Colorectal Cancer Flashcards
What are some of the symptoms for colorectal cancer?
Symptoms vary depending upon where in the colon the cancer has arisen
Right Sided- Insidious onset, Iron Deficiency Anaemia, Pain, Weight loss, Fatigue, Metastatic features, dark blood in stool
Left Sided- Change in bowel habits: constipation or overflow diarrhoea, weight loss, fatigue, pain, blood in stool
Rectal- Tenesmus, PR bleeding, weight loss, pain, constipation
Who should be investigated for colorectal cancer if presenting with unexplained anemia?
All men
Postmenopausal women
What are some risk factors for the development of colorectal cancer?
Increasing age Obesity Smoking Alcohol Diet high in red meat and processed meat Low fibre intake Family history Inherited cancer genes- FAP, HNPCC
What are the bowel cancer screening procedures offered by NHS england?
Fecal Occult Blood Test- Aged 60-74 and a kit is sent in the post every 2 years. People can choose to continue this if they want to after 74
One off colonoscopy is offered at 55 years of age
What does a fecal occult blood test test for?
FOB tests for the presence of blood in the stool, which can occur with bowel cancer as well as a number of other conditions
How is fecal occult blood testing carried out?
This is an OSCE role play station so explain it to the patient
A kit is sent in the post to patients aged 60-74 every two years which includes equipment required to take samples of your poo for testing, it includes detailed instructions.
The test requires you to send off six samples in total. A sample is a small cardboard strip with some of your poo on it. You will need to poo in some sort of container, which can be lined with toilet roll so you can flush the poo away when you’re done. This is to avoid getting to poo wet and making it so you can take a sample. For a single poo or motion use two cardboard strips to take two different samples from different areas of the poo. Repeat this for another two poos you have giving a total of 6 samples all together. These can then be send to a laboratory for testing, the kit arrives with a free-post envelope which you can use to dp this.
What does a fecal occult blood test check for? What does a positive test result mean?
This is an OSCE role play station so explain it to the patient
This test checks for blood in your poo which can be a sign of bowel cancer, but other things can also cause there to be blood in your poo. A positive test result therefore does not mean you absolutely have bowel cancer but further investigation is needed to check to see if you may have bowel cancer. Other things that can cause there to be blood present include piles or hemorrhoids and inflammation of your bowel.
Why is it important that patient carry out FOB testing?
This is an OSCE role play station so explain it to the patient
FOB testing aims to pick up a serious problem in your bowel before it can progress to causing symptoms. This serious problem is bowel cancer. It is a test for people who do not have any symptoms of bowel cancer, if you have any symptoms such as bleeding or changes in bowel habit you should go and see your doctor urgently.
FOB can help to pick up bowel cancer or growths that can develop into bowel cancer earlier on. Detecting these problems earlier on allows for much earlier treatment which is associated with far better outcomes than disease that is picked up late, potentially having spread to other parts of your body. Ultimately, and very importantly, this reduces your risk of early death due to bowel cancer. This is why it is important to send off some samples so you can be tested.
What does a positive FOB test mean? Do they have cancer?
This is an OSCE role play station so explain it to the patient
A positive FOBT result means some blood has been found in your poo. This can happen with a number of conditions, and one of these is bowel cancer. Other causes include hemorrhoids and inflammation of your bowel.
Because a positive result can be a sign of bowel cancer in some patients further testing is needed to investigate for this. At its early stages you can have bowel cancer without any symptoms and so you could not have any problems at the moment but there could be a cancer in your colon. You’ll be invited to go for a colonoscopy to check to see if there could be a cancer in your bowel, this is when a thin, flexible camera is inserted in your back passage and used to look inside the bowel. It is important to do this because the earlier a cancer is picked up the more treatment options are available and the better the outcomes, reducing risk of early death due to cancer.
Does a positive FOB test mean I am going to die?
This is an OSCE role play station so explain it to the patient
A positive FOBT does not equal death. It simply means that some blood has been found in your poo. This can be due to a number of causes including haemorrhoids, bowel inflammation, small growths in the bowel and bowel cancer.
You’ll be invited to go for colonoscopy to investigate for bowel cancer or growths that could develop into cancer. If anything suspicious is found this will be discussed by a number of doctors, nurses and surgeons to decide which direction to go in and what treatments should be considered. Importantly, picking up cancers early is associated with much better outcomes and reduces risk of death due to the cancer.
Always do ICE for these!!!
What could be done to increase FOBT uptake?
GPs explaining to patients why it is done
Better patient education
Normalising it
Make advice readily available in case people are unsure- e.g. telephone helplines
Reminder systems- e.g. text reminders
What is the uptake for bowel cancer screening?
Around 50-60%
What tumour marker is used to monitor bowel cancers?
CEA (Carcinoembryonic antigen)
This is only for monitoring and not for diagnosis as not all bowel cancers express CEA. After treatment CEA is measured at each clinic visit.
What are the T stages for CRC?
T1- Tumour confined to mucosa and submucosa
T2- Tumour invasion into muscularis propria
T3- Tumour invasion into serosa
T4- Tumour penetrating through the bowel wall
What are the treatment options for colorectal cancer?
Surgical resection- for localised disease
Chemotherapy- Adjuvant or neoadjuvant
Targeted therapies- e.g. if EGFR over-expressed
Radiotherapy- for rectal cancer mostly
What should be done if a suspicious lesion is seen during colonoscopy?
Biopsy can be taken for histological analysis.
