Colorectal Carcinoma Flashcards
What are some risk factors for colorectal cancer?
- Familial adenomatous polyposis
- Hereditary nonpolyposis colorectal cancer (Lynch syndrome) - More common
- Peutz-Jeghers syndrome
- IBD
- Increased age
- Obesity, smoking, diet
What are features of familial adenomatous polyposis?
Caused by a mutation in the APC gene. It is autosomal dominant.
Patient’s develop hundreds of polyps are are almost guarantied to develop cancer by their 20s. Also at risk of other cancers
What are some features of Lynch syndrome (HNPCC)
Autosomal dominant condition caused my mutation in mismatch repair genes MLH1. High risk of colon cancer by 30s and increased risk of other cancers. Managed with endoscopy survailence
What is Peutz-Jeghers syndrome?
Autosomal dominant condition caused by mutation in STK11 gene. Causes mucocutaneous pigmentation and hamartomatous polyps (which are at risk of developing into cancer)
What is MUTYH/MYH-associated polyposis?
Autosomal recessive condition causing polyposis
What are the signs and symptoms of colorectal cancer?
- Change in bowel habit (constipation or diarrhoea)
- Rectal bleeding
- Abdominal pain and discomfort
- Unexplained weight loss of loss of appetite
- Anaemia (unexplained iron def anaemia can be the only sign of right sided colorectal cancer)
- Bowel obstruction
- Appendicitis (CT anyone over 50 with appendicitis)
What are the investigations for suspected colorectal cancer?
- Bloods
- Colonoscopy/CT colonoscopy
- CT CAP scan for staging
- Genetic testing
- MRI for rectal cancers
What is the screening for colorectal cancer?
qFIT stool test every 2 years age 50-74 years old
Who should be referred via the urgent 2 week wait referral?
Age >40 with weight loss and abdo pain
Age > 50 with unexplained rectal bleeding
Age > 60 with iron def anaemia or change in bowel habit
Positive qFIT
Rectal/abdo mass
Patients < 50 with rectal bleeding AND abdo pain, change in bowe habit, weight loss or iron def anaemia
What is the treatment for colon cancer?
Resectional surgery (only curative option) with adjuvant chemotherapy
What is the treatment for rectal cancer?
Anterior resection for tumours >8cm away from anal canal /proximal 2/3rd of rectum
Abdomino-perineal resection for tumours <8cm away from anal canal.
+ Adjuvant chemotherapy (FOLFOX)/radiation
What is a right hemicolectomy?
Resection of caecal, ascenting or proximal transverse colon
What is a left hemicolectomy?
Resection of distal transverse or/and descending colon
What is a high anterior resection?
Sigmoid colon
What is an anterior resection?
Rescetion of upper or lower rectum
