Colorectal Cancer

Question 1

Most to least common site

Answer 1

Rectum/sigmoid
then right colon
then left and transverse colon

Question 2

Treatment modalities

Answer 2

Surgery - only curative option
Radiotherapy - sometimes curative in rectal cancer
Chemotherapy

Question 3

Elective Tx

Answer 3

Colon = surgery then chemo
Rectum = radiotherapy chosen over surgery, then chemo

Question 4

What is found on examination?

Answer 4

• palpable tumour mass
• hepatomegaly
• large rectal mass
• palpable lymph nodes

Question 5

Staging method

Answer 5

Duke’s

Question 6

Duke’s stages

Answer 6

T1N0M0/A = submucosa only
T2N0M/B1 = muscularis propria
T3N0M0/B2 = transmural extension
T2N1M0/C1 = T2, enlarged mesenteric nodes
T3N1M0/C2 = T3, enlarged mesenteric nodes
T4/C2 = Invasion of adjacent organs
AnyTM1/D = distant metastases present

Question 7

Define N0-2

Answer 7

N0 = no spread to lymph nodes
N1 = Cancer found in 1-3 lymph nodes
N2 = 4 or more

Question 8

Define Tis - T4

Answer 8

Tis = confined to innermost layer of colon or rectum
T1 = grown through first few layers of colon/rectum
T2 = grown into thick muscular layer of colon/rectum
T3 = grown through entire colon or rectum wall
T4 = through entire colon or rectum wall into nearby tissue or organs

Question 9

Surgical Resections R0-R2

Answer 9

R0 = no residual tumour following resection
R1 = microscopic residual tumour following surgery
R2 = macroscopic residual tumour at completion of surgery

Question 10

Ix

Answer 10

Colonoscopy/OGD with multiple biopsies = ulcerating lesion narrowing lumen
Barium enema = mass lesion in colon
CT Colongraphy = sensitive, ulcerating lesions narrowing lumen
CT thorax, abdo, pelvis = metastasis

Question 11

3 types of colonic cancer

Answer 11

Sporadic
Hereditary non-polyposis colorectal carcinoma
Familial adenomatous polyposis

Question 12

Hereditary non-polyposis colorectal carcinoma

Answer 12

Autosomal dominant
Mostly proximal colon
Also risk of endometrial cancer
MSH2 and MSH1 gene

Question 13

Amsterdam criteria

Answer 13

Hereditary non-polyposis colorectal carcinoma

• at least 3 family members with colon cancer
• span 2 generations at least
• 1 case at least diagnosed <50

Question 14

Familial Adenomatous Polyposis

Answer 14

Autosomal Dominant

Also risk of duodenal tumours

Question 15

Screening

Answer 15

Faecal Occult Blood Testing
Screen every 2 years to all men and women 60-74 years
If Over 74 can request screening

Question 16

Most common treatment

Answer 16

Nearly always surgical resection

Question 17

Rectal Cancer Tx

Answer 17

• surgical resection
  APER = abdo-perineal excision of rectum (if on anal verge)
  or
  Anterior resection (if upper/lower rectum)

Question 18

What is important to give post op?

Answer 18

Analgesia
Epidural
Accelerates return of normal bowel function

Question 19

Spouted Stomas

Answer 19

• small bowel stomas so irritant contents don’t contact skin

- colonic stomas do not need to be spouted as colonic contents less irritant

Question 20

Define gastrostomy

Answer 20

• epigastrum

- for feeding/gastric decompression

Question 21

Define loop jejunostomy

Answer 21

• very high output
• after emergency laparotomy with planned early closure
• any location

Question 22

Define percutaneous jejunostomy

Answer 22

• feeding
• proximal bowel
• LUQ

Question 23

Define loop ileostomy

Answer 23

• RIF

- defunctioned colon after rectal surgery

Question 24

Define end ileostomy

Answer 24

• RIF
• after excision of colon
• to defunction colon

Question 25

Define end colostomy

Answer 25

• colon diverted or resection and anastomosis not achievable

- LIF or RIF