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GI lectures > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

how common is colorectal cancer?

A

2nd most common cause of cancer death in UK

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2
Q

where are majority of colorectal cancers?

A

most on left side forming from pre-existing adenomatous polyps over 3-5 years
38% in rectum
21% in sigmoid

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3
Q

how can cancer spread?

A

direct spread
lymphatic spread (hence remove many lymph nodes in surgery)
blood borne spread
- liver
- lung
Transcoelomic spread (rare - throughout abdominal cavity)

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4
Q

what can cause colorectal cancer?

A

Genetic
- mutation in APC (adenomatous polyposis coli)
- Mutations of P58 gene
Predisposing condition:
- Long standing inflammatory bowel disease

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5
Q

how might colorectal cancer present?

A

emergency - bowel obstruction/bleeding
chronic (Years = not worried, months = worry):
- change in bowel habit
- colicky abdominal pain
- iron deficiency (unexplained = V important so investigate don’t just give tablets)
- rectal bleeding (mainly in left sided, wouldn’t see the blood if right sided)
- weight loss
- abdominal mass

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6
Q

how is colorectal cancer investigated?

A 
barium enema (not as common)
sigmoidoscopy/colonoscopy = gold standard (colonoscopy goes further)
CT colonography
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7
Q

what is the apple core sign?

A

sign of colorectal cancer in barium enema

looks like an apple core

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8
Q

what are the components of a colonoscopy scope?

A 
camera
light
irrigation
air
instrument channel
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9
Q

what do polyps look like?

A

mushrooms

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10
Q

what are the worrying signs for polyps?

A

> 2cm

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11
Q

how can polyps be removed?

A

cut
cauterised
no pain/temp receptors in bowel so wont be painful

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12
Q

what is done for polyp cancer?

A

depends on where it is
If it is only at the tip of the pedunculated polyp just remove and they are fine
Deeper down the cancer goes = worse prognosis

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13
Q

how do you prepare for a CT colonography?

A 
faecal tagging
- picolax and omnipaque
- gastrografin
carbon dioxide insufflation
Buscopan IV to relax bowels
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14
Q

Is CEA a good screening tool for bowel cancer?

A

no
gives false positves and negatives
but can be used after surgery to check recurrence

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15
Q

what is the bowel screening tool used?

A

FOBT/FIT test

can detect polyps, cancer or just haemorrhoids

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16
Q

what are the next steps after colorectal cancer is diagnosed?

A 
histopathology confirmation
stage cancer 
- CT for chest/abdo/pelvis
- MRI for rectal cancers
MDT (multidisciplinary team)
Surgery
FOU (follow up)
17
Q

what is the prognosis for metasteses from colorectal cancer compared to other cancers?

A

much better

can downsize metasteses if young and fit through intense chemo/radiotherapy and removing parts of organs

18
Q

which cancer has better prognosis and QoL?

A

lower GI

19
Q

What is the benefit of removing all of the fat around the cancerous section of the bowel/rectum?

A

also removes lymph nodes

Increases survival hugely

20
Q

stage 1 and 2?

A

superficial

40%

21
Q

stage 3?

A

entered muscularis

22
Q

stage 4?

A

metastases

23
Q

unstaged?

A

already died so cant tell

24
Q

what does superior mesenteric supply?

A

all small bowel

2/3rds large bowel

25
Q

what is the significance of blood supply in colon cancer surgery?

A

must resect vessels to an extent to prevent spread through vessels

26
Q

what types of surgery can be performed for colorectal cancer?

A 
right hemicolectomy
extended right hemicolectomy
transferse colectomy (not common)
Sigmoid colectomy
Anterior resection
APR (needs a stoma)
27
Q

what are the benefits of laparoscopic surgery over open surgery?

A

easier, can reach more places

less scar tissue formed so can go back in if needed

28
Q

what is dukes staging?

A

stages cancer

29
Q

what are the steps after surgery?

A

cancer resection + chemo
cancer + liver + lung resection
HIPEC for mesothelioma

30
Q

what palliative measures can be used for colorectal cancer?

A

stanting
palliative chemo/radiotherapy
Defunctioning

GI lectures (75 decks)

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