Colorectal cancer - management

Question 1

What is the gold standard Ix?

Answer 1

Colonoscopy - may include biopsy

Question 2

Name two other imaging that can be used?

Answer 2

1. Barium enema - for diagnosis

2. CT scan for staging

Question 3

What is the tumor marker and when is it used?

Answer 3

Carcinomembryonic Antigen (CEA)

• tumor marker blood test for bowel cancer
• used to predict relapse
• not used for screening

Question 4

Describe the Duke’s classification?

Answer 4

1. Dukes A – confined to mucosa and part of the muscle of the bowel wall
2. Dukes B – extending through the muscle of the bowel wall
3. Dukes C – lymph node involvement
4. Dukes D – metastatic disease

Question 5

Treatment

Answer 5

1. surgical resection - hemiresection/

Question 6

TNM staging ( T1-4)

Answer 6

TX – unable to assess size
T1 – submucosal involvement
T2 – involvement of muscularis propria
T3 – involvement of the subserosa
T4 – spread directly to other tissues / peritoneum

Question 7

TNM staging (N0-2

Answer 7

NX – unable to assess nodes
N0 – no nodal spread
N1 – spread to 1-3 nodes
N2 – spread to >3 nodes

Question 8

TNM staging (M0-1)

Answer 8

M (metastasis)

M0 – no petastasis
M1 – metastasis