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Year 4 CCC > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

Which environmental factor plays a major role in the aetiology of colorectal cancer?

A

Diet

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2
Q

What % of colorectal cancers are associated with a genetic predisposition syndromes for example FAP or HNPCC (lynch syndrome)?

A

<8%

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3
Q

What pathology are the majority of colorectal cancers?

A

Adenocarcinoma

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4
Q

In rectal cancer, what is there a propensity for the tumour to do?

A

For it to infiltrate laterally into the peri-rectal fat and lymph nodes

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5
Q

What is the main curative therapy for colorectal cancer?

A

Surgery

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6
Q

What is required pre-operatively to resection of colorectal cancer? (5)

A
  1. Knowledge of precise site and extent of tumour
  2. Full colonoscopy and air-contrast barium enema
  3. CT/US liver
  4. MRI of pelvis to stage rectal cancer
  5. Peri-operative antibiotics and thromboembolic prophylaxis are mandatory
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7
Q

In a primary resection, what needs to be removed?

A

Bowel segment and its lymphatic field

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8
Q

If resecting rectal cancer, what need to be removed?

A

Total excision of the mesorectum (TME)

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9
Q

How many cases of colorectal cancer are there each year in the UK?

A

41,200

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10
Q

How many deaths are there per year due to colorectal cancer?

A

16,000

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11
Q

How do colorectal cancers develop?

A

From polyps - adenomatous polyps

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12
Q

If polyps are found, why are they removed?

A

To prevent later development of cancer

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13
Q

Colorectal cancer can present as rectal bleeding, but what are the other causes of rectal bleeding? (5)

A
  1. Haemorrhoids
  2. Anal fissures
  3. Gastroenteritis
  4. Trauma
  5. Anticoagulants
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14
Q

Of all the people who present to GP with rectal bleeding, what % have colorectal cancer?

A

3.6%

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15
Q

What are the red flag symptoms for colorectal cancer? (6)

A
  1. Change in bowel habits
  2. Weight loss
  3. Rectal bleeding
  4. Abdominal pain
  5. Mucous/blood PR (DRE)
  6. Anorexia
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16
Q

What 4 key questions need to be asked when taking a history about change in bowel habits?

A
  1. Do they get up at night to open their bowels? (this is highly unusual)
  2. Are they incontinent?
  3. Is it stopping them from doing things?/interfering with their everyday life?
  4. Associated with any other symptoms e.g. bleeding/mucous/pain
17
Q

What should you look out for on examination in suspected colorectal cancer? (4)

A
  1. Loss of weight
  2. Signs of anaemia
  3. Abdominal mass
  4. Mass on rectal examination
18
Q

If patients are suspected of having colorectal cancer, with clear red flag symptoms, what test/investigations are they referred for? (1)

A

Colonoscopy/flexible sigmoidoscopy

19
Q

If the patient is unfit/unwell, multiple co-morbidities, or their symptoms aren’t red flags - what will the referral be for?

A

To be seen by a colorectal surgeon or gastroenterologist within 14 days

20
Q

What should a GP do before referring directly in suspected CRC? (3)

A
  1. Blood tests (FBC, ferritin)
  2. Examination
  3. DRE
21
Q

When is screening for CRC offered?

A

Every 2 years for men and woman aged between 60-74

22
Q

What does the CRC screening test comprise of?

A

An invitation letter and kit with 3 separate samples need to be given for faecal occult blood (FOB) with results 2 weeks later

23
Q

What does an emergency presentation of CRC normally refer to? (4)

A

A&E presentation with:

  1. Obstruction
  2. Perforation
  3. Bleeding
  4. Abdominal pain
24
Q

What is the distribution of occurrence of CRC within the colon?

A

1/3 in the rectum
1/3 on the left side
1/3 remainder of the colon

25
Q

What is the difference in terms of treatment for colon and rectal cancer?

A

Colon cancer: local recurrence uncommon, neo-adjuvant treatment is currently experimental but generally patients do not receive this, and go straight to surgery e.g. hemicolectomy
Rectal cancer: local recurrence is more common, so neoadjuvant treatment is required unless the patient is low risk. If the patient is moderate risk, they will receive radiotherapy alone and then surgery, whereas if they are high risk they will receive radiotherapy and chemotherapy and then surgery.

26
Q

In TNM staging, there is also a V and R stage, what do these refer to?

A 
V = vascular
R = completeness of surgical resection
27
Q

A patient with T3, N2, V1, R0, is classed as high risk, whats treatment will they hopefully benefit from?

A

Chemotherapy

28
Q

What will the staging look like for a patient with moderate risk staging/CRC?

A

T3, N0, V1, R0

29
Q

Which drug is used in chemotherapy for treated CRC?

A

5FU given with Folinic acid (given for 3 months)

30
Q

What is CEA?

A

carcinoembryonic antigen

31
Q

What is CEA use as in CRC?

A

It is a marker used to determine if there is a recurrence of the disease, however it can also be raised in smokers or people with alcoholic liver disease

32
Q

If patients have isolated metastatic disease within the liver, what is the first-line treatment choice?

A

Surgery - 40% chance of resection of the liver mets, as long as there is a single site and low volume disease

33
Q

What side effects do patients have to live with, even with cure of the cancer?

A 
Bowel:
1. Diarrhoea 
2. Urgency
3. Frequency 
4. Incontinence 
(anterior bowel disorder)
Bladder:
1. Frequency
2. Incontinence
Sexual:
1. Impotence
2. Vaginal stenosis
Infertility:
1. Premature menopause 
Psychological:
1. Living with a stoma
2. Sexual
3. Anxiety
Financial
1. Loss of job
2. Loss of earnings

Year 4 CCC (17 decks)

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