Colorectal cancer

Question 1

Name 3 risk factors for developing colorectal cancer

Answer 1

• Family history of bowel cancer
• Familial adenomatous polyposis (FAP)
• Hereditary nonpolyposis colorectal cancer (HNPCC) - Lynch syndrome (more common than FAP)
• IBD
• Increased age
• Diet high in red and processed meat and low in fibre
• Obesity and sedentary lifestyle
• Smoking
• Alcohol

Question 2

1) What is familial adenomatous polyposis?
2) What does it result in?

Answer 2

1) Autosomal dominant condition involving malfunctioning of the tumour suppressor genes called adenomatous polyposis coli (APC)
2) Many polyps (adenomas) developing along the large intestine which have the potential to develop into cancer

Question 3

1) What is Lynch syndrome/HNPCC?
2) What is the consequence of Lynch syndrome?

Answer 3

1) Autosomal dominant condition that results from mutations in DNA mismatch repair (MMR) genes
2) Patients are much more likely to develop cancers - especially colorectal

Question 4

Name 3 red flag symptoms of colorectal cancer

Answer 4

• Change in bowel habit (usually to more loose and frequent stools)
• Unexplained weight loss
• Rectal bleeding
• Unexplained abdominal pain
• Iron deficiency anaemia
• Abdominal or rectal mass on examination

Question 5

1) What does the faecal immunochemical test (FIT) look for in bowel cancer screening?
2) FIT is used in bowel cancer screening in the UK - who is this screening targeted at?
3) As well as in screening, when else may the FIT be used for?

Answer 5

1) Human haemoglobin in the stool
2) People aged 60 – 74 years are sent a home FIT test to do every 2 years
3) In general practice to help assess for bowel cancer in specific patients who do not meet the criteria for a two week wait referral (but have some of the criteria)

Question 6

1) What is the gold standard investigation for colorectal cancer?
2) Name another investigations that can be used

Answer 6

1) Colonoscopy
2) Sigmoidoscopy, CT colonography

Question 7

What are the options for managing bowel cancer (in any combination) [4]?

Answer 7

• Surgical resection
• Chemotherapy
• Radiotherapy
• Palliative care

Question 8

What is the ideal scenario in terms of the treatment of colorectal cancer?

Answer 8

Surgically remove the entire tumour

Question 9

What type of resection is done to a cancer of the caecal, ascending or proximal transverse colon?

Answer 9

Right hemicolectomy

Question 10

What type of resection is done to a cancer of the distal transverse and descending colon?

Answer 10

Left hemicolectomy

Question 11

What type of resection is done to a cancer of the sigmoid colon?

Answer 11

High anterior resection

Question 12

What type of resection is done to a cancer of the upper rectum?

Answer 12

Anterior resection (TME)

Question 13

What type of resection is done to a cancer of the lower rectum?

Answer 13

Anterior resection (low TME)

Question 14

What type of resection is done to a cancer of the anal verge?

Answer 14

Abdomino-peritoneal excision of rectum

Question 15

What happens/what is a Hartmann’s operation?

Answer 15

Sigmoid colon resection and end colostomy is fashioned