Colorectal Cancer Flashcards
What is the most common site of Colorectal Cancer?
Rectum
Where does Colorectal Cancer most commonly metastasise to?
Liver
Give three syndromes associated with polyps
Familial Adenomatous Polyposis
Cowdens Syndrome
Peutz Jegher
What is Familial Adenomatous Polyposis?
Autosomal dominant mutation of APC gene resulting in >100 polyps
If left untreated they are likely to have cancer by the age of 40
What is HNPCC/Lynch Syndrome?
Autosomal dominant affecting DNA mismatch repair
Other than genetics, give four risk factors for Colorectal Cancer
IBD
Obesity
Smoking
Diabetes
Describe the pathophysiolgy of Colorectal Cancer
Almost always adenocarcinoma
Polyp to Adenoma to Adenocarcinoma (via progression)
How does Right Colon Cancer present?
Weight Loss
Anaemia
Occult bleeding
Mass in RIF
Wider lumen so more advanced at presentation
How does Left Colon Cancer present?
Colic pain
Rectal Bleeding
Bowel Obstruction
LIF mass
What are the two most common signs of Colorectal Cancer?
Rectal Bleeding
Change in Bowel Habit
Give three differentials for Colorectal Cancer
Diverticular Disease
IBD
Haemorrhoids
Who should receive a quantitative FIT test in Primary Care if no rectal bleeding?
> 50 with unexplained abdo pain OR weight loss
<60 with changes in bowel habit OR iron deficiency anaemia
60 with any anaemia (not IDA)
Who should be referred for 2ww for Colorectal Cancer?
> 40 with unexplained weight loss and abdominal pain
50 with unexplained rectal bleeding
60 with change in bowel habit/iron deficiency anaemia
What is the first line investigation for Colorectal Cancer in Secondary Care?
Colonoscopy (and biopsy for histology)
if comorbidities can use flexible sigmoidoscopy and barium enema
What is CEA used for?
Not useful in screening but can be used to predict relapse
Describe Duke’s Staging?
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
Describe the ‘T’ of TNM staging in Colorectal Cancer
T0 - Intraepithelial T1 - Invades submucosa T2 - Invades muscularis proproa T3 - Invades subserosa T4 - Invades other tissues
Describe the ‘N’ of TNM staging in Colorectal Cancer
N0 - No nodes
N1 - 1-3 regional nodes
N2 - 4 or more regional nodes
How can Colorectal Cancer be graded?
1 - Well Differentiated
2 - Moderately differentiated
3 - Poorly differentiated
Surgery is the mainstay of treatment for Colorectal Cancer. Describe the Pre-Op Management
- Site of tumour marked with ink via colonoscopy
- Full colonoscopy and barium air enema
- Preop Abx and VTE prophylaxis
Give 6 surgical options for Colorectal Cancer
- Right Hemicolectomy
- Left Hemicolectomy
- Sigmoid Colectomy
- Anterior Resection (low sigmoid/high rectum)
- AP Resection (<8cm from anal canal)
- Total Excision of Mesorectum
What stages of Colorectal Cancers have the greatest response to Chemotherapy?
Duke C with spread to nearby lymph nodes
Rectal
What is the first line chemotherapy regime?
FOLFOX (Folinic Acid, Fluorouracil, Oxaliplatin)
How is Advanced Colorectal Cancer managed?
FOLFOX
Describe the use of Radiotherapy for Colorectal Cancer
Generally limited to a palliative situation
For locally advanced rectal cancer
For liver metastases unsuitable for resection
What Biological agent can be used in Colorectal Cancer?
Cetuximab (Anti GFR)
How is Colorectal Cancer followed up after resection
6 monthly CT and CEA for 3 years
Colonoscopy one year after surgery
Give three early consequences of Colorectal Cancer treatment
Pain
Fatigue
Negative Body Image
Give three late consequences of Colorectal Cancer treatment
Leakage and Soiing
Waking at night for bowel movements
Urgency
