Colorectal cancer

Question 1

How should patients be staged?

Answer 1

CT TAP

entire colon evaluated via colonoscopy

discussion with colorectal MDT to formulate management

Question 2

Management of colonic cancer

Answer 2

surgery - resectional surgery is the only option for cure

Question 3

Following resection of obstructing lesion in the colon what are patients with risk factors for disease recurrent offered?

Answer 3

Chemo - 5FU and oxaliplatin

Question 4

management of rectal cancer

Answer 4

anterior resection

abdomen-perineal excision of rectum (APER) - involvement of sphincter complex or very low tumours

defunctioning loop colostomy -

many offered neoadjuvant radiotherapy

t4 disease chemo radiotherapy

T3 short course radiotherapy prior to surgery

Question 5

What type of operation and what anastomosis is recommended if the site of the cancer is in the caecal, ascending or proximal transverse colon?

Answer 5

right hemicolectomy

ileo-colic

Question 6

What type of operation and what anastomosis is recommended if the site of the cancer is in the distal transverse, descending colon?

Answer 6

left hemicolectomy

colo-colon

Question 7

What type of operation and what anastomosis is recommended if the site of the cancer is in the sigmoid colon?

Answer 7

high anterior resection

colo-rectal

Question 8

What type of operation and what anastomosis is recommended if the site of the cancer is in the upper rectum?

Answer 8

anterior resection TME

colo-rectal

Question 9

What type of operation and what anastomosis is recommended if the site of the cancer is in the low rectum?

Answer 9

anterior resection. low tme

colorectal +/- defunctioning stoma

Question 10

What type of operation and what anastomosis is recommended if the site of the cancer is in the anal verge?

Answer 10

abdomen-perineal excision of rectum

none

Question 11

In an emergency setting where the bowel has perforated what is advised?

Answer 11

end colostmy

Question 12

what is an Hartmann’s procedure?

Answer 12

When resection of the sigmoid colon is performed and an end colostomy is fashioned

Question 13

Referral guidelines for urgent 2 ww follow up

Answer 13

patients >= 40 years with unexplained weight loss AND abdominal pain

patients >= 50 years with unexplained rectal bleeding

patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces

Question 14

when should an urgent referral be considered?

Answer 14

there is a rectal or abdominal mass

there is an unexplained anal mass or anal ulceration

patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
abdominal pain

change in bowel habit

weight loss

iron deficiency anaemia

Question 15

national screening programme

Answer 15

60-74 years

every 2 years
patients over 74 years may request

sent FIT through post

Question 16

who else is FIT testing recommend to?

Answer 16

patients >= 50 years with unexplained abdominal pain OR weight loss

patients < 60 years with changes in their bowel habit OR iron deficiency anaemia

patients >= 60 years who have anaemia even in the absence of iron deficiency

Question 17

who else is FIT testing recommend to?

Answer 17

patients >= 50 years with unexplained abdominal pain OR weight loss

patients < 60 years with changes in their bowel habit OR iron deficiency anaemia

patients >= 60 years who have anaemia even in the absence of iron deficiency

Question 18

Where do most cancers develop from?

Answer 18

adenomatous polyps