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Y4: Colorectal surgery > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

Describe the incidence of colorectal cancer?

A
  • Third most common cancer in the UK
  • Second highest mortality
  • Strongly associated with age
  • Different types of inherited syndromes
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2
Q

Describe the aetiology of colorectal cancers?

A
  • Originate from epithelial cells, most commonly adenocarcinoma
    • Also lymphoma, carcinoid and sarcoma
  • Normal mucosa -> colonic adenoma (polyps) -> invasive adenocarcinoma
  • Genetic mutations implicating in colorectal cancer:
    • APC
    • HNPCC
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3
Q

Describe the APC mutation?

A
  • Adenomatous polyposis coli
  • Tumour suppressor gene
  • Mutation causes growth of adenomatous tissue
  • Associated with Familial Adenomatous Polyposis (FAP)
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4
Q

Describe the HNPCC mutation?

A
  • Hereditary nonpolyposis colorectal cancer (HNPCC)
  • DNA mismatch repair gene
  • Mutation leads to defects in DNA repair
  • Associated with Lynch syndrome
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5
Q

What are the risk factors for colorectal carcinoma?

A
  • 75% are sporadic with no specific risk factors
  • Potential risk factors:
    • Increasing age
    • Family history
    • Inflammatory bowel disease
    • Low dietary fibre, calcium, vitamin D
    • Processed meat intake
    • Smoking, alcohol
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6
Q

Clinical features of all colorectal cancers?

A
  • Change in bowel habit
  • Rectal bleeding
  • Weight loss (usually metastatic disease)
  • Abdominal pain
  • Iron-deficiency anaemia
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7
Q

Specific clinical features of right-sided colon cancers?

A
  • Abdominal pain
  • Occult bleeding / anaemia
  • Mass in right iliac fossa
  • Often present late
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8
Q

Specific clinical features of left-sided colon cancers?

A
  • Rectal bleeding
  • Change in bowel habit
  • Tenesmus
  • Mass in left iliac fossa or on PR exam
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9
Q

What patients does NICE recommend be referred for urgen invesitgation of bowel cancer?

A
  • >40 with unexplained weight loss and abdominal pain
  • >50 with unexplained rectal bleeding
  • >60 with IDA or change in bowel habit
  • Positive occult blood screening test
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10
Q

Name some differentials for symptoms associated with colorectal cancer?

A
  • Inflammatory bowel disease (20-40yrs old)
  • Haemorrhoids
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11
Q

Describe the colorectal cancer screening process?

A
  • Age 55
    • Invited for one off colonoscopy
  • Age 60-74
    • Home testing kit every 2 years
    • Usually faecal immunochemistry test (FIT)
    • If positive, colonscopy is performed
  • Age >74
    • Request home testing kit every 2 years
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12
Q

Investigations into someone with a suspected colorectal carcinoma?

A
  • FBC: microcytic anaemia, LFTs, clotting
  • Carcinoembryonic antigen (CEA) tumour marker
  • Colonscopy with biopsy (GOLD STANDARD)
    • If colonoscopy is unsuitable: flexible sigmoidoscopy, CT colonography
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13
Q

After a diagnosis of colorectal cancer is made, how can the neoplasm be staged?

A
  • CT CAP (for mets)
  • MRI rectum (rectal cancers only)
    • Assess depth of invasion
  • Endo-anal US
  • DUKES or TNM STAGING
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14
Q

How can disease progression be monitored in colorectal cancer?

A

Carcinoembryonic antigen (CEA) tumour marker

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15
Q

Describe TNM staging of colorectal cancer?

A
  • T: depth of tumour into bowel wall
  • N: extent of spread to local lymph nodes
  • M: whether there are distant METs
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16
Q

Describe Dukes’ staging for colorectal cancer?

A
17
Q

Describe the general management of someone with colorectal cancer?

A
  • Discussion at a MDT
  • Surgery +/- chemo + radiotherapy
  • Regional colectomy followed by primary anastomosis or stoma formation
18
Q

Describe the surgical management of caecal or ascending colon tumours?

A
  • Right hemicolectomy
    • Ileocolic, right coli and right branch of middle colic vessels are divided and removed with their mesenteries
19
Q

Describe the management of a transverse colon tumour?

A

Extended right hemicolectomy

20
Q

Describe the management of a descending colon tumour?

A
  • Left hemicolectomy
    • Left branch of middle colic vessels, inferior mesenteric vein and left colic vessels are divided and removed with their mesenteries
21
Q

Describe the management of a sigmoid colon tumour?

A
  • Sigmoidcolectomy
    • IMA is fully dissected out with the tumour to ensure adequate margins
22
Q

Describe the management of high rectal tumours?

A
  • Anterior resection
    • Leaves renal sphincter intact
23
Q

Describe the management of a low rectal tumour?

A
  • Abdominoperineal (AP) resection
    • <5cm from the anus
    • Excision of distal colon, rectum and anal sphincters
    • Requires permanent colostomy
24
Q

Describe the use of Hartmann’s procedure?

A
  • Used in emergency bowel surgery
    • Obstruction or perforation
  • Complete resection of recto-sigmoid colon with formation of an end colostomy and closure of the rectal stump
25
Q

Describe the palliative management of advanced colorectal cancers?

A
  • Reduce cancer growth and symptom control
    • Stoma formation
      • Patients with acute obstruction
    • Endoluminal stenting
      • Relieve acute bowel obstruction in patients with left-sided tumours

Y4: Colorectal surgery (8 decks)

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