Colorectal Cancer

Question 1

What is the most common site of Colorectal Cancer?

Answer 1

Rectum

Question 2

Where does Colorectal Cancer most commonly metastasise to?

Answer 2

Liver

Question 3

Give three syndromes associated with polyps

Answer 3

Familial Adenomatous Polyposis
Cowdens Syndrome
Peutz Jegher

Question 4

What is Familial Adenomatous Polyposis?

Answer 4

Autosomal dominant mutation of APC gene resulting in >100 polyps
If left untreated they are likely to have cancer by the age of 40

Question 5

What is HNPCC/Lynch Syndrome?

Answer 5

Autosomal dominant affecting DNA mismatch repair

Question 6

Other than genetics, give four risk factors for Colorectal Cancer

Answer 6

IBD
Obesity
Smoking
Diabetes

Question 7

Describe the pathophysiolgy of Colorectal Cancer

Answer 7

Almost always adenocarcinoma

Polyp to Adenoma to Adenocarcinoma (via progression)

Question 8

How does Right Colon Cancer present?

Answer 8

Weight Loss
Anaemia
Occult bleeding
Mass in RIF

Wider lumen so more advanced at presentation

Question 9

How does Left Colon Cancer present?

Answer 9

Colic pain
Rectal Bleeding
Bowel Obstruction
LIF mass

Question 10

What are the two most common signs of Colorectal Cancer?

Answer 10

Rectal Bleeding

Change in Bowel Habit

Question 11

Give three differentials for Colorectal Cancer

Answer 11

Diverticular Disease
IBD
Haemorrhoids

Question 12

Who should receive a quantitative FIT test in Primary Care if no rectal bleeding?

Answer 12

> 50 with unexplained abdo pain OR weight loss
<60 with changes in bowel habit OR iron deficiency anaemia
60 with any anaemia (not IDA)

Question 13

Who should be referred for 2ww for Colorectal Cancer?

Answer 13

> 40 with unexplained weight loss and abdominal pain
50 with unexplained rectal bleeding
60 with change in bowel habit/iron deficiency anaemia

Question 14

What is the first line investigation for Colorectal Cancer in Secondary Care?

Answer 14

Colonoscopy (and biopsy for histology)

if comorbidities can use flexible sigmoidoscopy and barium enema

Question 15

What is CEA used for?

Answer 15

Not useful in screening but can be used to predict relapse

Question 16

Describe Duke’s Staging?

Answer 16

A - Cancer in innermost bowel lining
B - Grown through muscle layer
C - Spread to atleast one lymph node close to bowel
D - Metastasised to other areas

Question 17

Describe the ‘T’ of TNM staging in Colorectal Cancer

Answer 17

T0 - Intraepithelial
T1 - Invades submucosa
T2 - Invades muscularis proproa
T3 - Invades subserosa
T4 - Invades other tissues

Question 18

Describe the ‘N’ of TNM staging in Colorectal Cancer

Answer 18

N0 - No nodes
N1 - 1-3 regional nodes
N2 - 4 or more regional nodes

Question 19

How can Colorectal Cancer be graded?

Answer 19

1 - Well Differentiated
2 - Moderately differentiated
3 - Poorly differentiated

Question 20

Surgery is the mainstay of treatment for Colorectal Cancer. Describe the Pre-Op Management

Answer 20

• Site of tumour marked with ink via colonoscopy
• Full colonoscopy and barium air enema
• Preop Abx and VTE prophylaxis

Question 21

Give 6 surgical options for Colorectal Cancer

Answer 21

• Right Hemicolectomy
• Left Hemicolectomy
• Sigmoid Colectomy
• Anterior Resection (low sigmoid/high rectum)
• AP Resection (<8cm from anal canal)
• Total Excision of Mesorectum

Question 22

What stages of Colorectal Cancers have the greatest response to Chemotherapy?

Answer 22

Duke C with spread to nearby lymph nodes

Rectal

Question 23

What is the first line chemotherapy regime?

Answer 23

FOLFOX (Folinic Acid, Fluorouracil, Oxaliplatin)

Question 24

How is Advanced Colorectal Cancer managed?

Answer 24

FOLFOX

Question 25

Describe the use of Radiotherapy for Colorectal Cancer

Answer 25

Generally limited to a palliative situation
For locally advanced rectal cancer
For liver metastases unsuitable for resection

Question 26

What Biological agent can be used in Colorectal Cancer?

Answer 26

Cetuximab (Anti GFR)

Question 27

How is Colorectal Cancer followed up after resection

Answer 27

6 monthly CT and CEA for 3 years

Colonoscopy one year after surgery

Question 28

Give three early consequences of Colorectal Cancer treatment

Answer 28

Pain
Fatigue
Negative Body Image

Question 29

Give three late consequences of Colorectal Cancer treatment

Answer 29

Leakage and Soiing
Waking at night for bowel movements
Urgency