Bowel Cancer

Question 1

What is carcinoid syndrome?

Answer 1

• occurs when enterochromaffin tumours secrete serotonin, histamines and prostaglandins
• usually happens when liver mets have happened

Question 2

What are the symptoms of carcinoid syndrome?

Answer 2

flushing
diarrhoea 
bronchospasm + wheeze
RHF valvular stenosis 
hypotension

Question 3

How do you diagnose carcinoid syndrome?

Answer 3

• urinary 5-HIAA
• plasma chromogranin
• liver USS for mets

Question 4

How do you treat carcinoid syndrome?

Answer 4

• ocretide - somatostatin analogue
• cyproheptadine - diarrhoea causes by histamines
• surgery or chemo for tumour

Question 5

3 types of bowel Ca?

Answer 5

• sporadic (95%)
• Hereditary non-polyposis colorectal carcinoma (5%)
• familial adenomatous polyposis (<1%)

Question 6

Tell me more about hereditary non-polyposis colorectal carcinoma???

Answer 6

• autosomal dominant
• poorly differentiated and highly aggressive Ca
• MSH 2 & MLH 2 genes involved
• also associated with endometrial Ca, gastric Ca and pancreatic Ca
• Amsterdam criteria - 3 family members, 2 generations, one before aged 50

Question 7

Most common colon cancer, how does it present, how do you investigate?

Answer 7

• rectal
• like haemorrhoids - rectal bleeding, mucous, tensmus, think stool
• DO A PR, colonoscopy + biopsy, CT

Question 8

How gets a 2 week wait?

Answer 8

> =40 w/ unexplained weight loss w/ abdo pain
=50 w/ unexplained rectal bleeding
=60 w/ new iron deficiency anaemia OR change in bowel habit
occult blood found in faeces

Question 9

Who gets colon cancer screening? What is it? How often? what’s the follow up?

Answer 9

• 60-74 (over 74 can request)
• every 2 years
• faecal occult blood testing through the post
• colonoscopy follow up
• 5/10 normal, 4/10 polyp removal, 1/10 Ca
• reduce mortality by 16%

Question 10

How should suspected bowel cancer be investigated?

Answer 10

• tumour marker - CEA (carcinoembryonic antigen)
• colonoscopy + biopsy
• double contrast barium enema
• CT (not as sensitve)

Question 11

What’s the classification for bowel cancer? Tell me the stages too please.

Answer 11

Duke's classification 
A-D
A= confined to mucosa 
B= invading bowel wall 
C= lymph node mets 
D= distant mets