Colorectal and Anus Flashcards
Colorectal epidemiology and aetiology?
Clinical Management
-Primarily resection
-Post-op RT to tumour bed / nodal areas
-If unresectable: Chemo/RT or Pre-op RT
RT and Chemo:
-Generally poor radiosensitivity (except sarcomas)
-Whole abdo RT for lymphomas
-20-25Gy +/- radiosensitising chemo
-5-FU or cisplatin based chemo
Colorectal
Epidemiology & Aetiology
2nd most commonly diagnosed cancer in Australia, 3rd most common in the UK
Age – majority occurs in over 50s
Dietary factors:
-High meat consumption
-High total fat consumption
-High calorific intake
-High alcohol intake
-Familial factors
- 2 to 410`3-fold increased risk
-history of polyps
Genetic/ Hereditary:
-Polyposis
-Crohn’s Disease
-Diverticulitis
-Alcohol, smoking, obesity, low physical activitySigns and symptoms colorectal?
Signs & Symptoms -Palpable mass -Rectal bleeding &/or blood in stool -Diarrhoea Depending on site of tumour: -Change in bowel habit -Blood per rectum -Mucus per rectum -Tenesmus -Obstructive symptoms -Iron deficiency anaemia
Signs and symptoms based off position in colon?
Right Pain – 80% Mass – 70% Rectal bleeding – 20% Diarrhoea and change in bowel habit – 40% Weight loss – 50% Vomiting – 30% Obstruction – 5%
Left Pain – 60% Mass – 40% Rectal bleeding – 20% Change in bowel habit – 60% Weight loss – 15% Vomiting – 10% Obstruction – 20%
Rectum Pain – 5% Mass – 0% Rectal bleeding – 60% Change in bowel habit – 80% Weight loss – 25% Vomiting – 0% Obstruction – 5%
Colorectal stabilisation?
Standard Prone: Prone Pillow Belly board Straight & level Arms “up” Bolster under ankles
Colorectal detection?
- Faecal occult blood test
- Digital rectal exam (DRE)
- Sigmoidoscopy/colonoscopy
Patterns of spread colorectal?
- Local through mucosal walls
- Lymph & blood -submucosal layer
- More lateral than longitudinal
- Peritoneal Seeding
- Pelvic lymph nodes
- Distant metastases
Colorectal pathology?
Adenocarcinomas (44%)
Carcinoid (29%)
Sarcoma (12%)
Lymphoma (15%)
3 types of colon staging?
- Dukes - A = no bowel penetration
B = bowel penetration
C = positive nodes
D = mets
A – Confined to bowel wall i.e. mucosa and sub mucosa, or early muscular invasion
B – Invasion through the muscle wall but no lymph node involvement
C1 – Lymph node involvement but not up to highest point of vascular ligation
C2 – Nodes involved up to highest nodes at the point of vascular ligation - Aster-Coller - Modification of Dukes with more specific staging for degree of penetration & nodal spread
3.TNM - Most commonly used.
T0-4 1 = submucosa
2 = muscularis propria
3 = beyond 2
4 = other organs invaded
N0-2 1 = 1-3 nodes
2 = >3 nodes
M0-1 1 = Metastatic
Grading quite important
Clinical management colon?
Surgery: Surgery remains the cornerstone of treatment with a high percentage of tumours being resectable.
Radiotherapy: Radiotherapy has little role in the curative treatment of colon cancer for a number of reasons: - Local recurrence not a major cause of relapse
- Difficult to determine volume to be irradiated
- Proximity of OARs
Chemotherapy
Clinical management rectum?
Surgery: remains the main primary ‘definitive’ treatment. Surgery is the only curative treatment modality – around 80% of tumours are resectable
-Surgery gives 5-year overall survival rates:
93 per cent (stage I),
72–85 per cent (stage II),
44–83 per cent (stage III) and
8 per cent (stage IV). The 5-year survival in stage IV disease with resection of liver metastases after primary treatment is 36 per cent.
- Total mesorectal excision (TME) which has reduced local recurrence rate to less than 10 per cent, compared with 30 per cent with older surgical techniques
Radiation therapy: - Pre-operative RT to downstage tumours
- Useful for inoperable or recurrent tumours
- Useful for palliation of symptoms
Chemo: - Adjuvant treatment for both colon and rectal cancer
- 5 FU
What is and why do we use pre op RT for rectum?
- More popular than post operative RT
-Patient is well when attending RT
-Imaging techniques (CT, MRI, PET) allow for more accurate
staging
-easier to assess which pt suitable for EBRT
-Results similar pre vs post op EBRT in terms of reduction of
pelvic recurrence
Rectum pre-op prescriptions?
-Short course Swedish protocol, does not unduly delay surgery
25Gy in 5 fractions over 1 week, surgery follows in next 7-10 days
- Standard fractionations:
45Gy in 25 fractions over 5-6 weeks, surgery follows approx. 8-10 weeks
50.4Gy in 28 fractions over 5-6 weeks, surgery follows approx. 8-10 weeks
Acute side effects?
Erythema/moist desquamation Diarrhoea Tenesmus Rectal bleeding Cystitis and dysuria Fatigue
Late side effects (6-18 mths after?)
Ulceration
Fistula
Risk of obstruction in small bowel
Chronic diarrhoea
Patient care?
- Skin care aqueous creams apply 2-3 times a day (avoid powders, other creams unless approved by RO)
- medication to reduce diarrhea
- reduce fibre intake
- dietitian consultation
- Dysuria – urinary alkalisers
- Booked to see RO weekly and when necessary.
- Remember chemo will increase severity
