Colorectal Cancer

Question 1

most common type of colorectal cancer

Answer 1

adenocarcinoma

Question 2

where are the majority of cancers located

Answer 2

rectum / sigmoid colon (left side)

Question 3

genetic risk factors for colorectal cancer

Answer 3

familial adenomatous polyposis syndrome (FAP)

hereditary non-polyposis colorectal cancer (HNPCC)

Question 4

What is FAP

Answer 4

familial adenomatous polyposis

• autosomal dominant disorder of tumour suppressor APC gene
• many adenomatous polyps throughout the colon

Question 5

what is HNPCC

Answer 5

hereditary non-polyposis colorectal cancer

• autosomal dominant disorder of DNA mismatch repair system
• develop right sided carcinomas (usually most common sigmoid colon- left sided)
• no polyps

Question 6

risk factors for colorectal cancer

Answer 6

increasing age
family hx
IBD
low fibre diet
high processed meat intake
smoking + alcohol

Question 7

most common presenting symptom of colorectal cancer

Answer 7

change in bowel habit

Question 8

presentation of right sided cancers

Answer 8

often present late

• weight loss
• anaemia
• abdo pain

Question 9

presentation of left sided cancers

Answer 9

change in bowel habit
PR bleeding
tenesmus

Question 10

which patients should be referred for urgent investigation of suspected bowel cancer

Answer 10

1. > 40 with unexplained weight loss + abdo pain
2. > 50 with unexplained rectal bleeding
3. > 60 with iron deficiency anaemia / change in bowel habit
4. +ve occult blood screening test

Question 11

what colorectal cancer screening is offered in the UK

Answer 11

FIT test every 2 years for men + woman between 60-75

- detects blood in faeces

Question 12

gold standard investigation for diagnosing colorectal cancer

Answer 12

colonoscopy with biopsy

Question 13

tumour marker in colorectal cancer

Answer 13

CEA

- Used to monitor disease progression

Question 14

management of colorectal cancer

Answer 14

surgery if suitable + chemotherapy

Question 15

surgical procedure for tumour of the caecum or ascending colon

Answer 15

right hemicolectomy

- extended right hemicolectomy for tumours of transverse colon

Question 16

surgical procedure for tumour of descending colon

Answer 16

left hemicolectomy

Question 17

surgical procedure for tumour of sigmoid colon

Answer 17

sigmoidcolectomy

Question 18

when is an anterior resection done

Answer 18

tumours of low sigmoid colon or high rectum

Question 19

surgical procedure for tumour of low rectum

Answer 19

abdominoperoneal resection

• removes rectum + anus
• patient has permanent colostomy

Question 20

what is a primary anastomosis

Answer 20

reconnection of two sections of an organ following excision of diseased tissue

Question 21

what is a covering (defunctioning) loop ileostomy

Answer 21

temporary ileostomy created to protect an anastomosis

• left for 6-8 weeks to allow anastomosis to heal then reversed
• loop refers to both ends of the small intestine being brought onto the skin

Question 22

when is a hartmanns procedure done

Answer 22

emergency bowel surgery e.g. obstruction

• distal segment of colon is left in situ
• proximal segment brought onto skin as an end colostomy
• can be reversed at later date