Cancer

Question 1

How common is colorectal cancer?

Answer 1

3rd most common cancer

Question 2

How does colorectal cancer occur?

Answer 2

normal epithelium → hyper proliferative epithelium → benign adenoma → invasive carcinoma (spreads by local invasion, lymph or coelomic spread)

Question 3

What is the most common type of colorectal cancer? What are the other types?

Answer 3

Adenocarcinoma 95%
Carcinoid
GI Stromal
Primary malignant lymphoma

Question 4

Where is colorectal cancer most commonly found?

Answer 4

Rectum-40%
Sigmoid-20%
Caecum- majority develop from polyps

Question 5

What are the risk factors for colorectal cancer?

Answer 5

Western diet
Familial: HNPCC, FAP, Gardner’s, Peutz-Jahger
Mutations: P53, RAS

Question 6

What are the typical features of colorectal cancer?

Answer 6

Altered bowel habits
Weight loss
Rectal bleeding
Vague abdo pain

Question 7

What are the Sx of a RHS cancer?

Answer 7

Occult bleeding
Mass in RIF
MORE ADVANCED AT PRESENTATION

Question 8

What are the Sx of a LHS Cancer?

Answer 8

Obstruction & Tenesmus
Rectal bleeding (fresh blood)
Colicky abdo pain
Mass in LIF
LESS ADVANCED AT PRESENTATION

Question 9

What criteria needs to be met for a 2week referral for ?colorectal carcinoma?

Answer 9

Abdo mass
>40yo w/↓weight + abdo pain
>50yo w/rectal bleeding
>60yo w/Fe+ anaemia OR altered bowel habits
<50yo w/rectal bleeding AND 1 of: Abdo pain/bowel change/↓weight/Fe anaemia

Question 10

What is the screening process for colorectal cancer?

Answer 10

Faecal occult blood
60-70yo every 2years
Abnormal → Colonoscopy
Sigmoidoscopy if 55yo as a one off

Question 11

How is colorectal cancer investigated?

Answer 11

1) DRE (75% rectal lesions detected) & Bloods
2) Scope & biopsy: Sigmoid if <25cm or colonoscopy = GOLD STANDARD
3) CT- staging

Question 12

How is colorectal cancer managed?

Answer 12

1) Surgery: Radical resection, palliative = stent
2) RT = 1st line for rectal cancers
3) Chemo: 5-FU
4) Cetuximab: Targets EGFR, can cause painful rash

Question 13

What staging is used for colorectal cancers?

Answer 13

Duke's staging
A: Tumour confined to mucosa
B: Into muscularis propria
C: Spread to regional lymph nodes
D: Distal mets

Question 14

What is the prognosis for colorectal cancers in relation to Duke’s staging?

Answer 14

A = 80%
B = 50%
C = 40-15%
D = 5%

Question 15

Where does colorectal cancer commonly metastasize to?

Answer 15

Liver

Question 16

Describe an ileostomy

Answer 16

Often for bowel resection
Liquid- unformed faeces
RIF
Spout to skin

Question 17

Describe a colostomy

Answer 17

Single loop- removal of sigmoid segment
Loop- Anastomosis to allow surgery to heal
Solid faeces
LIF
Flush to skin

Question 18

What are the complications of stomas

Answer 18

FOUL SHITS
F: Fluid loss
O: Odour
U: Ulcers
L: Leakage
S: Stenosis
H: Hernia
I: Ischaemia
T: Terminal ileum loss (↓B12)
S: Sexual issues

Question 19

What is the most common inherited cause of colonic cancer?

Answer 19

HNPCC aka Lynch Syndrome

Question 20

What is Lynch Syndrome?

Answer 20

Autosomal Dominant
MSH2 or MLH1
Mutation of DNA mismatch repair genes

Question 21

In which location in the bowel is Lynch syndrome most commonly seen?

Answer 21

Right sided proximal colon- poor differentiation & highly aggressive
Also endometrial cancer

Question 22

What are the investigations for HNPCC?

Answer 22

Colonoscopy every 1-2years from 25yo

Amsterdam Criteria- Aid diagnosis

Question 23

How is HNPCC treated?

Answer 23

Surgery

Question 24

What is FAP?

Answer 24

Autosomal dominant mutation in TSG leading to hundreds of adenomatous polyps

Question 25

What does Gardner's syndrome cause?

Answer 25

Osteomas of the skull/mandible Retinal pigmentation Thyroid Ca Epidermal cysts on skin

Question 26

How is FAP investigated?

Answer 26

Annual flexible sigmoidoscopy from 15yo No polyps = 5yearly colonoscopy started at 20yo Amsterdam Criteria- Aid diagnosis

Question 27

How is FAP managed?

Answer 27

Total colectomy + ileo-anal pouch formation

Question 28

What is Peutz-Jagher?

Answer 28

Multiple benign intestinal harmatomas | Autosomal dominant mutation of STK11

Question 29

How does Peutz-Jagher present?

Answer 29

Episodic obstruction Intussusception Pigmented lesions on lips, oral mucosa, face, palms, soles

Question 30

How is Peutz-Jagher investigated?

Answer 30

Annual exam | Pan-intestinal endoscopy 2-3years

Question 31

What are the risk factors for gastric cancer?

Answer 31

``` ↑Age Male H.Pylori Diet: Low in fruit + veg Smoking Gastritis Pernicious anaemia ```

Question 32

What are the clinical features of a gastric cancer?

Answer 32

ALARMS

Question 33

How is a gastric cancer investigated?

Answer 33

2week endoscopy- Biopsy & histology Bloods: FBC, LFTs CT/EUS- Staging

Question 34

What may histology show in gastric cancer?

Answer 34

Signet ring cells- higher number = poor prognosis

Question 35

How is gastric cancer managed?

Answer 35

Gastrectomy | Chemo/RT

Question 36

What are the types of liver tumours?

Answer 36

Hepatocellular carcinoma 90% | Cholangiocarcinoma

Question 37

What are the majority of liver cancers- primary or secondary?

Answer 37

Secondary mets from breast, bronchus, GI tract

Question 38

What are the risk factors for a hepatocellular carcinoma?

Answer 38

``` Primary biliary Cirrhosis!! OH- Haemochromotosis A1-Antitrypsin DM Hepatitis ```

Question 39

What tumour marker is raised in hepatocellular carcinoma?

Answer 39

↑AFP

Question 40

If ↑AFP what MUST be checked?

Answer 40

CHECK FOR TESTICULAR CANCER

Question 41

What are the causes of cholangiocarcinoma?

Answer 41

Primary sclerosis cholangitis Flukes N-nitrosamines

Question 42

What do the LFTs show for someone with cholangiocarcinoma?

Answer 42

↑↑ALP ↑AST/ALT ↑Bil 2 | ↑CEA ± ↑CA19-9, CA125

Question 43

How are hepatocellular carcinoma and cholangiocarcinoma treated?

Answer 43

Surgical resection- Curative