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Peri-op > Colon Cancers > Flashcards

Colon Cancers Flashcards

1
Q

Risk factors for bowel cancer?

A
  1. Family history
  2. FAP
  3. HNPCC (Lynch syndrome)
  4. IBD

+ age, diet (↑red meat, ↓fibre), obesity, smoking and alcohol

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2
Q

What is Familial adenomatous polyposis (FAP)?

A

Autosomal dominant condition

Results in many polyps (adenomas) developing in the large intestine, which have the potential to become cancerous

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3
Q

What gene is mutated in FAP?

A

tumour suppressor genes called adenomatous polyposis coli (APC)

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4
Q

Treatment of FAP?

A

Prophylactic removal of the large intestine → panproctocolectomy

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5
Q

At what age does cancer due to FAP usually occur?

A

< 40yrs

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6
Q

What is Hereditary nonpolyposis colorectal cancer (HNPCC)?

ie. Lynch syndrome

A

Autosomal dominant condition which increases risk of a number of cancers, esp colorectal cancer

Unlike FAP it does not cause adenomas, tumours develop in isolation

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7
Q

What are the mutations in HNPCC?

A

In DNA mismatch repair (MMR)

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8
Q

List 4 reg flags for bowel cancer?

A
  • Change in bowel habit (more loose, frequent stools)
  • Unexplained weight loss
  • Rectal bleeding
  • Unexplained abdominal pain
  • Iron deficiency anaemia
  • Abdominal or rectal mass on examination
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9
Q

How may bowel cancer present? (Hint: red flags)

A
  • Change in bowel habit (more loose, frequent stools)
  • Unexplained weight loss
  • Rectal bleeding
  • Unexplained abdominal pain
  • Iron deficiency anaemia
  • Abdominal or rectal mass on examination
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10
Q

What type of anaemia is seen in bowel cancer?

A

Iron deficiency anaemia → microcytic anaemia with low ferritin

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11
Q

NICE two week wait referral criteria for suspected bowel cancer?

A
  1. Over 40 years + abdominal pain and unexplained weight loss
  2. Over 50 years + unexplained rectal bleeding
  3. Over 60 years + a change in bowel habit or iron deficiency anaemia
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12
Q

To whom is FIT testing offered?

A

To assess patients for bowel cancer that do not meet the two week wait referral criteria:

  • Over 50 with unexplained weight loss and no other symptoms
  • Under 60 with a change in bowel habit
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13
Q

Bowel cancer screening?

A

FIT testing offered to patients aged 60 – 74 years every 2 years

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14
Q

Screening for bowel cancer in patients with risk factors? (ie FAP, HNPCC or IBD)

A

Colonoscopy at regular intervals

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15
Q

Gold standard investigation for suspected bowel cancer?

A

Colonoscopy + biopsy

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16
Q

Other investigations for suspected bowel cancer?

A
  1. Sigmoidoscopy
  2. CT colonography
  3. Staging CT TAP
  4. Tumour marker blood tests (CEA)
17
Q

What tumour marker may be raised in bowel cancer?

A

Carcinoembryonic antigen (CEA)

NOT helpful in screening, but may be used to predict relapse

18
Q

What classification system was used for bowel cancer? (No longer used)

Explain

A

Dukes’

  • A – confined to mucosa, part of the muscle in the bowel wall
  • B – extends through muscle
  • C – lymph node involvement
  • D – metastatic disease
19
Q

What classification is more commonly used to stage bowel cancer?

Explain

A

TNM classification

20
Q

List 4 options for managing bowel cancer (in any combination)

A
  1. Surgical resection
  2. Chemotherapy
  3. Radiotherapy
  4. Palliative care
21
Q

Surgery for bowel cancers involves what 4 steps?

A
  1. Identifying the tumour
  2. Removing section of bowel containing tumour
  3. creating an end-to-end anastomosis
  4. OR alternatively creating a stoma
22
Q

What is a Right hemicolectomy?

A

Removal of the caecum, ascending and proximal transverse colon

23
Q

What is a left hemicolectomy?

A

Removal of the distal transverse and descending colon

24
Q

What is a High anterior resection?

A

Removing the sigmoid colon (sigmoid colectomy)

25
Q

What is a Low anterior resection?

A

Removing the sigmoid colon and upper rectum but sparing the lower rectum and anus

26
Q

What is a Abdomino-perineal resection (APR) ?

A

Removing the rectum and anus (plus or minus the sigmoid colon) and suturing over the anus

Leaves the patient with a permanent colostomy

27
Q

Complications of bowel cancer surgery?

A
  1. Bleeding, infection and pain
  2. Damage to nerves, bladder, ureter or bowel
  3. Post-operative ileus
  4. Anaesthetic risks
28
Q

What is Low Anterior Resection Syndrome?

A

May occur after resection of a portion of bowel from the rectum, with anastomosis between the colon and rectum

  • Urgency and frequency of bowel movements
  • Faecal incontinence
  • Difficulty controlling flatulence
29
Q

How long is the follow up period time following curative surgery?

A

3 years

30
Q

List 2 common indications for a Hartmann’s procedure

A
  1. Acute obstruction by a tumour
  2. Significant diverticular disease
31
Q

List 2 follow up investigations

A
  • CEA
  • CT TAP
32
Q

What is a Hartmann’s procedure?

A

Usually an emergency procedure

Removal of the rectosigmoid colon and creation of an colostomy with closure of the anorectal stump ?

Colostomy may be permanent or reversed at a later date

Peri-op (22 decks)

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