Colorectal Cancer Flashcards
What does lower GI cancers involve?
Large bowel (colon + rectum) + anus
What are the symptoms?
Abdominal pain
Change in bowel habit
Passing of mucus
Blood in stool/rectal bleeding
Anaemia
Intestinal obstruction
Palpable mass in abdomen
What are the risk factors?
Family history
Male gender
T2DM
IBD
Smoking
Alcohol
Red meat
Low intake of fruit + veg
Body fat
Physical activity
Lack of fibre, dairy, fish intake, tree nuts + vitamins
What happens when there is a family history?
Early preventable bowel surgery
Screening for Lynch syndrome
Preventable aspirin use
What is the screening?
Faecal immunochemical test (FIT)
= aims to detect small amounts of blood in the faeces
If blood detected doesn’t mean have cancer BUT if negative extremely likely you don’t
Colonoscopy referral in positive patient
What are the investigations?
Colonoscopy
Biopsy
CT imaging
Tumour markers
Must be 2 week referral if suspected in GP
What is the staging?
Tis = earliest stage
T1 = in inner layer or bowel
T2 = into muscle layer
T3 = into outer lining
T4 = grown through outer lining
N1 = 1-3 lymph nodes contain cancer cells
N2 = cancer cells in 4 or more lymph nodes
M1 = spread to other parts of the body
What are the treatment options?
Surgery - basically always done
Radiotherapy
Chemo
What does surgery depend on?
Location of tumour
Patient must be prepared for a stoma
What does NICE recommend for adjuvant chemo?
Stage 3 or high risk stage 2
CAPOX (XELOX) = oxaliplatin + capecitabine
FOLFOX = oxaliplatin + 5FU
Recommends shorter courses to minimise toxicity
Describe 5FU
Most widely used
Inhibits synthesis of thymidine monophosphate
IV
Must screen for DPD deficiency = fatal
Describe Capecitabine
5FU pro-drug = mimics continuous infusion of 5FU
Enzyme thymidine phosphorylase (TP) converts pro-drug to 5FU
TP higher conc in colon = more selective action
Oral
What are the adverse effects of Oxaliplatin (platinum derivative)
Acute neuropathy =
Cold-induced paraesthesia (tingling, numbness or pain in hands, feet or throat)
Pharyngolaryngeal dysesthesia (throat tightness or difficultly swallowing)
Can be managed by slow infusion of drug
Chronic neuropathy =
Develops after repeated cycles
Persistent numbness, pain + tingling in hands in feet
Hypersensitivity reactions =
During infusion
What happens in metastatic cancer?
Palliative colon surgery
Resection of liver or lung metastases
Palliative chemo or targeted therapies
What is the monitoring + follow-up?
Very long treatment = basically treat as long as patient can tolerate
Lung cancer is very short
Monitoring:
Toxicity symptoms
Disease-related symptoms
Treatment complications
Response to treatment - CT + decrease in biomarkers
Healthy living + emotional well-being
