Colorectal cancer Flashcards
What is the most common site of colorectal cancer?
Rectum
What are the risk factors for colorectal cancer?
Family history of bowel cancer
IBD
Increased age
Diet
Obesity and sedentary lifestyle
Smoking
Alcohol
What genetic syndromes can predispose someone to colorectal cancer?
FAP - familial adenomatous polyposis
HNPCC - hereditary nonpolyposis colorectal cancer (also known as Lynch syndrome)
What is the presentation of colorectal cancer?
Progressive change in bowel habit
Abdominal pain
Unexplained weight loss
Rectal bleeding
Iron deficiency anaemia
Abdominal or rectal mass
What are the criteria for a 2 week wait referral?
Over 40 years with abdominal pain and unexplained weight loss
Over 50 years with unexplained rectal bleeding
Over 60 years with a change in bowel habit or iron deficiency anaemia
When should a patient be offered a FIT test?
Any patient with:
- An abdominal mass
- Change in bowel habit
- Iron deficiency anaemia
Aged over 40 with unexplained weight loss and abdominal pain
Aged under 50 with rectal bleeding and either abdo pain or weight loss
Age over 50 with:
- Rectal bleeding
- Abdominal pain
- Weight loss
Aged over 60 with anaemia
What screening is offered for colorectal cancer?
All patients aged 60 to 74 are sent a FIT test in the post every 2 years
What is a FIT test?
Faecal immunochemical test - uses antibodies to detect and quantify human blood in a stool sample
What is the gold standard investigation for colorectal cancer?
Colonoscopy
What other investigations can be useful in the diagnosis of colorectal cancer?
FBC - iron deficiency anaemia
FIT test
U&Es
LFTs
Sigmoidoscopy - if only feature is rectal bleeding
CT colonography
Staging CT (CT thorax, abdo, pelvis)
CEA (carcinoembryonic antigen) - tumour marker
What is Dukes’ classification?
Dukes A - confined to mucosa and part of the muscle of the bowel wall
Dukes B - extending through the muscle of the bowel wall
Dukes C - lymph node involvement
Dukes D - metastatic disease
What is the TNM staging of colorectal cancer?
T1 - submucosa involvement
T2 - involvement of the muscularis propria
T3 - involvement of the subserosa and serosa
T4 - spread through the serosa (4a) and reaching other tissues/organs (4b)
N0 - no nodal spread
N1 - spread to 1-3 nodes
N2 - spread to more than 3 nodes
M0 - no metastasis
M1 - metastasis
What are the management options for colorectal cancer?
Surgical resection
Chemotherapy
Radiotherapy
Palliative care
What operation for colorectal cancer are there?
Right hemicoloectomy - removal of caecum, ascending and proximal transverse colon
Left hemicoloectomy - removal of distal transverse and descending colon
High anterior resection - removal of sigmoid colon
Low anterior resection - removal of sigmoid colon and upper rectum
Abdomino-perineal resection - removal of rectum and anus (leaves patient with permenant colostomy)
What types of cancer are most commonly associated with HNPCC?
Colon cancer (most common association)
Endometrial cancer (next most common association)
