Colorectal cancer Flashcards
1
Q
Colorectal cancer
A
- abnormal cell growth in large intestine - caecum, colon, rectum
- most commonly adenocarcinoma
- usually arises from pre-cancerous polyp
- colorectal epithelium becomes adenoma
2
Q
Genetic risk factors for colorectal cancer
A
- family history
- hereditary non-polyp colorectal cancer
- familial adenomatous polyposis
3
Q
Lifestyle risk factors for colorectal cancer
A
- low fibre diet
- physical inactivity
- obesity
- smoking
- alcohol
4
Q
Medical risk factors for colorectal cancer
A
- inflammatory bowel disease
- acromegaly
- previous history of colorectal cancer
- diabetes mellitus
5
Q
Symptoms of colorectal cancer
A
- change in bowel habit
- rectal bleeding - fresh or dark, mixed in or separate, beginning or end, constant or intermittent
- abdominal pain or bloating
- tenesmus
- unexplained weight loss
- fatigue or breathlessness
6
Q
FIT testing criteria
A
- change in bowel habit
- abdominal mass
- iron deficiency anaemia
- > 40 with weight loss, abdominal pain
- age under 50, rectal bleeding AND abdo pain or weight loss
- age over 50, rectal bleeding OR abdo pain or weight loss
- > 60 with anaemia
7
Q
Colorectal cancer differential diagnosis
A
- colorectal polyps (potential for malignant transformation, polypectomy)
- IBD (may have extra-intestinal features)
- haemorrhoids - fresh rectal bleeding
- coeliac disease - family history, autoimmune conditions, extraintestinal
8
Q
Investigations for colorectal cancer
A
- check weight for weight loss
- FIT testing (primary care)
- FBC and iron studies for anaemia
- baseline U&Es and LFT, CRP and ESR
- tissue transglutaminase - ?coeliac
- CEA for monitoring NOT diagnosis
- genetic testing if indicated
- colonoscopy with biopsy, alternative CT colonography
- imaging - CT TAP, MRI pelvis
9
Q
Bowel cancer screening programme
A
- England, Wales and NI - every 2 years for people aged 60 to 74
- receive invitation letter and stool FIT test
- results by letter within 2 weeks
- colonoscopy or repeat tests may be indicated
10
Q
Colorectal cancer staging
A
- stage 0 - confined to inner lining of colon
- stage 1 - spread beyond inner lining but not to any lymph nodes
- stage 2 - spread to lymph nearby nodes
- stage 3 - spread to distant lymph nodes
- stage 4 - distant metastasis
11
Q
Colorectal cancer management
A
- surgical removal of tumour and local lymph nodes with tumour-free margin
- often segmental resection with either stoma or anastomosis
- rectal cancer - often neoadjuvant chemo
- colon cancer - often adjuvant chemo
- palliative - segmental resection or diversion for symptom control
12
Q
Complications of colon cancer
A
- metastasis, often to liver, thorax and nervous system
- bowel obstruction or perforation
- iron deficiency anaemia
- fistula
- complications from treatment, e.g. infection or bleeding
