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GASTROINTESITNAL SYSTEM > COLORECTAL CANCER > Flashcards

COLORECTAL CANCER Flashcards

1
Q

WHAT TYPE OF CANCER IS MAJORITY OF COLORECTAL CANCER?

A

Adenocarcinoma (start in mucus secreting cells) derived from epithelial cells lining colon or rectum

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2
Q

WHAT ARE THE RISK FACTORS FOR COLORECTAL CANCER?

A

1) Increasing age > 44 years old
2) Genetic mutations - APC or HNPCC
3) FHx
4) IBD
5) Low fibre diet

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3
Q

WHAT ARE THE CLINICAL FEATURES OF COLORECTAL CANCER?

A

1) Change in bowel habits - increase frequency, loose stool
2) Rectal mass
3) Rectal bleeding
4) Abdominal pain
5) Iron- deficiency anaemia
6) Weight loss - unexplained
7) Night sweats

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4
Q

WHAT ARE THE FEATURES OF RIGHT SIDED COLON CANCER?

A

1) Abdominal pain
2) Occult bleeding (blood in faeces that is not visible)
3) Mass in RIF
4) Anaemia
5) Present late

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5
Q

WHAT IS AFFECTED IN RIGHT SIDED COLON CANCER?

A
  • ascending colon

- proximal 2/3rd of transverse colon

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6
Q

WHAT ARE THE FEATURES OF LEFT SIDED COLON CANCER?

A

1) Rectal bleeding
2) Change in bowel habits
3) Tenesmus
4) Mass in LIF

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7
Q

WHAT IS AFFECTED IN LEFT SIDED COLON CANCER?

A
  • distal 1/3rd of transverse colon
  • descending colon
  • sigmoid colon
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8
Q

WHAT ARE THE DIFFERENTIAL DIAGNOSIS FOR COLORECTAL CANCER?

A

1) Haemorrhoids - PR bleed, altered bowel habits, weight loss but no abdominal pain
2) IBD - however younger age of onset

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9
Q

WHAT LABORATORY INVESTIGATIONS ARE THERE FOR COLORECTAL CANCER?

A

1) FBC (anaemia)
2) LFTs
3) Clotting factors
4) Carcinoembryonic antigen (CEA) - not diagnostic but monitors disease progression and treatment response.

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10
Q

WHAT LABORATORY IMAGING IS THERE THRERE FOR COLORECTAL CANCER?

A

1) Colonoscopy with biopsy
2) Flexible sigmoidoscopy - for fragile/ comorbid patients who can’t have 1
3) Staging investigations- CT scan (chest, pelvis, abdo) for distant metastasis and local invasion/ MRI rectum (rectal cancers).

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11
Q

WHAT STAGING SYSTEM IS USED FOR COLORECTAL CANCER?

A
  • Duke’s TNM staging
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12
Q

WHAT IS INVOLVED IN THE SURGICAL MANAGEMENT OF COLORECTAL CANCER?

A

Suitable regional colectomy (remove primary tumour with adequate margin and lymphatic drainage), followed by primary anastomosis (join 2 ends of healthy bowel) or stoma formation (divert stool away from surgical area).

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13
Q

WHAT IS A RIGHT HEMICOLECTOMY AND WHEN IS IT USED?

A
  • caecal or ascending colon tumours
  • Removal of right side of colon (caecum, ascending colon and proximal 2/3rd of transverse colon)
  • Ileocolic, right colic and right branch of middle colic vessels (branch of SMA) divided and removed with mesenteries
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14
Q

WHAT IS AN EXTENDED RIGHT HEMICOLECTOMY?

A
  • performed for any transverse colon tumours
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15
Q

WHAT IS A LEFT HEMICOLECTOMY AND WHEN IS IT USED?

A
  • descending colon tumours
  • removal of descending and sigmoid colon
  • Left branch of middle colic vessel, inferior mesenteric vein, left colic vessel divided and removed with mesentery
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16
Q

WHAT IS A SIGMOIDCOLECTOMY AND WHEN IS IT USED?

A
  • sigmoid colon tumours

- IMA fully dissected with tumour

17
Q

WHAT IS AN ANTERIOR RESECTION AND WHEN IS IT USED?

A
  • high rectal tumours
  • remove sigmoid colon and rectum
  • leaves rectal sphincter intact
18
Q

WHAT IS ABDOMINOPERINEAL RESECTION AND WHEN IS IT USED?

A
  • low rectal tumours
  • excision of sigmoid colon, rectum and anal sphincter
  • permanent colostomy
19
Q

WHAT IS HARTMANN’S PROCEDURE AND WHEN IS IT USED?

A
  • emergency bowel surgery such as perforation or obstruction

- complete resection of recto-sigmoid colon and formation of end colostomy and closure of rectal stump.

20
Q

WHAT ARE THE COMPLICATIONS OF THE SURGERY?

A

1) Adhesions leading to bowel obstruction
2) Hernia
3) Infection
4) Ileus - paralysis of bowel,
5) Anastomotic leak
6) Blood clots- DVT and PE

21
Q

WHAT DOES THE SMA SUPPLY?

A
  • organs of the midgut

- distal half of duodenum, ileum, caecum, ascending colon and proximal 2/3rd of transverse colon

22
Q

WHAT DOES THE MIDDLE COLIC ARTERY SUPPLY?

A
  • transverse colon
23
Q

WHAT DOES THE RIGHT COLIC ARTERY SUPPLY?

A
  • ascending colon
24
Q

WHAT DOES THE ILEOCOLIC ARTERY SUPPLY?

A
  • ascending colon, caecum, ileum, appendix
25
Q

WHAT DOES THE IMA SUPPLY AND ITS BRANCHES?

A
  • organs of the hindgut
  • distal 1/3rd of transverse colon, descending colon, sigmoid colon, rectum
  • Branches - left colic artery, sigmoid artery, superior rectal artery
26
Q

WHAT DOES THE LEFT COLIC ARTERY SUPPLY?

A
  • distal 1/3rd of transverse colon, descending colon
27
Q

WHAT DOES THE SIGMOID ARTERY SUPPLY?

A
  • descending and sigmoid colon
28
Q

WHAT DOES THE SUPERIOR RECTAL ARTERY SUPPLY?

A
  • rectum

GASTROINTESITNAL SYSTEM (19 decks)

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