Colorectal cancer Flashcards
What are the signs and symptoms of LOWER GI cancers
- abdominal pain
- change of bowel habit
- passing mucus
- blood in stool/rectal bleeding
- anaemia
- intestinal obstruction
- palpable mass in abdomen
What are the signs and symptoms of UPPER GI cancers
- anorexia
- epigastric mass
- dysphagia
- unintentional weight loss
- iron deficiency anaemia
- persistent vomiting
What increases the risk of colorectal cancer (risk factors)
- positive family history
- smoking
- processed meat
- alcohol intake
- red meat
- low intake of vegetables and fruits
- body fat and obesity
- ethnicity - increased in black men
- male gender
- type 2 diabetes
- inflammatory bowel disease
What decreases the risk of colorectal cancer
- physical acitivity
- whole grains
- fruits and vegetables
- diary products
- fish intake
- vitamins
- calcium supplements
How is colorectal cancer screened
-faecal immunochemical test (FIT)
it detects small amounts of blood in the faeces
It is given to asymptomatic men and women age 60-74yrs
What investigation is carried out for colorectal cancer
- clinical history + examinations
- colonoscopy
- histological examinations - biopsy
- imaging CT abdomen
- tumour markers - increased levels indicate malignant cells
What is the TNM staging for colorectal cancer
T1 - tumour in the inner lining of the bowel
T2 - tumour into the muscle layer of the bowel
T3-tumour grown into the outer lining of the bowel cells
T4 - tumour grown through the outer lining of the bowel wall to the other parts of the bowel
N0 - no lymph nodes involved
N1 - 1-3 lymph nodes close to the bowel involved
N2 - cancer cells in 4 or more nearby lymph nodes
M0 - no metastatic spread
M1 - metastatic spread
What are the treatment options for colorectal cancer
- Surgery
- Radiotherapy
- Chemotherapy
How do you prepare a patient for surgery
- informed consent
- preparation for stoma formation
- bowel preparation - using oral osmotic laxative
- antibiotic prophylaxis - reduce chance of infection
- thromboembolism prophylaxis
What are the complication associated with colorectal surgery
Immediate:
- anastonic leakage - it is dependent on technique used
- Infection
- haemorrhage
- venous thromboembolism
- inadvert injury to anatomical structure
Longer term:
- urinary incontinence
- sexual dysfunction
- bowel dysfunction
What is the common adjuvant chemotherapy given for colorectal cancer
- with curative intent
- CAPOX (Oxaliplatin & Capcitabine)
- FOLFOX (Oxaliplatin & 5-FU)
What does dihydropyrimidine dehydrogenase (DPD)deficiency mean and what are the implications
- the patient is unable to break down uracil and thymine.
- so patient with this condition cannot metabolise 5-FU and capecitabine, so it will accumulate in their body and cause toxicity
What are the atypical side-effects of Oxaliplatin
- progressive neuropathy such as paraesthiseia and dysataesthesias which is a burning or prickling sensation
- patients need to be counciled not this side-effect
What monoclonal antibody targeting EGFR are used for colorectal cancer and what is the MOA
- Panitumumab
- Cetuximab
MOA:
- they bind to the extracellular domain EGFR
- competitive antagonist of EGFR leading to down regulation of EGFR
- block EGFR-mediated signalling
- reduce angiogenesis and tumour invasiveness
How do you monitor a patient’s response to chemotherapy in colorectal cancer
- radiological findings
- tumour markers
- clincal exams
