Colorectal Cancer Flashcards
What type of cancer is it, 95% of the time?
Where is the most common site?
Adenocarcinoma - the rest are lymphoma or squamous cell
Rectum - 25%
Sigmoid colon - 25%
Caecum next - 15%
What does TNM stand for?
What does the TNM staging refer to? - preferred classification
What about the Dukes’ classification? (ABCD)
Tumour, Node, Metastases
Depth - not size
A - confined to mucosa
B - through muscle
C - lymph nodes
D - distant mets
It is the 4th most common in the UK. What are the 1st, 2nd and 3rd?
Breast
Prostrate
Lung
S+S:
Main general symptom
Where may a mass be felt? - 2
PR bleeding with anaemia
Mass felt PR or abdominally
S+S for right-sided (up to hepatic flexure):
Main symptoms - 3
Why are you more likely to get obstruction with distal cancer?
Blood and mucus PR
Altered bowel habit (especially diarrhoea)
Tenesmus
Stool more more solid here and thus flow more easily blocked
S+S of left-sided (up to splenic flexure):
2 typical signs of bowel cancer
Where may you feel pain?
Weight loss
Anaemia
RIF pain
Risk factors mneumonic
DIAPERS MD
Diet - low in fibre - high in cured meats IBD Age - old - mean onset around 65 Polyps Ethanol - alcohol Relatives - FH Smoking
Male sex
DM and obesity
Risk factors:
There are also some genetic syndromes that are GI specific. Name a few.
Associated cancers which are a risk for CRC?
Hereditary non-polyposis colorectal cancer (HNPCC)
Familial adenomatous polyposis (FAP)
Small bowel
Endometrial
Breast
Ovarian
Screening and Prevention:
What age range is screened?
What is offered to everyone between that age range?
How many stool samples need to be sent within 2 wks?
How long does it take for results to get there?
How often is it repeated?
What can patients do after the max-age?
60-75
FOB - faecal occult blood
Flexible sigmoidoscopy
3 before they touch the water
2 wks
2 yrs
Request a test
Urgent referral criteria for those:
<55 yrs
> 55 yrs
2 other things that should be red flags
PR bleed
AND
Persistent (>6 wks) change in bowel habit towards diarrhoea (loose and frequent stools)
Either of above is sufficient (providing no other anal symptoms)
Palpable right abdo mass
Unexplained iron-deficiency anaemia in men or post-menopausal women
Investigations:
Bloods:
- Why do FBC?
- Why do U&E?
- Why do LFT?
GI:
- To look for blood
- Imaging of bowel - 1
Microcytic anaemia Baseline Liver mets as common site for mets ---- FOB Colonoscopy
Staging
What imaging is used to stage it? - don’t forget you also look for mets
What is an apple core lesion on double-contrast (air and contrast) barium enema and what does it suggest?
Contrast CT CAP
Short, sharply defined regions of annular colonic narrowing with overhanging margins; ulcerated mucosa; and eccentric, irregular lumen.
Can suggest cancer
Management:
General approach
Surgical resection +/- chemo or radiotherapy
Surgery:
What is a right hemicolectomy done for? - 2
What is a left hemicolectomy done for? - 2
What is a sigmoid colectomy done for? - 1
Caecal ascending colon tumours
Proximal transverse colon tumours
Sigmoid descending colon tumours
Distal transverse colon tumours
Sigmoid tumours
Surgery:
What is an anterior resection done for? - 2
What is an abdomino-perineal (AP) resection done for? What will happen as a result of it?
When is a Hartmann’s procedure done? - 3
Why is Hartmann’s not favoured?
Low sigmoid and high rectal tumours
Tumours low in the rectum
Permanent colostomy and removal of rectum and anus
As an emergency in bowel obstruction, perforation or palliation
It leaves a temporary colostomy and oversewn rectal stump from which secretions can still pass through anus
