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The Alimentary Canal > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Explain the epidemiology of colorectal cancer

A

Second largest cause of cancer death
3rd commonest cancer diagnosis
2 thirds colic and 1 third rectal

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2
Q

Describe colorectal cancer and genetics

A

Most are sporadic - no familial genetic influence
10% have familial risk
HPNCC, FAP, MAP

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3
Q

What are the risk factors for sporadic cases of colorectal cancer?

A

Age, male gender, previous adenoma/ CRC and environmental influences - diet, obesity, lack of exercise, smoking and diabetes

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4
Q

Describe colorectal polyps

A

Protuberant growths and variety of histological types
Can be benign or malignant
Epithelial or mesenchymal

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5
Q

What are adenomas?

A

Benign and pre-malignant
Epithelial in origin
Can be tubular, villous or tubulo-villous
Pedunculated or sessile

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6
Q

What promotes cell growth, proliferation and apoptosis?

A

Activation of oncogene
Loss of tumour suppressor gene
Defective DNA repair pathway genes

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7
Q

What is the presentation of colorectal cancer?

A

Rectal bleeding, altered bowel opening to loose stools, iron deficiency, rectal or lower abdomen mass, acute chronic obstruction
Systemic symptoms of malignancy

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8
Q

Describe colonoscopy for investigation of colorectal cancer

A

Investigation of choice
Allows tissue biopsy
Therapeutic as well as diagnostic - polypectomy

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9
Q

What are some problems with a colonoscopy?

A

Sedation
Bowel preparation
Risks are perforation and bleeding

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10
Q

What radiological imaging is used for colorectal cancer?

A

Barium enema
CT colonography - 3d virtual colonoscopy
CT abdo pelvis

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11
Q

What are some problems with radiological imaging of colorectal cancer?

A

Ionising radiation
Bowel prep
No histology
No therapeutic intervention

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12
Q

What are some staging investigations used?

A

CT scan chest/abdomen/pelvis
MRI
PET scan

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13
Q

What staging is used for colorectal cancer?

A

Duke’s staging
A-D

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14
Q

Describe surgery in colorectal cancer

A

80% need surgery
Dukes A - endoscopic or local resection
Depends on site and shape
May need laparotomy, laparoscopic, stoma formation, removal of lymph nodes

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15
Q

When is chemo used for colorectal cancer?

A

Adjuvant
Dukes C and maybe B
Positive lymph node histology
Mops up micro metastases
Agents - 5-FU

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16
Q

When is radiotherapy needed for colorectal cancer?

A

Rectal cancer only
Is neoadjuvant and can also can involve chemo to control tumour before surgery

17
Q

What is involved in palliative care for colorectal cancer?

A

Chemo, colonic stenting to prevent obstruction

18
Q

Describe duke’s staging and prognosis

A

5 year survival decreases from A to D from 83% to 3%

19
Q

What is the aim of population screening?

A

Detect pre-malignant adenomas and early cancers in general population

20
Q

What are the modalities for population screening of colorectal cancer?

A

Faecal occult blood test (FOBT)
Faecal immunochemical test (FIT)
Flexible sigmoidoscopy
Colonoscopy
CT colonography

21
Q

What is the Scottish bowel screening programme?

A

Roll out in 2007
50-74 years
FOBT every 2 years and if positive then colonoscopy
but has lower positivity in women and high interval cancer rate

22
Q

What is the FIT in Scotland?

A

Faecal immunochemical testing
Specific for human haemoglobin
Automated and quantitative

23
Q

What are heritable conditions for colorectal cancer?

A

FAP, MAP, HNPCC

24
Q

What groups are screened for colorectal cancer?

A

Heritable conditions
Inflammatory bowel disease
Familial risk
Previous adenomas/CRC

25
Q

Explain FAP

A

Autosomal dominant condition
Can show young
Mutation of the APC gene on chromosome 5
Annual colonoscopy from age 10-12
Prophylactic proctocolectomy age 16-25

26
Q

What are some manifestations of FAP?

A

Extracolonic -Benign gastric fundic cystic hyperplastic
Duodenal adenomas
Desmoid tumours
CHRPE

27
Q

What is NSAIDs chemoprevention of FAP?

A

Sulindac reduces polyp numbers and prevents recurrence of higher grade adenomas

28
Q

Explain MAP

A

Autosomal recessive
Caused by pathogenic variants in the MUTYH base excision repair gene
CRC is most likely to be right sided and synchronous

29
Q

When is surveillance in MAP?

A

Annual age starts at 18-20
Duodenal adenomas so GI surveillance at 35years

30
Q

Explain HNPCC

A

Autosomal dominant condition
Mutation in DNA repair genes
Tumours typically have molecular characteristic called microsatellite instability
Early onset colorectal cancer right sided at 40
Screening from 25 and every 2 years

31
Q

What are some other high risk groups?

A

FH of CRC
IBD
Previous CRC
Previous adenomas

32
Q

Who needs FIT test?

A

Asymptomatic screenings
Assess and triage symptomatic patients

The Alimentary Canal (33 decks)

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