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Gastroenterology > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

How common is colorectal cancer?

A

It is the third most common in the UK and second most common cause of UK cancer death (16,000/yr)

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2
Q

How common is colorectal cancer?

A

It is the third most common in the UK and second most common cause of UK cancer death (16,000/yr)

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3
Q

What are the risk factors that you could ask about for colorectal cancer?

A

PMH - IBD, Ca and Polyps
FH - FAP/HNPCC/P-J
SH - Smoking, alcohol and diet - increased red/processed meat, low fibre
>60years

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4
Q

What are the risk factors for colorectal cancer?

A

PMH - IBD, Ca and Polyps
FH - FAP/HNPCC
SH - Smoking, alcohol and diet - increased red/processed meat, low fibre
>60years

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5
Q

Are there any drugs that reduce the chance of CRCa?

A

Aspirin 75mg/OD

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6
Q

What are the different sites in which you can get CRCa? and most/least likely?

A 
Appendix
Caecum
Ascending 
Hepatic flexure
Transverse
Splenic flexure (least common)
Descending
Sigmoid (2MC)
Rectal (most common)
Anal
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7
Q

What are the s/s of descending CRCa?

A 
Change in bowel habits
Blood/mucus in stool 
Obstruction
Tenesmus RED FLAG
PR mass
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8
Q

What s/s can occur with any CRCa?

A

Abdominal mass
Weight loss
Perforation
Haemorrhage

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9
Q

What tests can you do for suspected CRCa?

A

FBC - low Hb
LFTs
Faecult Occult Bloods
CEA carcinoembryonic antigen - tumour marker for CRCa used to monitor

USS liver

Sigmoid/colonoscopy and biopsy

DNA for FAP if >15yrs

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10
Q

Where is CRCa most likely to spread?

A 
Local
Lymph
Lungs
Liver
Bone
Transcoelomic
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11
Q

What are the staging systems for CRCa?

A 
TNM 
Dukes:
A - not yet penetrated submucosa (up to muscularis mucosa)
B - penetrated through muscularis mucosa
C - spread to local lymph nodes
D - metastasised
DRAW THE LAYERS
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12
Q

What are the different curative procedures, and for which type of cancers?

A

Laparoscopic -
Right hemicolonectomy: right sided cancers to 1/2 TC
Left hemicolonectomy: 1/2 TC and left sided cancers
Anterior Resection: sigmoid cancers and high rectal
Abdominalperoneal Resection: rectal cancers = permanent stoma
Hartmann’s - emergency

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13
Q

What are the different curative procedures, and for which type of cancers?

A

Right hemicolonectomy: right sided cancers
Left hemicolonectomy: left sided cancers
Sigmoid colectomy: sigmoid cancers
Anterior Resection: rectal cancers

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14
Q

What palliative procedures can we do for CRCa?

A

Stenting

Hartmann’s

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15
Q

When do we use radiotherapy?

A

Mostly in palliation
Post-op if rectal and high risk of recurrance
Sometimes pre-op for rectal to allow for resection

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16
Q

What chemotherapy do we use for CRCa?

A

FOLFOX
Fluororacil
Folinic acid
Oxiloplatin

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17
Q

What biological therapies can we use and when would we use them?

A

MABs
Bevacizumab
Cetuxiab
Panitumumab

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18
Q

What biological therapies can we use and when would we use them?

A

MABs
C
R
B

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19
Q

How does race and gender tie into where you are more likely to get a cancer?

A

Black females - more proximal

White males - more distal

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20
Q

What are the aims of CRCa surgery?

A

Cure

Increase survival by 50%

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21
Q

What kind of cancer is colorectal cancer usually?

A

Adenocarcinoma

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22
Q

What are the risk factors for colorectal cancer?

A

PMH - IBD, Ca and Polyps
FH - FAP/HNPCC
SH - Smoking, alcohol and diet - increased red/processed meat, low fibre
>60years

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23
Q

Are there any drugs that reduce the chance of CRCa?

A

Aspirin 75mg/OD

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24
Q

What are the different sites in which you can get CRCa? and most/least likely?

A 
Appendix
Caecum
Ascending 
Hepatic flexure
Transverse
Splenic flexure (least common)
Descending
Sigmoid (2MC)
Rectal (most common)
Anal
25
Q

What are the s/s of ascending CRCa?

A

low Hb
Abdominal pain
Weight loss

26
Q

What are the s/s of descending CRCa?

A

Change in bowel habits
Blood/mucus in stool
Obstruction

27
Q

What s/s can occur with any CRCa?

A

Abdominal mass

Weight loss

28
Q

What tests can you do for suspected CRCa?

A

FBC - low Hb
LFTs
Faecult Occult Bloods

USS liver

Sigmoid/colonoscopy and biopsy

29
Q

Which other cancers does Lynch syndrome put you at risk of?

