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Large Bowel > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

How common is colorectal cancer

A

Third most common cancers in the world

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2
Q

Which cells do colorectal cancers originate from

A

Epithelial cells lining the colon - simple columnar cells

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3
Q

What is the most common type of cancer in the colon

A

Adenocarcinoma- glandular tissue

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4
Q

What is the adenoma - carcinoma sequence

A

colorectal cancers develop via a progression of normal mucosa to colonic adenoma (colorectal ‘polyps’) to invasive adenocarcinoma

This is called adenoma - Carcinoma sequence

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5
Q

What is the conversion percentage from adenoma to adenocarcinoma

A

10%

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6
Q

What are colonic adenoma commonly referred to as.

A

Colonic polyps

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7
Q

Which gene mutations have been implicated in those who pre-dispose to colorectal cancer

A

Adenomatous polyposis coli - APC
- this is a tumor suppressor gene therefore mutation in this leads to abnormal tissue growth associated with FAP - Familial Adenomatous Polyposis

Hereditary nonpolyposis colorectal cancer ( HNPCC)

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8
Q

Outline in detail the adenoma - carcinoma sequence

A

Normal epithelium

Abnormal epithelium

Small adenoma

Large adenoma

Colonic carcinoma

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9
Q

what are the risk factors in developing colorectal cancer

A

75% sporadic - developing out of the blue - not associated with risk factors at all

Increasing age

FH

IBD

Low fibre diet

Smoking

High alcohol intake

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10
Q

What are the general clinical features of colorectal cancer

A

Change in bowel habit

Rectal bleeding

Weight loss

Abdo pain

Iron deficiency anaemia

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11
Q

What are the features of right sided colonic cancer

A

Abdo pain

Occult bleeding/anaemia

Mass in RIF

Presents late

Late change in bowel habit - more water in the faeces still

Fungating

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12
Q

What are the features of left sided colonic cancers

A

Rectal bleeding

Tenesmus

Mass in LIF / PR exam

Constipation - more water absorbed at this point

Early change in bowel habit

Less advanced at presentation

Stenosing - apple core sign

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13
Q

According to NICE when should patients be referred for urgent investigations of suspected bowel cancer

A

≥40yrs with unexplained weight loss and abdominal pain

≥50yrs with unexplained rectal bleeding

≥60yrs with iron‑deficiency anaemia or change in bowel habit

Positive occult blood screening test

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14
Q

What are the main differential diagnoses to consider when thinking about colorectal cancer

A

IBD

Internal haemorrhoids

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15
Q

To what ages is the colorectal cancer screening tool recommended

A

Men and women aged 60-75, this screening is offered every 2 years

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16
Q

What is used in the screening tool

A

Faecal immunochemistry test is most currently used

Also occult blood testing in faeces can also be used.

17
Q

what happens if the samples from the screening tool test positive

A

Patient will be referred to have a colonoscopy

18
Q

Which lab tests are ordered to investigate colorectal cancer

A

FBC - microcytic anaemia ( iron deficiency )
LFTs
COAG

Carcinoembryonic antigen ( CEA ) should not be used for diagnoses but can be used to monitor disease progression

19
Q

What is the gold standard imaging modality used to investigate colorectal cancers

A

Colonoscopy with biopsy

If pt not suitable then flexible sigmoidoscopy/ CT colonography can be done

20
Q

If gold standard picks up cancer, what further investigations are needed

A

CT CAP - for staging

CT colonogram

MRI rectum

Endo-anal USS - for rectal cancers

21
Q

Which staging system is used for the staging of colorectal cancer

A

Dukes staging: stage A-D

A - confined beneath the muscularis propria

B - extension through muscularis propria

C - involvement of regional lymph nodes

D - distant mets

22
Q

How would you manage colorectal cancer

A

Discuss at MDT
Surgery
Chemo and radiotherapy - important role in adjuvant and Neoadjuvant chemo

23
Q

What is the main aim of surgery

A

Regional colectomy - take out tumor

Lymphatic drainage followed by anastomosis or stoma formation

24
Q

What is a right hemicolectomy and how does this differ from extended right hemicolectomy

A

right hemicolectomy - caecum, ascending colon and proximal transverse colon removed

Extended right hemicolectomy - as above but also transverse colon until the splenic flexure is reached

https://www.bmj.com/content/bmj/366/bmj.l4561/F2.medium.jpg

25
Q

When would you do a right hemicolectomy/ extended right hemicolectomy

A

Caecal tumors

Ascending colon tumors

26
Q

Which arteries are clamped during a right hemicolectomy

A

Ileocolic, right colic and right branch of middle colic are clamped and removed with their mesenteries

27
Q

What is a Left Hemicolectomy

A

From the splenic flexure to the sigmoid colon is removed

28
Q

Which arteries have to be clamped for a Left Hemicolectomy

A

Left branch of middle colic

IMV

Left colic vessels

29
Q

What is a sigmoidcolectomy

A

Taking out the sigmoid colon.

Done for taking out sigmoid cancers

30
Q

What is Anterior Resection

A

Can be high or low

High - sigmoid colon plus 5 cm above anus

Low - sigmoid colon plus anus ( but not anal sphincter )

31
Q

What is a Abdominoperineal (AP) Resection

A

Sigmoid, rectum and anus taken out

Usually done for low rectal tumours

Will result in a permanently colostomy as anal spinchter is also taken out

32
Q

What is the hartmanns procedure

A

Used in emergency bowel surgery

Involves complete resection of the recto-sigmoid colon with the formation of a End colostomy and the closure of the rectal stump.

33
Q

What chemotherapy options are available for patient with advanced colorectal cancer ( metastatic )

A

FOLFOX

Folinic acid

Flurouracil ( 5 -FU)

Oxaliplatin

34
Q

When is radiotherapy used

A

Used in rectal cancer due to risk of damaging small bowel if used in colon cancer

35
Q

What treatments are included in palliative care

A

Endoluminal Stenting
- used to relieve bowel obstruction ( cannot be done in rectal tumors due to feeling of tenesmus )

Stoma formation
- can be used to bypass obstruction

Resection of secondaries
- done with adjuvant chemo

Large Bowel (7 decks)

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