50+ with unexplained rectal bleeding
- 60+ with Fe deficient anemia/bowel habit
If you have low suspicions but symptoms persist, refer to clinic but not via 2ww pathway
Management
If colorectal cancer confirmed
- surgery is the most common => stoma
- may use chemo, radio to kill residual cells
Prognosis
Dependent on stage but generally
- around 80% survive for 1 year+
- around 60% survive for 5years+
- around 55% survive for 10years+
What are the life changes that will occur with a stoma
Bowel changes
- frequency and urgency increases
- C/D, incontinence, leakage
- bloating/farting
- sore skin around anus
Can take 6-8wks for your bowel to settle after surgery
-may need to experiment with what food you can and can’t eat
Need to know where the toilets are
- Just can’t wait card for quick toilet access
- may become very socially isolated after incidents
Mood and body issue worries
-work with stoma nurse to find a stoma bag that works for you
All exercise and watersports are still possible
What screening tests exist
When would you do it?
Everyone between 60-74 automatically sent a bowel cancer screening kit every 2 years => FIT test
-poo on stick which is tested for occult blood
If +ve => only proves that occult blood was found, colonoscopy needed to look for cause
If -ve => unlikely to have bowel cancer but see your GP if you still have symptoms
