Colorectal Cancer Flashcards
Is colorectal cancer more common in the colon or rectum?
Colon
What are the risk factors for CRC?
Age Male Previous adenoma Diet/obesity lack of exercise smoking DM
What is the significance of colorectal polyps?
Majority of CRC arise from pre-existing polyps
What is the highest risk type of Colorectal polyp?
Adenomas
What are adenomas
Pre-malignant, benign polyps
What are the 3 main histological types of adenomas?
Tubular
Villous
Tubulovillous
What are the clinical presentations of CRC?
Rectal bleeding Altered bowel habit Iron deficiency Palpable rectal or right lower abdominal mass Weight loss Anorexia
What are the investigations for suspected CRC?
Colonoscopy
Biopsy
Barium swallowing
FOBT
What is the main technique/investigation used for staging CRC?
CT
MRI
PET
What 2 systems are used to stage CRC?
TNM
Duke Classification
In TNM what does T mean?
The size, position and type of tumour
In TNM what does N stand for?
Lymph node involvement
In TNM what does M mean?
Any metastases?
In Dukes Classification what does A mean?
Tumour is confined to the mucosa
In Duke classification what does B mean?
Tumour has extended through mucosa to muscle layer
In Dukes Classification what does C mean?
There is involvement of lymph nodes
In Dukes Classification what does D mean?
There is metastatic spread
What is the treatment for CRC?
Surgery
Can metastasis to the liver be treated in CRC?
Yes with partial hepatectomy
When removing the CRC why are lymph nodes also removed?
For histological analysis and staging of the CRC
Apart from surgery which other treatment is given for CRC?
Chemotherapy
Why is chemotherapy given as well as surgery?
To mop up any micro metastases
Who is radiotherapy given to?
Those with rectal cancer only
What is general advice given to prevent CRC?
30 mins exercise a day
Maintain healthy BMI (between 18-25)
Don’t smoke
Balance diet
Which age group receives the bowel screening programme?
50-75
How often is the bowel screening programme offered?
Every 2 years
What does the screening programme look for?
Blood in stool sample
If blood is detected in the sample what is the next stage?
Invited for colonosocopy
Who are considered at high risk of developing CRC?
Familial history of CRC
IBD
Previous CRC
Previous adenomas
How often are those with first degree familial history of CRC invited for colonoscopy?
5 yearly
How often are those with IBD invited for colonoscopy?
10 yearly
How often are those with previous CRC history invited for colonoscopy?
5 yearly
How often are those with previous adenomas invited for colonoscopy?
Dependant on number of polyps, size, degree of dysplasia
What is FAP?
Autosomal dominant condition
What will happen if FAP gene is left untreated?
Nearly everyone with the gene will have CRC by the 30-40 years
How often are those with the FAP gene screened?
Yearly
If you carry the FAP gene are develop polyps what is the treatment>
Prophylactic proctocolectomy
What is HNPCC?
Autosomal dominant conditino
What does the HNPCC affect??
Mutations that affect DNA repairment
Which side of the colon is often affected in HNPCC?
Right side
When is screening offered with those with HNPCC?
Biannually from the age of 25
