colorectal cancer

Question 1

inheritance

Answer 1

autosomal dominant

Question 2

dukes A

Answer 2

confined by muscularis propria

Question 3

dukes B

Answer 3

through muscularis propria

Question 4

dukes C

Answer 4

to lymph nodes

Question 5

which lymph nodes does it spread to

Answer 5

pericolic and perivascular

Question 6

dukes d

Answer 6

distant metastases

Question 7

symptoms if on right side

Answer 7

asymptotic till present with iron deficiency anaemia

weight loss

Question 8

symptoms if on left side

Answer 8

pain, changes of bowel habit, rectal bleeding, tenesmus

Question 9

emergency presentation

Answer 9

obstruction (distension, constipation, pain, vomiting) bleeding and perforation

Question 10

how do we treat obstruction

Answer 10

colostomy with/out resection and stenting

Question 11

investigations - screening test

Answer 11

FOBT

Question 12

gold standard test

Answer 12

colonoscopy - allow biopsy for histology also

Question 13

other investigations

Answer 13

barium enema can visualise the bowel but is now superseded by CT colonography

Question 14

what would one see on barium enema

Answer 14

apple core lesion

Question 15

what do we use to stage rectal cancer

Answer 15

endoanal US and pelvic MRI

Question 16

what to we use to look at metastases

Answer 16

chest, abdominal and pelvic CT

Question 17

what is the treatment if the cancer is on the caecal, ascending or proximal transverse colon

Answer 17

right hemicolectomy

Question 18

what is the treatment if the cancer is on the distal transverse or descending colon

Answer 18

left hemicolectomy

Question 19

what is the treatment fi the cancer is on sigmoid colon

Answer 19

sigmoid colectomy

Question 20

what is the treatment for rectal tumours low in the rectum

Answer 20

abdomino-perinela excision

Question 21

what is the treatment for tumours in the upper rectal area

Answer 21

anterior resection

Question 22

what is stenting used for

Answer 22

palliation in malignant obstruction and as a bridge to surgery in acute obstruction

Question 23

what is the use of radiotherapy

Answer 23

adjuvant/palliative

inoperable cancer

Question 24

what it the use of chemotherapy

Answer 24

reduces dukes C mortality by 25%

Question 25

what drugs are used for chemo

Answer 25

5-Fluorouracil or Capecitabine

Question 26

bowel cancer screening

Answer 26

offered every 2 years to people between age of 60 and 75 using FOB home testing kits.

Question 27

what is the most common cause of anaemia with no other symptoms in a 55 year old male

Answer 27

colorectal cancer

Question 28

what is the order of mutations that occur (?)

Answer 28

APC - Kras - p53 and 18q loss