colorectal cancer Flashcards
inheritance
autosomal dominant
dukes A
confined by muscularis propria
dukes B
through muscularis propria
dukes C
to lymph nodes
which lymph nodes does it spread to
pericolic and perivascular
dukes d
distant metastases
symptoms if on right side
asymptotic till present with iron deficiency anaemia
weight loss
symptoms if on left side
pain, changes of bowel habit, rectal bleeding, tenesmus
emergency presentation
obstruction (distension, constipation, pain, vomiting) bleeding and perforation
how do we treat obstruction
colostomy with/out resection and stenting
investigations - screening test
FOBT
gold standard test
colonoscopy - allow biopsy for histology also
other investigations
barium enema can visualise the bowel but is now superseded by CT colonography
what would one see on barium enema
apple core lesion
what do we use to stage rectal cancer
endoanal US and pelvic MRI
what to we use to look at metastases
chest, abdominal and pelvic CT
what is the treatment if the cancer is on the caecal, ascending or proximal transverse colon
right hemicolectomy
what is the treatment if the cancer is on the distal transverse or descending colon
left hemicolectomy
what is the treatment fi the cancer is on sigmoid colon
sigmoid colectomy
what is the treatment for rectal tumours low in the rectum
abdomino-perinela excision
what is the treatment for tumours in the upper rectal area
anterior resection
what is stenting used for
palliation in malignant obstruction and as a bridge to surgery in acute obstruction
what is the use of radiotherapy
adjuvant/palliative
inoperable cancer
what it the use of chemotherapy
reduces dukes C mortality by 25%
what drugs are used for chemo
5-Fluorouracil or Capecitabine
bowel cancer screening
offered every 2 years to people between age of 60 and 75 using FOB home testing kits.
what is the most common cause of anaemia with no other symptoms in a 55 year old male
colorectal cancer
what is the order of mutations that occur (?)
APC - Kras - p53 and 18q loss
