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3A week 2 - lower GI tract > colorectal and anal cancer > Flashcards

colorectal and anal cancer Flashcards

1
Q

what is the epidemiology of colorectal cancer

A
  1. equal M:F for colonic but men have slightly more rectal cancers
  2. highest incidence is in europe and north america (lowest in asia, africa and south america)
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2
Q

what kind of diet increases the risk of colorectal cancer

A

diet high in fat and cholesterol (esp from animal sources), processed and red meat

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3
Q

risk factors for colorectal cancer (6)

A
  1. genetic syndromes/ other genetic mutations
  2. diet
  3. obesity
  4. alcohol (>6 units per day)
  5. diabetes
  6. smokers
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4
Q

what is familial adenomatous polyposis (FAP)

A

and autosomal dominant inherited condition characterised by hundreds of adenomatous polyps

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5
Q

what is the mgx for someone with familial adenomatous polyposis

A

prophylactic surgery at 16-25 yro -> if don’t opperate then will almost definately get colorectal cancer

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6
Q

extracolonic manifestations of familial adenomatous polyposis (5)

A
  1. desmoid tumours
  2. duodenal adenomas
  3. skin lesions/epidermal cysts
  4. osetomas in mandible and maxilla
  5. congenital hypertrophy retinal pigment epithelium (can be easily tested in children)
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7
Q

what is lynch syndrome

A

and autosomal dominant DNA mismatch condition where a person is predisposed to getting cancer (lifetime risk 85%)

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8
Q

what screening is given to those w lynch syndrome

A

colonoscopy every 2 years

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9
Q

genetic mutations associated w increased risk of colorectal cancer (not syndromes)

A

ACP; CTNNB1; AXIN1; hMLH1/2

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10
Q

possible aetiological factors for colorectal cancer (6)

A
  1. adenoma-carcinoma sequence
  2. IBD
  3. ureterosigmoidostomy (no longer performed but seen in elderly)
  4. acromegaly (related to serum GH/IGF1 levels)
  5. gastric surgery (changes in bile acid)
  6. irradiation
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11
Q

what is the distribution of tumours within the colon

A

majority occur on the left side
1. rectum -27%
2. sigmoid colon - 20%
3. caecum (R side, near ileum) - 14%
4. anus - 2%

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12
Q

what bowel screening tests may pick up a colorectal cancer (3)

A
  1. faecal occult blood and colonoscopy
  2. faecal immunochemical test
  3. flexible sigmoidoscopy
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13
Q

colorectal cancer presentation

A
  1. change in bowel habit
  2. rectal bleeding
  3. anaemia
  4. abdominal pain
  5. mucus/tenesmus
  6. abdominal mass
  7. weight loss
  8. emergency presentation (obstruction, peritonitis, bleeding etc.)
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14
Q

when is colonic stenting used (3)

A
  1. metastatic disease
  2. large bowel obstruction -> get pt fit for elective surgery
  3. benign strictures
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15
Q

6 complications of colorectal cancer resection

A
  1. anastomotic leak (high rates of this, L hemicolectomy more than R)
  2. wound infection
  3. DVT/PE
  4. bleeding
  5. nerve injury (bladder + sexual function)
  6. stoma complications
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16
Q

when to consider that there is an anastomotic leak post colorectal surgery (4)

A
  1. any deterioration in condition within 10 days
  2. elderly - often present w AF or respiratory symptoms
  3. defunctioning stoma
  4. metabolic acidosis, raised CRP and WCC
17
Q

4 methods of tumour spread

A
  1. nodal
  2. vascular
  3. direct
  4. transcoelomic
18
Q

Duke’s staging for colorectal cancer

A

A - inner lining of bowel
B - through the muscular layer
C - spread to at least 1 lymph node
D - metastases

19
Q

pT tumour classification (coloncancer)

A

pT1 - submucosa invasion
pT2 - muscularis propria invasia
pT3 - subserosa/ non-peritonealised pericolic/ peri-rectal tissues
pT4 - perforates visceral peritoneum (4a) anddirectly invades other structures (4b)

20
Q

what pre-op treatment can be given for rectal cancer (2)

A
  1. short course of radiotherapy and then surgery the following week
  2. long course chemo-radiotherapy and then delayed surgery for 8-12 weeks
21
Q

what is transanal endoscopic microsurgery (TEMS)

A

a type of robotic surgery where rectal tumours are removed (full thickness or submucosal thickness) and defects can be closed

22
Q

what is transanal total mesorectal excision (TaTME)

A

a specific surgical technique used in the treatment of rectal cancer in which the bowel with the tumor is entirely removed along with surrounding fat and lymph nodes

23
Q

what is anal intraepithelial neoplasia

A

precancerous changes to the lining of the ansu

24
Q

how is anal intraepithelial neoplasia treated

A

imiquimod

25
Q
A

3A week 2 - lower GI tract (8 decks)

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