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Y4 Gastrointestinal > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

What is a polyp

A

It a protrusion above an epithelial surface (it is a tumour/swelling)

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2
Q

What are the 4 main classes of polyps ?

A
  1. Adenoma
  2. Serrated polyp
  3. Polypoid carcinoma
  4. Other

Need histopathology to tell them apart!

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3
Q

What do the majority of colorectal cancers arise from ?

A

Pre-existing adenomatous polyps

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4
Q

What is the main type of colorectal cancer ?

A

Adenocarcinoma

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5
Q

What are the risk factors for developing colorectal cancer?

A
  • Older age - ¾ of cases occurring in people over age of 65
  • Low intake of fibre
  • High intake of fat, sugar, alcohol, red meat, processed meats
  • Obesity
  • Smoking
  • Lack of physical exercise
  • Long-standing IBD - UC more than crohns
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6
Q

What are the genetic mutations which increase the risk of colorectal cancer ?

A
  • Mutations in APC ( adenomatous polyposis coli)
  • Mutations of p53 gene
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7
Q

What are the 2 main familial conditions which greatly increase the risk of colorectal cancer ?

A
  1. Familial adenomatous polyposis (FAP)
  2. Hereditary non-polyposis colorectal carcinoma - HNPCC (Lynch syndrome)
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8
Q

What is HNPCC and what mutations cause it

A
  • It is an autosomal dominant condition and is the most common form of inherited colorectal cancer.
  • Around 90% of patients will develop cancers
  • It is most commonly caused by MSH1/2 mutations
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9
Q

What criteria can be used to help recognise HNPCC?

A

The Amsterdam criteria are sometimes used to aid diagnosis:

  1. At least 3 family members with colon cancer
  2. The cases span at least two generations
  3. At least one case diagnosed before the age of 50 years
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10
Q

What other cancers is HNPCC condition associated with causing ?

A

Gastric and endometrial carcinoma

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11
Q

What is the management/screening required for someone with HNPCC?

A
  • Colonoscopy every 1-2 years from age 25
  • Consideration of prophylactic surgery
  • Extra colonic surveillance recommended
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12
Q

What can patients with lynch syndrome take to help reduce the risk of colorectal cancer ?

A

Daily aspirin for > 2 years

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13
Q

What is FAP and what mutations cause it

A
  • A rare autosomal dominant condition which leads to the formation of hundreds of polyps by the age of 30-40 years. Patients inevitably develop carcinoma.
  • Due to Mutation of APC gene
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14
Q

What other cancers is FAP associated with ?

A

Desmoid tumours and thyroid carcinoma

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15
Q

What is the management/screening required for someone with FAP?

A
  1. Annual flexible sigmoidoscopy from 15 years
  2. If no polyps found then 5 yearly colonoscopy started at age 20
  3. Polyps found = resectional surgery

Patients generally have a total colectomy with ileo-anal pouch formation in their twenties.

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16
Q

What type of colorectal cancers does HNPCC and FAP cause ?

A
  • HNPCC causes mucinous tumours
  • FAP causes adenocarcinomas
17
Q

What are the signs/symptoms of a left-sided (rectum, sigmoid, descending) colorectal cancer ?

A
  • Rectal bleeding
  • Feeling of incomplete emptying
  • Worsening constipation/obstruction
18
Q

What are the signs/symptoms of a right-sided (Caecum, Ascending) colorectal cancer ?

A
  • Unexplained Iron deficiency anaemia - persistent tiredness
  • A persistent and unexplained change in bowel habit
  • Unexplained weight loss
  • Abdominal pain (colicky in nature)
  • Lump in the abdomen
19
Q

When should someone excluding for screening be offered faecal occult blood testing (FOBT)?

A
  1. ≥ 50 years with unexplained abdominal pain OR weight loss
  2. < 60 years with changes in their bowel habit OR iron deficiency anaemia
  3. ≥ 60 years who have anaemia even in the absence of iron deficiency
20
Q

When should patients be referred urgently to the colorectal services for investigation and what should be done ?

A
  1. ≥ 40 years with unexplained weight loss AND abdominal pain
  2. ≥ 50 years with unexplained rectal bleeding
  3. ≥ 60 years with iron deficiency anaemia OR change in bowel habit
  4. Tests show occult blood in their faeces on FOBT

Should be seen urgently (within 2 weeks) for colonoscopy

21
Q

What are the 2 screening tests offered in scotland for colorectal cancer ?

A
  1. Faecal Immunochemical Test (FIT) screening - this is the FOBT offered to people aged 50-74 every 2 years.
  2. Flexible sigmoidoscopy screening - Offered to 55 year-olds (this is a one off screen to detect and treat hopefully reducing rates of future cancer)
22
Q

What can be used as an alternative to colonoscopy to diagnosed colorectal cancer ?

A

CT colonography

23
Q

Following diagnosis of colorectal cancer what needs to be done ?

A

The pathology sample is sent to histopathology

Cancer staging needs to be done:

  • CT chest/abdo/pelvis
  • MRI for rectal cancers

This is followed by MDT review and decision for Surgery (hopefully curative or paliation treatment

24
Q

What are the common sites of metastasis for colorectal cancer ?

A
  1. Direct spread - Mesorectum, Peritoneum,Other organs
  2. Lymphatic spread - mesenteric nodes
  3. Blood borne spread - to the Liver and Lungs
25
Q

What may patients with liver and lung metastases prior to surgery recieve ?

A

Chemo - needs a PET/CT scan prior to doing the chemo

26
Q

What is the treatment of colorectal cancer ?

A

Local disease:

  • Ressection +/- chemo if risk of recurrence (a combination of 5FU and oxaliplatin is common.)
  • Rectal tumours can be resected with either an anterior resection or an abdomino-perineal excision of rectum (APER). Involvement of the sphincter complex or very low tumours require APER. Removal of the mesorectal fat and lymph nodes (total mesorectal excision/ TME) if required regardless.

Advanced disease:

  • Cancer resection (Cancer + liver + lung resection) + chemo
  • HIPEC ( hyperemic intraperitoneal chemotherapy) for mesothelioma, pseudomyxoma peritonei and peritoneal metastasis
  • All tumours stage III and greater require chemo
27
Q

What are the palliative options for treatment of colorectal cancer ?

A
  • Stenting
  • Palliative radio/chemotherapy
  • Defunctioning
  • bypass

Y4 Gastrointestinal (28 decks)

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