COLORECTAL CANCER

Question 0

How does a right side colon cancer present?

Answer 0

IDA in adult man/post menopausal women is CRC until proven otherwise

Tends to BLEED

FOBT may be -ve

Question 1

What types of cancer?

Answer 1

95% adenocarcinomas

Question 2

Left sided colon cancers presentation?

Answer 2

Cause obstruction and even perforation

Constipation -> overflow diarrhoea -> alternative bowel pattern

Abdominal pain

Distension

N+V

FRESH PR bleed

Question 3

Recto sigmoid colon?

Answer 3

Tenesmus, constipation

Fresh PR bleed

IDA infrequently

Question 4

How do metastases present?

Answer 4

Always to liver

Synthetic: bleeding/bruising
Cleansing function: encephalopathy
Excretory function: jaundice, pruritus
Metabolic function

Question 5

What physical findings?

Answer 5

Pr exam

• rectal tumour
• frank blood

Liver metastases

• hepatomegaly
• ascites
• lymphadenopathy

Question 6

Investigations?

Answer 6

CBE EUC LFT
FOBT
CEA - measure baseline for recurrence or metastases

COLONOSCOPY

• allows for bilious as well
• risk: bleeding, perforation

Flexible sigmoidoscopy
CT abdomen

Question 7

Predictors of poor prognosis after surgical resection?

Answer 7

High t- depth of penetration
High n
High grade
Pre-op elevated CEA

Question 8

Rx of colorectal cancer?

Answer 8

Surgical resection

Removal of arterial supply and lymph nodes

At least 12 nodes should be removed

Question 9

Surgery for rectal is different how and why?

Answer 9

Difficulty to achieve clear margins in recital cancer hence radiotherapy additionally for rectal cancer

Question 10

Complications of colorectal ?

Answer 10

IDA
BO
METS
REOCCURENCE 
CACHEXIA
PARANEOPLASTIC SYNDROME

Question 11

Follow up of pts?

Answer 11

Serum CEA 3-6 months
Colonoscopy 1st yr, then 3-5yr after resection 
CT yearly
CT scan of liver 
CXR