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General Surgery > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

What are colorectal cancers?

A

Originate from epithelial cells lining the colon or rectum, most commonly adenocarcinoma.

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2
Q

What is the adenoma-carcinoma sequence?

A

Progression from normal mucosa to colonic adenoma to invasive adenocarcinoma

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3
Q

Which genetic mutations have been implicated in predisposing individuals to colorectal cancer?

A

Adenomatous polyposis coli (APC) - tumour suppressor gene mutation - leads to growth of adenomatous tissue such as Familial Adenomatous Polyposis (FAP)

Hereditary nonpolyposis colorectal cancer (HNPCC) - DNA mismatch repair gene leads to Lynch syndrome

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4
Q

What are the risk factors for colorectal cancer?

A

75% sporadic

Increasing age 
Male
FH 
IBD
Low fibre diet 
Smoking and alcohol 
High processed meat intake
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5
Q

What are the common clinical features of bowel cancer?

A 
Change in bowel habit
Rectal bleeding 
Weight loss
Abdominal pain 
Symptoms of (iron-deficiency) anaemia
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6
Q

What clinical features may be present for right-sided colon cancer?

A

Abdominal pain, iron-deficiency anaemia, palpable mass in RIF

Often present late

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7
Q

What are the clinical features of left-sided colon cancers?

A

Rectal bleeding, change in bowel habit, tenesmus, palpable mass in LIF or on PR exam

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8
Q

What are the NICE guidelines for urgent investigations for bowel cancer?

A

≥40yrs with unexplained weight loss and abdominal pain
≥50yrs with unexplained rectal bleeding
≥60yrs with iron‑deficiency anaemia or change in bowel habit
Positive occult blood screening test

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9
Q

What are the differential diagnosis for colorectal cancer?

A

IBD

Haemorrhoids

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10
Q

What is the colorectal cancer screening?

A

Men and women aged 60-75 years offered a faecal immunochemistry test (FIT) every 2 years

One off screening flexible sigmoidoscopy offer to all people on year of 55th birthday

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11
Q

What investigations bloods should be ordered for suspected colorectal cancer?

A

FBC - look for microcytic anaemia
LFTS
Clotting
U+Es

CEA - carcinoembryonic antigen - used to monitor disease progression rather then diagnosis

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12
Q

What is the gold standard imaging for diagnosis of colorectal cancer?

A

Colonoscopy with biopsy

Can tattoo area if think malignant for future laparoscopic surgery

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13
Q

What investigation may be done colonoscopy with biopsy is not suitable for the patient with suspected colorectal cancer?

What are the reasons for not been suitable?

A

CT colongraphy

Reasons for not being suitable:
Frailty
Co-morbidities
Intolerance

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14
Q

What investigation will be required after the diagnosis of colorectal cancer is made?

A

CT chest, abdo, pelvis - look for metastases

MRI rectum - for rectal cancers to look for depth of invasion and potential need for pre-op chemo

Endo-anal ultrasound - for early rectal cancer (T1 or T2) to assess suitability for trans-anal resection.

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15
Q

What is done to the biopsy samples in colorectal cancers?

A

Send for histology - TNM staging, histological sub typing, grading and assessment of lymphatic, perineurial and venous invasion.

Assessed for tumour based markers - e.g. lynch syndrome - optimise potential chemo regimes

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16
Q

What is the staging for colorectal cancer?

A

Stages cancer according to depth of invasion into the bowel wall (T stage), spread to lymph nodes (N stage) and distant metastasis (M stage).

Dukes classification: not used anymore
Stage A - confined beneath the muscularis propria
Stage B - extension through the muscularis propria
Stage C - involvement of regional lymph nodes
Stage D - distant metastasis

17
Q

What is the definitive curative option in colorectal cancers?

A

Surgery although chemotherapy and radiotherapy have important role as neoadjuvant and adjuvant treatments alongside their role in palliation.

18
Q

What is the general surgery plan for colorectal cancers?

A

Regional colectomy, to ensure removal of the primary tumour with adequate marigins and lymphatic drainage, followed either by primary anastomosis or formation of a stoma.

19
Q

What is the surgical options for caecal tumour or ascending colon tumours or transverse colon tumours?

Which vessels are removed?

A

Right hemicolectomy or extended right hemicolectomy

Ileocolic, right colic and right branch of the middle colic along with their Mesenteries

20
Q

What is the surgical option for descending colon tumours?

Which vessels are removed?

A

Left hemicolectomy

Left branch of the middle colic, the inferior mesenteric vein, left colic vessels along with their mesenteries

21
Q

What is the surgery for sigmoid colon tumours?

Which vessel is removed?

A

Sigmoidcolectomy

IMA fully dissected in order to remove adequate margins

22
Q

What is the surgery of choice for high rectal tumours, typically >5cm for anus?

A

Anterior resection - with anastomosis leaving rectal sphincter intact.

Often defunctioning loop ileostomy is performed to protect anastomosis in case of complications such as a leak. Can be reversed electively 4-6 months later

23
Q

What is the surgery of choice for low rectal tumours, <5cm from anus?

A

Abdominoperineal (AP) resection - involves excision of the distal colon, rectum, anal sphincters with permanent colostomy.

24
Q

What is the advantages of performing elective colectomies laparoscopically?

A

Faster recovery time
Reduced surgical site infection risk
Reduced post-op pain

25
Q

When is Hartmanns procedure used?

A

Emergency bowel surgery such as bowel obstruction or perforation

26
Q

What is hartmanns procedure?

A

Complete resection of the recto-sigmoid colon with end colostomy and closure of the rectal stump

27
Q

What are the options for patients presenting with bowel obstruction from colorectal cancer?

A

Decompressing colostomy

Endoscopic stenting

28
Q

When is chemotherapy used in colorectal cancer?

A

Pts with advanced disease - adjuvant therapy

29
Q

When is radiotherapy used in colorectal cancer?

A

Rectal cancers - most often neo-adjuvant

Can be given alongside chemo to shrink the tumour

30
Q

When is neoadjuvant radiotherapy +/- chemotherapy used in colorectal cancers?

A

Downstage rectal cancers before surgery

31
Q

When is adjuvant therapy chemotherapy used for colorectal cancers?

A

Colon cancers with involved lymph nodes

32
Q

When palliative chemotherapy used in colorectal cancers?

A

Metastatic disease

Unrestectable disease

General Surgery (20 decks)

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