Colorectal cancer

Question 1

What is the second most common cause of cancer death?

Answer 1

Colorectal cancer

Question 2

What side of the colon is most common for cancer to occur?

Answer 2

Left is 50%

Right is 25%

Question 3

What do the majority of colonic cancers arise from?

Answer 3

Pre-existing adenomatous polyps

Question 4

How can cancer be spread?

Answer 4

Direct spread
Lymphatic
Blood borne
Transcolelomic spread (rare)

Question 5

What could be a predisposing condition to colorectal cancer?

Answer 5

Long standing inflammatory bowel disease

Crohn’s and Ulcerative Colitis

Question 6

What genetic mutations can cause increased change of bowel cancer?

Answer 6

APC

p58

Question 7

What are the presentations of bowel cancer?

Answer 7

EMERGENCY - bowel obstruction/bleeding
Change in bowel habit
Colicky abdominal pain
Iron deficiency anaemia
Rectal bleeding
Weight loss
Abdominal mass

Question 8

What don’t you do to patient’s with unexplained iron deficiency anemia?

Answer 8

DON’T give iron tablets

DO investigate

Question 9

What time of blood will you see with caecum bleeding?

Answer 9

No blood
Mixed with stool
Need Biopsy asap

Question 10

What are three investigations for colorectal cancer?

Answer 10

Barium enema
Sigmoidoscopy v colonoscopy
CT colonography

Question 11

What is the gold standard investigation for colorectal cancer?

Answer 11

Sigmoidoscopy (just splenic flecture)

Colonoscopy (whole colon)

Question 12

What is the appearance of cancer on a barium enema?

Answer 12

Apple core appearance

Question 13

What size polyp has 25% of being cancerous?

Answer 13

> 2cm

Question 14

How do surgeons know where the polyp was?

Answer 14

They tattoo the site

Question 15

What is the pre-requirements for CT colonography?

Answer 15

Bowel preperations
Faecal tagging
Picolax + Omnipaque
Gastrografin
Carbon dioxide insufflation

Question 16

If the bowel cancer screening test is positive what is the next line investigation?

Answer 16

Colonoscopy

Question 17

Once a cancer is diagnosed, what is next?

Answer 17

Histopathology confirmation
Cancer staging
-CT chest/abdo/pelvis
-MRI for rectal cancers
MDT
Surgery
FOU

Question 18

In colorectal cancers, can metastases be controlled?

Answer 18

Yes! Can have 5+ years survival

Question 19

True or false: the more lymph nodes removed in a cancer patient, the higher the chance of survival

Answer 19

True

Question 20

What are the three types of surgery for colorectal?

Answer 20

Open
Laproscopic
Robotic

Question 21

What is the post operative care for colorectal cancer staging?

Answer 21

Cancer resection + chemo

Cancer + liver + lung resection

Question 22

Would you do a transplant of a liver to a cancer patient?

Answer 22

No
High chance of patient developing cancer in the new liver
‘Could be a waste of a liver’