colorectal cancer

Question 1

CRC - RFs

Answer 1

FH
familial polyposis (autosomal dominant)
UC (with pseudopolyps)
benign adenomatous polyps - malignant change

Question 2

CRC - presentation

Answer 2

IDA
weight loss
LBO
perforation / peritonitis
fistula to stomach, bladder, vagina
change of bowel habit - descending colon
tenesmus + bleeding - rectum

Question 3

CRC - management

Answer 3

rectal - ?neoadjuvant radio

resection:
curative - 2cm clearance
palliative - for obstruction + bleeding
remove with local nodes
aim to rejoin cut ends in same op

adjuvant chemo - eg 6mo 5FU + folinic acid
± oxaliplatin - SE peripheral neuropathy
depending on stage

Question 4

CRC - staging

Answer 4

TNM increasingly used over duke’s

Question 5

commonest type of anal cancer?

Answer 5

squamous cell carcinomas (80%)

Question 6

anal cancer - RFs

Answer 6

HPV - 16 + 18
immunosuppression
smoking

Question 7

anal cancer - investigations

Answer 7

anoscopy + biopsy
CT, MRI, endo-anal USS, PET
test for infections incl HIV

Question 8

surgeries for diff CRCs

Answer 8

anal/distal ⅓ rectum - abdominoperineal excision of rectum

middle + upper ⅓ - anterior resection

sigmoid - hartmann’s

Question 9

what is hartmann’s? indications?

Answer 9

sigmoid resected + end-colostomy made

can be reversed

good in emergency perf

Question 10

types of colostomy: end (temp, permanent) + loop

Answer 10

end - one opening
temp end - diseased bit removed + remaining bit needs to rest for a bit before re-joining
permanent end - too risky/not possible to rejoin

loop - 2 ends
usually temporary + emergency

Question 11

difference between permanent + temporary end colostomies / commonest indications?

Answer 11

can’t differentiate clinically

permanent - abdominoperineal resection of rectal cancers → entire rectum removed - imperforate anus

temp - to rest the bowel eg diverticulitis or obstruction by tumour. 2-stage hartmann’s. rectum + bowel rejoined at later date

Question 12

what is a loop colostomy? why done?

Answer 12

to protect distal anastomoses after recent surgery - loop brought to surface + half-opened, allowing faecal matter to drain into bag without reaching the distal anastomoses. supporting rod secures the 2 parts to the skin. 2 parts are still attached as it’s a temp procedure that’ll be reversed

Question 13

indication for a permanent end ileostomy?

Answer 13

panproctocolectomy for UC
FAPP

perm + temp end-iles cant be differentiated clinically

Question 14

indication for temporary end ileostomy?

Answer 14

emergency bowel resection when it’s unsafe to form anastomosis with remaining bowel at the time (eg intra-abdo sepsis or bleeding)

Question 15

temp loop ileostomies - indications

Answer 15

same way as colosts
2 openings which are connected + used to protect distal anastomoses

eg to defunction colon after rectal cancer surgery