Colorectal cancer

Question 1

What kind of cancer are colorectal cancers usually?

Answer 1

Adenocarcinomas as from the epithelial cells lining the colon or rectum

Question 2

How do colorectal cancers usually begin and progress?

Answer 2

progression of normal mucosa to colonic adenoma (colorectal polyps) to invasive adenocarcinoma

Question 3

What genetic mutation predispose people to colorectal cancer?

Answer 3

adenomatous polyposis coli gene, hereditary non-polyposis colorectal cancer

Question 4

What are some risk factors for colorectal cancer?

Answer 4

age, family history, IBD, Low fibre diet, high processed meat intake, smoking, high alcohol intake

Question 5

What are the clinical features of colorectal cancer?

Answer 5

change in bowel habit, rectal bleeding, weight loss, abdominal pain, iron deficiency anaemia

Question 6

What are the clinical features of right sided colon cancer?

Answer 6

abdominal pain, occult bleeding, mass in right iliac fossa

Question 7

What are the clinical features of left sided colon cancer?

Answer 7

Rectal bleeding, change in bowel habit or tenesmus, mass in left iliac fossa

Question 8

What are the differential diagnosis of colorectal cancer?

Answer 8

IBD, haemorrhoids, Diverticulitis

Question 9

When is colorectal cancer screening offered to people in the UK?

Answer 9

every 2 years for men and women between 60-75 years

Question 10

What test is used for colorectal cancer screening in the UK?

Answer 10

Faecal immunochemistry test

Question 11

What laboratory tests are done if colorectal cancer is suspected?

Answer 11

routine bloods including a FBC (looking for microcytic anaemia) U And E, LFTs and coagulation screening, carcinoembryonic Antigen is used just to monitor the disease

Question 12

What is the gold standard imaging for colorectal cancer?

Answer 12

colonoscopy with biopsy

Question 13

If a colonoscopy is not suitable for a patient, what other imaging can be done for a patient with suspected colorectal cancer?

Answer 13

flexible sigmoidoscopy, CT colography

Question 14

Once a diagnosis of colorectal cancer is made, what imaging can be done for staging?

Answer 14

CT scan to look for distant metastasis and invasion, MRI rectum, Endo-anal ultrasound

Question 15

What is Dukes staging?

Answer 15

the stages of the colorectal cancer according to the depth of the invasion into the bowel wall, spread of lymph nodes and distant metastasis

Question 16

What is the management for Colorectal cancer?

Answer 16

chemotherapy and radiotherapy, regional colectomy

Question 17

When a regional colectomy is done, what is done to restore bowel function?

Answer 17

Primary anastomosis or formation of a stoma

Question 18

What surgery is preformed for Cacal or ascending colon tumours?

Answer 18

Right semicolectomy and extended right hemicolectomy

Question 19

What is the surgery approach for a descending colon tumour?

Answer 19

Left hemicoloectomy

Question 20

What is the surgery approach for a sigmoid colon tumour?

Answer 20

sigmoidcolectomy

Question 21

What is an anterior resection?

Answer 21

This is for high rectal tumours, leaves the rectal sphincter intact and functioning so an anastomosis can be preformed

Question 22

After an anterior resection what stoma is put in and why?

Answer 22

defunctioning loop ileostomy to protect the anastomosis and reduce complications, this is reversed 4-6months later

Question 23

What is an abdominoperineal resection?

Answer 23

low rectal tumours, excise distal colon, rectum and anal spinsters so gives a permanent colostomy

Question 24

What is a hartmans procedure?

Answer 24

Emergency bowel surgery, complete resection of sigmoid colon with the formation of an end colostomy and closure of the rectal stump

Question 25

What is an example of a chemotherapy regime for patients with metastatic colorectal cancer?

Answer 25

FOLFOX

Colonic acid, Fluorouracil, Oxaliplatin

Question 26

What is some examples of palliative care for colorectal cancer?

Answer 26

Endoluminal stenting, stoma formation, resection of secondaries