Cancer surgery Flashcards
Symptoms of colorectal cancer?
Where may cancer occur?
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
How do surgeons investigate and diagnose colorectal cancer?
Colonoscopy CT Colonoscopy Contrast CT ( chest/abdomen and pelvis) MRI of the pelvis Ultrasound of the liver
What % of tumours are inoperable/incurable and what is the main cause of this?
20
Advanced local or metastatic disease
Describe a right hemicolectomy
Right extended hemicolectomy
1: Tumours of caecum, ascending colon, proximal transverse colon, hepatic flexure
2: Tumours of distal transverse colon + splenic flexure
Describe a left hemicolectomy
Tumours of splenic flexure + descending colon
Describe a sigmoid colectomy
Tumours of sigmoid colon
Describe an anterior resection
Tumours of distal sigmoid colon and upper/mid rectum
Describe an abdominal perineal resection
Tumours of lower rectum and ano-rectal junction
What is a bowel anastomoses?
Bowel rejoined again after tumour removal
When are stomas used?
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
What are the two types of stoma ?
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
Features of colostomy
Thicker effluent as water absorbed through colon Less skin excoriation Left iliac fossa Harder to reverse Easier to manage
Features of ileostomy
Thinner liquid effluent
Sprouting to keep effluent away from skin surface which can cause excoriation
Easier to reverse
Right iliac fossa
What staging is used for colorectal cancee?
Dukes staging is based on invasion
TNM - Tumour type, nodular disease, metastases
How do we screen for colorectal cancer?
FIT test for all 60-74 year olds every 2 years
Detects human haemoglobin in stool
Positive test = colonoscopy
How long does it take for colorectal cancer to develop?
5-10 years
Start and polyps and then adenomas ( benign epithelial tumour)
Colonoscopy risks?
Bleeding Bowel perforation Sedation effects Bowel prep effects ( dehydration) Missed pathology ( 90-95% accuracy)
What is a carcinoma, adenoma, sarcoma, dysplasia?
Epithelial malignancy
Benign epithelial tumour
Connective tissue malignancy
Non invasive cellular changes
How can tumours spread?
Example of breast cancer?
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
What are the 5 ways cancer causes illness?
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
How does a surgeon treat cancer?
Detect cancer by symptoms and screening
Treat: Sugery, chemo + radiotherapy
Prevent cancer: Identify pre malignant conditions
How is cancer staged + why is it important?
All tumours = TMN classification
Tumour, nodal disease and metastases)
What is breast cancer screening?
All women 50-70 every 3 years
What is lead time bias?
Time of cancer and death is at a fixed point, difference is time with known cancer
Breast cancer symptoms
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
How do we investigate + diagnose breast cancer?
Mammogram Biopsy CT MRI Ultrasound Chest X ray, Bone scan + CT to identify signs of metastatic spread
How is breast cancer treated?
Removal of local cancer i.e masectomy or lumpectomy + reconstruction
Axillary management by sentinel lymph node biopsy
What is sentinel LN biopsyt?
Detects cancerous cells in the sentinel LN ( Next to breast) requiring removal or radiation
How is nottingham prognostic index created?
Tumour stage
Metastatic spread
Tumour
How do we prevent breast cancer?
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
Features of Horner’s syndrome?
Facial flushing on same side as lesion
Inability to sweat on affected side
Small constricted pupil
Drooping eyelid