A 
Endometrial
Ovary
Stomach
Small bowel 
Hepatobiliary tract
Urinary tract
30
Q

What are the staging systems for CRCa?

A 
TNM 
Dukes:
A - penetrated submucosa
B - penetrated anywhere to longitudinal muscle
C - spread to local lymph nodes
D - metastasised
31
Q

What are the different curative procedures, and for which type of cancers?

A

Right hemicolonectomy: right sided cancers
Left hemicolonectomy: left sided cancers
Sigmoid colectomy: sigmoid cancers
Anterior Resection: rectal cancers

32
Q

What palliative procedures can we do for CRCa?

A

Stenting

Hartmann’s

33
Q

When do we use radiotherapy?

A

Mostly in palliation
Post-op if rectal and high risk of recurrance
Sometimes pre-op for rectal to allow for resection

34
Q

When do we use chemotherapy?

A

For stage 3 disease as reduces recurrance by 30%

35
Q

What sort of FH would make you refer to a specialist genetic service?

A 
2 x 1st degree relatives with CRCa <60yrs
OR
Lynch
FAP
P-J
36
Q

What biological therapies can we use and when would we use them?

A

MABs
C
R
B

37
Q

What is the prognosis of CRCa?

A

75% 5yr for stage 1

5% 5yr for stage 4

38
Q

How does race and gender tie into where you are more likely to get a cancer?

A

Black females - more proximal

White males - more distal

39
Q

What are the aims of CRCa surgery?

A

Cure

Increase survival by 50%

40
Q

What is the NHS cancer screening programme?

A

Since 2006
Colonoscopy offered to all those who test positive for faecal occult bloods on the home testing kit.
The testing kit is sent to all men and women aged 60-75 every two years

41
Q

What is a polyp?

A

A growth that appears above the mucosa

42
Q

What is FAP?

A

Multiple (>100) colorectal adenomas caused by a mutation in APC tumour suppressor gene 5q

43
Q

Why does FAP increase your CRCa risk?

A

Causes hyper proliferation = higher chance of malignant change

44
Q

Which other genes mutations are involved in CRCa?

A

K-RAS oncogene
DCC
p53 tumour suppressor gene

45
Q

What is HNPCC?

A

AKA Lynch syndrome. Mutation of mismatch repair gene

46
Q

What is the Amsterdam criteria?

A 
This is to calculate the risk of someone having Lynch syndrome.
3-2-1
3 relatives
2 generations
1 <50 years
47
Q

What is the risk of CRCa if you have Lynch syndrome?

A

80%

48
Q

Which other cancers does Lynch syndrome put you at risk of?

A 
Endometrial
Ovary
Stomach
Small bowel 
Hepatobiliary tract
Urinary tract
49
Q

What percentage of CRCa are genetic?

A

5%
1% FAP
1-3% HNPCC

50
Q

Which genetic problems increase your risk of CRCa?

A

Lynch syndrome
FAP
Peutz-Jegher’s syndrome

51
Q

What is Peutz-Jeghers syndrome?

A

A mutation of a tumour suppressor gene resulting in the presence of hamartomatous polyps which are growths of mature tissue in a disordered arrangement.

52
Q

What is the risk of CRCa with P-J syndrome?

A

10-20%

53
Q

Which other cancers does PJ syndrome put you at risk of?

A

GI (50-60%)

Breast (60%)

54
Q

What sort of FH would make you refer to a specialist genetic service?

A 
2 x 1st degree relatives with CRCa <60yrs
OR
Lynch
FAP
P-J
55
Q

What happens in a right hemicolonectomy?

A

They remove from the terminal ileum to 5cm distal to the tumour. An ileocolic anastomosis is performed bc the ileum has a fantastic blood supply and so will anastomose nicely.
ANASTOMOSIS
NO STOMA

56
Q

What happens in a left hemicolonectomy?

A

5cm of healthy bowel either side of the tumour is resected. The colon is then anastomosed.
ANASTOMOSIS
NO STOMA

57
Q

What is an anterior resection?

A

This is very similar to a L hemicolonectomy but usually refers to procedures that are low descending/sigmoid regions. The colon is anastomosed and sometimes is given a rest with a
TEMPORARY STOMA.
ANASTOMOSIS

58
Q

What is an abdominoperineal resection?

A

This is where the tumour is so low down that there is not enough of the anus left to anastomose. Here instead there is a permanent end colostomy put in place and the anus is removed.
PERMANENT END COLOSTOMY
NO ANUS

59
Q

What is Hartmann’s procedure?

A

This is a mix between an anterior resection and AP resection.
The lesion and 5cm either side of it are removed. Usually for descending/sigmoid ops.
However no anastomosis is made usually because the patient is either contaminated or too sick.
The anus is not removed. So the patient is left with an anus and an end colostomy.
PERMANENT END COLOSTOMY
ANUS

Gastroenterology (18 decks)

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