Colorectal/Anal Disease Flashcards
Types of colorectal tumour?
Adenoma
Adenocarcinoma
How do you differentiate/stage colorectal cancer?
Duke’s staging (5 year survival)
- based on depth of tumour formation
TNM staging
NEED BIOPSY
What is the highest risk factor for colorectal cancer?
Smoking
Specific symptoms of colorectal cancer? (4)
Anaemia (due to bleeding/malabsorption)
Change in bowel habits
Tenesmus
Abdo mass
Investigation of colorectal cancer?
Colonoscopy
Pill endoscopy
CT colongraphy
Treatment of colorectal cancer?
Colectomy (removal of affected area and anatomise the two regions)
Radiotherapy - adjuvant or neoadjuvant
What is the only big difference between anorectal and colorectal cancer?
Anorectal cancers can be adenocarcinoma or SCC (from adjacent skin)
Colorectal - just adenocarcinoma
Who gets bowel cancer screening (FOB test)?
Pts 50-75 yo with risk factors every 2 yrs
What is diverticular disease? What is diverticulitis?
Diverticula which are symtpomatic
Diverticulitis - inflammation of diverticulum
What causes diverticulum to form
Low fibre diet
Colon has to work harder to move faeces … ADD
Signs and symptoms of diverticulitis
Symptoms like appendicits but on other side
Severe LIF pain
Fever
Tachycardia
Tenderness and guarding (muscle tenses around area of disease) of left side
Symptoms and signs of diverticular disease
Similar to IBD
LIF pain - colic (coming and going)
Altered bowel habit
Invx of diverticular disease
Colonscopy
Invx of diverticulitis?
-CT (gold)
-Increased ESR and CRP
DO NOT SCOPE -> perforation
Complications of diverticulitis (4)
Complications of diverticulitis = complicated diverticultis
Perforation
Haemorrhage
Fistula
Stricture
When would you use hinchey classification?
For acute diverticulitis (based on CT findings - used to find best treatment in diverticulitis complicated with abscess formation/peritonitis)
Treatment of diverticular disease
Balanced diet
Analgesia
Bulking laxative
Treatment of Uncomplicated diverticulitis
Analgesia if necessary
Antibiotics if suspected infection
Treatment of complicated diverticultis?
Precutatneous drainage of large abscess
Hartmann’s procedure (removal of sigmoid coloon)
Where is diverticulum most likely to occur?
Sigmoid colon - due to narrowing
What is a colonic polyp?
Abdnormal growth of tissue projecting from colonic mucosa
What is the most important polyp to know about?
Adenoma - all dysplastic (potential to become cancerous)
What inherited conditions put you at an increased risk of polyp formation?
Familial adenomatous polyposis (FAP)
- loads and loads of adenomas - very very high risk of cancer
Lynch syndrome - lots of adenomas on right side
Peutz-jeghers syndrome - Multiple benign intestinal hamartomas
What gene is their a mutuation in FAP and Lynch syndrome?
FAP - APC gene (tumour suppressor disease)
Lynch - MSH2 gene (DNA mismatch repair))
Signs and symtpoms of colonic polyps?
Asymptomatic mostly Rectal bleeding (often not frank) -> anaemia Mucus in stool Abdo pain Bowel change
Invx of colonic polyps?
- Fam history (inhertited conditions and cancers)
- Genetic testing
- Colonscopy
What is a haemorrhoid?
Enlargement of the vascular cushions in the wall of the anus and rectum due to increased pressure
Treatment of haemorrohoid?
Increase fibre and fluid
ADD
Where is the first site of metastasises of colorectal cancer?
Liver
Due to haematological spread via portal system
What is the difference between a true diverticulum and psudeo diverticulum?
Pseudo is missing muscularis externa
Difference between hyperplastic polyp and adenoma
Hyperplastic polyp - v. v. low risk of becoming malignant
Adenoma - high risk of malignancy (found in FAP)
Most commonly used tumour marker in colorectal cancer?
CEA
Pseudomembranous colitis (yellow plaques that are easily dislodged) is associated with what condition?
C.diff
