Cancer surgery

Question 1

Symptoms of colorectal cancer?

Where may cancer occur?

Answer 1

Abdominal mass
Weight loss 
Bleeding 
Iron deficiency anaemia 
Pain 
Constipation
Diarrhoea 

30% rectum
15% sigmoid colon
10% caecum
Remaining could be any part of the colon including the appendix

Question 2

How do surgeons investigate and diagnose colorectal cancer?

Answer 2

Colonoscopy 
CT Colonoscopy 
Contrast CT ( chest/abdomen and pelvis) 
MRI of the pelvis
Ultrasound of the liver

Question 3

What % of tumours are inoperable/incurable and what is the main cause of this?

Answer 3

20

Advanced local or metastatic disease

Question 4

Describe a right hemicolectomy

Right extended hemicolectomy

Answer 4

1: Tumours of caecum, ascending colon, proximal transverse colon, hepatic flexure
2: Tumours of distal transverse colon + splenic flexure

Question 5

Describe a left hemicolectomy

Answer 5

Tumours of splenic flexure + descending colon

Question 6

Describe a sigmoid colectomy

Answer 6

Tumours of sigmoid colon

Question 7

Describe an anterior resection

Answer 7

Tumours of distal sigmoid colon and upper/mid rectum

Question 8

Describe an abdominal perineal resection

Answer 8

Tumours of lower rectum and ano-rectal junction

Question 9

What is a bowel anastomoses?

Answer 9

Bowel rejoined again after tumour removal

Question 10

When are stomas used?

Answer 10

Complete bowel rest after surgery
When no distal bowel remains e.g AP resection
Allow anastomoses to heal
For patients with a high chance of leakage from the anastomoses

Question 11

What are the two types of stoma ?

Answer 11

End - Proximal Bowel end brought to the skin surface
Distal bowel closed off and remains in the abdomen

Loop - Proximal ( healthy bowel) and distal bowel ends ( inactive bowel) are bought to the skin surface

Question 12

Features of colostomy

Answer 12

Thicker effluent as water absorbed through colon
Less skin excoriation
Left iliac fossa
Harder to reverse 
Easier to manage

Question 13

Features of ileostomy

Answer 13

Thinner liquid effluent
Sprouting to keep effluent away from skin surface which can cause excoriation
Easier to reverse
Right iliac fossa

Question 14

What staging is used for colorectal cancee?

Answer 14

Dukes staging is based on invasion

TNM - Tumour type, nodular disease, metastases

Question 15

How do we screen for colorectal cancer?

Answer 15

FIT test for all 60-74 year olds every 2 years
Detects human haemoglobin in stool
Positive test = colonoscopy

Question 16

How long does it take for colorectal cancer to develop?

Answer 16

5-10 years

Start and polyps and then adenomas ( benign epithelial tumour)

Question 17

Colonoscopy risks?

Answer 17

Bleeding 
Bowel perforation 
Sedation effects
Bowel prep effects ( dehydration)
Missed pathology ( 90-95% accuracy)

Question 18

What is a carcinoma, adenoma, sarcoma, dysplasia?

Answer 18

Epithelial malignancy
Benign epithelial tumour
Connective tissue malignancy
Non invasive cellular changes

Question 19

How can tumours spread?

Example of breast cancer?

Answer 19

Direct invasion
Lymphatic spread
Metastatic spread
Fungating breast tumour invades directly into the skin,
Breast cancers spread to bone ( weakening + fractures), lungs, liver and brain

Question 20

What are the 5 ways cancer causes illness?

Answer 20

Interfere with normal function : Pancoast tumour of lung apex compresses brachial plexus -> shoulder pain + hand weakness

Horner’s syndrome: Facial flushing on same side as lesion, inability to sweat on affected side, small constricted pupil, dropping eyelid.

Direct metabolic effects
Cachexia : Nausea -> less appetite, cancer/tumour metabolism, inflammatory changes. Progressive muscle wastage
Erosion: GIST presenting with anaemia and upper GI haemorrhage
Obstruction: Colorectal cancers causing large bowel obstructions

Question 21

How does a surgeon treat cancer?

Answer 21

Detect cancer by symptoms and screening
Treat: Sugery, chemo + radiotherapy
Prevent cancer: Identify pre malignant conditions

Question 22

How is cancer staged + why is it important?

Answer 22

All tumours = TMN classification

Tumour, nodal disease and metastases)

Question 23

What is breast cancer screening?

Answer 23

All women 50-70 every 3 years

Question 24

What is lead time bias?

Answer 24

Time of cancer and death is at a fixed point, difference is time with known cancer

Question 25

Breast cancer symptoms

Answer 25

Pain
Pagets disease of the nipple/breast ( nipple retraction + bloody discharge)
Peu de orange ( invasion of ligaments of cooper)
Skin changes 
Lump 
Breast enlaregment 
Signs of metastatic disease 
Axillary/sub clavicular LN swelling

Question 26

How do we investigate + diagnose breast cancer?

Answer 26

Mammogram
Biopsy
CT
MRI 
Ultrasound 
Chest X ray, Bone scan + CT to identify signs of metastatic spread

Question 27

How is breast cancer treated?

Answer 27

Removal of local cancer i.e masectomy or lumpectomy + reconstruction
Axillary management by sentinel lymph node biopsy

Question 28

What is sentinel LN biopsyt?

Answer 28

Detects cancerous cells in the sentinel LN ( Next to breast) requiring removal or radiation

Question 29

How is nottingham prognostic index created?

Answer 29

Tumour stage
Metastatic spread
Tumour

Question 30

How do we prevent breast cancer?

Answer 30

ID high risk groups e.g BRCA1/2 gene mutations
ID Biomarkers e.g LCIS (Lobular carcinoma in situ)
Drug prevention - tamoxifen
Ovarectomy or masectomy

Question 31

Features of Horner’s syndrome?

Answer 31

Facial flushing on same side as lesion
Inability to sweat on affected side
Small constricted pupil
Drooping eyelid