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GI > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

Do more colonic cancers arise on the left or the right side?

A

More on the left

Only ~25% on the right

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2
Q

WHat pre-existing lesion in the colon can transform into colonic cancer?

A

pre-existing adenomatous polyps

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3
Q

How long does it take for polyps to transform into cancer?

A

Average 3-5 years

- can be up to 10

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4
Q

WHat increases a patient’s risk of getting colonic cancer?

A
  • Older age
  • Low intake of fibre
  • High intake of fat, sugar, alcohol, red meat, processed meats
  • Obesity
  • Smoking
  • Lack of physical exercise
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5
Q

WHat genetic mutations can predispose patients to bowel cancer?

A

Mutations in APC (adenomatous polyposis coli)
- 100% risk

OR Mutations of p53 gene

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6
Q

What pre-existing conditions can increase a patient’s risk of colon cancer?

A
  • Long standing IBD

UC > Crohn’s

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7
Q

How can bowel cancers spread?

A
  • Direct spread
  • Lymphatic spread
  • Blood borne spread
  • Transcoelomic spread (rare)
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8
Q

Where do bowel cancers commonly metastasise to?

A

Liver

Lung

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9
Q

Describe the Bowel Screening programme operated in the UK to pick up Bowel Cancer early

A

In Scotland – 50-72 years
In England 60-72

  • Every 2 years patient invited to give stool sample
  • If positive – offered colonoscopy
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10
Q

What symptoms usually indicate a left sided cancer?

A
  • Rectal bleeding
  • Feeling of incomplete emptying
  • Worsening constipation
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11
Q

What symptoms can indicate a right sided colon cancer?

A
  • Unexplained Iron deficiency anaemia
  • Persistent tiredness
  • change in bowel habit
  • weight loss
  • Abdominal pain (colicky in nature)
  • Lump in the abdomen
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12
Q

What investigations can be used in an attempt to diagnose a bowel cancer?

A 
Barium enema (widely abandoned)
Sigmoidoscopy  OR `colonoscopy
CT colonography
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13
Q

What happens after colon cancer is diagnosed?

A
  • Biopsy for Histology confirmation
  • Cancer staging (CT chest/abdo/pelvis)
  • MRI for rectal cancers
  • MDT
  • Surgery/ palliation
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14
Q

What percentage of colonic cancer is diagnosed at Stage I and II?

A

40%

therefore more are diagnosed at Stage 3 or above

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15
Q

If a tumour is found in the caecum, what type of surgery can remove the tumour?

A

Right Hemicolectomy

  • caecum to hepatic flexure removed
  • ileocolic anastomosis made
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16
Q

If a tumour is found on the RHS near the hepatic flexure, what type of surgery can be used to remove it?

A

Extended right hemicolectomy

  • Right colon and part of transverse colon removed
  • ileocolic anastomosis made
17
Q

If a tumour is found in the transverse colon only or the sigmoid colon only, how is it removed via surgery?

A

Transverse colectomy
- anastomosis made in transverse colon

Sigmoid colectomy
- anastomosis made in sigmoid colon

18
Q

If a tumour is found in the rectum, what are the two surgical options depending on its anatomical location?

A

Tumour in SUPERIOR rectum

  • anterior resection
  • small part of lower rectum remains to anastomose to colon

Tumour in INFERIOR rectum

  • anus resected, perianal skin closed
  • colostomy made
19
Q

After a tumour is removed during surgery, what staging criteria is used in Pathology?

A

Duke’s Staging

20
Q

After resection of colorectal cancer, what other treatment may a patient require?

A

Chemotherapy

Radiotherapy

21
Q

How are patients with colorectal cancer followed up?

A
  • CT
  • CEA (antigen to test how well Tx is working)
  • Colonoscopy
22
Q

What is involved in management of advanced colorectal cancer?

A
  • Cancer resection + chemo
  • May also need liver + lung resection
  • HIPEC ( hyperemic intraperitoneal chemotherapy) for mesothelioma, pseudomyxoma peritonei and peritoneal metastasis
23
Q

What is involved in palliation for colorectal cancer?

A
  • Stenting
  • Palliative radio/chemotherapy
  • bypass

GI (33 decks)

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