Colorectal cancer Flashcards
What conditions causes 100% incidence of bowel cancer?
Familial Adenamatous Polyptosis
Refer using a suspected cancer pathwya referral within 2 weeks for colorectal cancer if:
-aged 40+ unexplained weight loss and abdominal pain
-age 50+ with unexplained rectal bleeding
-aged 60+ with iron deficiency anaemia or changes in their bowel habit or tests that show positive FIT test (blood in faeces)
When consider referral to cancer pathway colorectal
rectal or abdominal mass
-under 50 years with rectal bleeding and any following unexplained:
-abdo pain, change in bowel habit, iron deficiency anaemia
Who to offer FIT to assess for colorectal cancer without rectal bleeding
50+ with
-unexplained abdo pain or weight loss
under 60 with
-changes in bowel habit or IDA or
Over 60 and have anaemia (even if not iron defieiency)
When to consider an urgent cancer referral for anal cancer
Unexplained anal mass or ulceration
Risks for colorectal cancer
- Lack of fibre: it is thought that reduced speed of transit exposes gut mucosa to potential carcinogens
- High fat Diet: thought to favour bacterial flora which can degrade bile salts into carcinogens
- Obesity(especially in men)
- Inflammatory bowel disease: chronic ulcerative, Crohn’s disease
- Family history of benign/malignant colorectal tumour
- Pelvic irradiation
- Colon polyps
Rectal tumour presentation
Bleeding
Change in bowel habit
Tenesmus
Palpable rectal mass
L colon tumour presentation
Constipation and obstruction
Abdo pain and perforation
More overt bleeding and bleeding PR
R colon tumours
Altered (dark) blood PR
Occult and asymptomatic often
Obstruction in advanced tumours
Symptoms of colorectal cancer
- Tenesmus - tumor signals to brain still something to pass
- PR Rectal bleeding - obvious or occult
- Weight loss - very late sign - metastases
- Abdominal mass
- Tired - anaemia - blood loss
- Blockage/obstruction
- Altered bowel habit - consistency
- Life style change
- Nocturnal/incontincence
Family hisotry qs for colorectal cancer
Colorectal cancer, FAP, lynch syndrome
Past medical history questions for Colorectal cancer
Preve CRC,
BCSP
colonscopy
DM
HPTN
CVA
MI
What to look for on GI exam for colorectal cancer
Signs of anaemia
Presence of palpable mass - abdo or rectal
Evidence of intestinal obstruction - abdo distension, reduced bowel sounds, vomit/hixxups
Evidence of metastatic disease - hepatomegaly, ascites, jaundice, enlarged lymph nodes
Weight loss
Investgiations for colorectal cancer first line
Bloods - FBCs, U+Es, LFTs, clotting screen
Coeliac serology
Endoscopy, colonoscopy
Barium enema
MRI scan for rectum
Staging investigations
CT thorac, abdo, pelvis = TAP
MRI scan for rectum
Screening for colorectal cancers
Faecal immmunochemistry test - FIT testing
Who is FIT testing currently offered to?
60-74 years
What screening tool will be offered for over 55yrs?
Colonoscopy
What are the positives?
High sensitivity + can remove polyps
Lower patient acceptability
Degree of risk
Management of Colorectal cancer
Surgical resection - radial, local
Adjuvant/palliative chemotherapy
What is the marker for colorectal cancer?
Colonic embryonic antigen - CEA
Staging colorectal cancer
TNM - tumour, node, metastases
T1-T4
NX-N3
MX-M1
2 week wait criteria CRC
Refer adults using asuspected cancer pathway referral(for an appointment within 2weeks) for colorectal cancer if:
- they are aged 40 and over withunexplainedweight loss and abdominal painor
- they are aged 50 and over with unexplained rectal bleedingor
- they are aged 60 and over with:
- iron‑deficiency anaemiaor
- changes in their bowel habit,or
- tests show occult blood in their faeces.
Consider a suspected cancer pathway referral (for an appointment within 2weeks) for colorectal cancer in adults with a rectal or abdominal mass.
Consider a suspected cancer pathway referral (for an appointment within 2weeks) for colorectal cancer in adults aged under 50 with rectal bleedingandany of the following unexplained symptoms or findings:
- abdominal pain
- change in bowel habit
- weight loss
