Colorectal Cancer

Question 1

How do most colorectal cancers arise and what is the most common type?

Answer 1

From polyps to form adenocarcinomas

Question 2

What part of the GI track does colorectal cancer affect?

Answer 2

rectum and sigmoid colon are the most common

Question 3

Give some risk factors for developing colorectal cancer

Answer 3

Age >65
Genetic syndromes (FAP, HNPCC/Lynch)
IBD
High fat/meat diet
Polyposis syndrome
Obesity, smoking, alcohol
Nullparity/Late pregnancy

Question 4

Where does colorectal cancer metastasise?

Answer 4

Firstly to liver - 25% present with liver mets

Can go to lung, brain and bone

Question 5

How do right sided colorectal cancers present?

Answer 5

Weight loss
Anaemia
RIF mass
Occult bleeding

Question 6

How do left sided colorectal cancers present?

Answer 6

Colicky pain
Rectal bleeding
Change in bowel habit
Tenesmus
LIF mass
Bowel Obstruction

Question 7

What signs would suggest advanced colorectal cancer?

Answer 7

Hepatomegaly

Jaundice

Question 8

How would you go about investigating ?colorectal cancer

Answer 8

FBC - anaemia
CEA
Faecal occult blood test
LFTs - mets

Question 9

What imaging is used to investigate colorectal cancer

Answer 9

Contrast CT staging
Colonoscopy or CT colonography

MRI of mesorectum if tumour below peritoneal reflection

Elderly/ major comorbidities: Flexi sig + barium enema

Question 10

Describe what each of the T stages in TNM stages means in relation to colorectal cancer

Answer 10

T1 - invade submucosa
T2 - invade muscularis propria
T3 - Invade pericolic tissues
T4 - perforate visceral peritoneum

Question 11

When do GP’s trigger the 2 week wait referral for colorectal cancer?

Answer 11

> 40 with WL and abdo pain
50 with rectal bleeding
60 with iron deficiency anaemia or change in bowel habit

Question 12

When is chemotherapy used in colorectal cancer?

Answer 12

Advanced and metastatic disease

Those with high risk of disease recurrence

Question 13

When is a right hemicolectomy performed? What is done during the procedure?

Answer 13

Any ascending colon tumours

Part or all of ascending colon and cecum removed. Colon anastomosed to small intestine (ileo-colic)

Question 14

When is a left hemicolectomy performed? What is done during the procedure?

Answer 14

Any descending colon tumours

Part or all of descending colon removed. Transverse colon anastomosed to rectum (colo-colic)

Question 15

When is a sigmoid colectomy performed? What is done during the procedure?

Answer 15

Tumours affecting the sigmoid colon

Part/all of sigmoid colon removed. Descending colon connected to rectum (colo-rectal)

Question 16

When is an anterior resection performed? What is done during the procedure?

Answer 16

High anterior resection: sigmoid tumours
Anterior resection: rectal tumours

sigmoid colon and portion of rectum removed. Colorectal anastomosis formed
+TME (removal of mesorectal fat and lymph)

Question 17

When is an abdo-perineal resection performed? What is done during the procedure?

Answer 17

Lower rectal tumours and any tumour involving the sphincter

removes the anus, rectum, and sigmoid colon. No anastomosis

Question 18

Where does a HNPCC colon cancer normally affect?

What other cancers is HNPCC associated with?

Answer 18

Proximal colon

Endometrial

Question 19

What is the current colorectal screening programme?

Answer 19

Every 2 years
Age 60-74
FOBT

Question 20

What are some complications of colorectal cancer surgical management?

Answer 20

Anastomotic leak, adhesions, hernia

Stoma complications:
- parastomal hernia, ischaemia/necrosis, obstruction, skin irritation, prolapse, retraction leading to a poor bag seal

Question 21

What is Hartmanns’ procedure?

Answer 21

Resection of sigmoid colon, closure of the anorectal stump and formation of end colostomy

Question 22

What are the advantages and disadvantages of parenteral nutrition?

Answer 22

little patient effort

sepsis
catheter obstruction
thrombosis
refeeding syndrome

Question 23

What are the advantages and disadvantages of enteral nutrition?

Answer 23

low cost
maintains gut
few infection risks

aspiration risk
tube displacement
gastric distention
risk of malnutrition