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GI > Colorectal Carcinoma > Flashcards

Colorectal Carcinoma Flashcards

1
Q

What age group presents most often with colorectal carcinoma?

A

Over 60s (86% of presentations)

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2
Q

Lost the factors that may predispose you to colorectal carcinoma?

A

Neoplastic polyps, IBD, genes (eg FAP 100% and HNPCC 60%), low fibre+red meat diet, high alcohol consumption, smoking, previous cancer

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3
Q

What measure can be taken to help prevent cancer development?

A

Taking aspirin 75mg daily reduces incidence and mortality by inhibiting polyp formation

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4
Q

How would left sided colorectal carcinoma present?

A

Bleeding/mucus PR, altered bowel habit, obstruction, tenesmus, PR mass, abdo mass, perforation, haemorrhage, fistula

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5
Q

How would a right sided colorectal carcinoma present?

A

Weight loss, decreased haemoglobin, abdo pain, abdo mass, perforation, haemorrhage, fistula.

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6
Q

What are the 2 week referral criteria for lower GI malignancy?

A

Over 40 with bleeding and bowel habit change
Any age with a palpable abdo mass that’s unlikely to be bowel
Palpable rectal mass
Men or non menstruating women with Hb below 11/10
Any individual with UC

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7
Q

What investigations would you do?

A

FBC, faecal occult blood, sigmoidoscopy, barium enema, CEA (carcinoembryonic antigen), LFTs, liver USS, CT/MRI, colonoscopy (gold standard)

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8
Q

Where is colorectal cancer most likely to spread to?

A

Liver, lung, brain

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9
Q

How does colorectal cancer spread?

A

Via local invasion, blood, lymph, transcoelomic

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10
Q

When would you do a right hemicolectomy?

A

For caecal, ascending and proximal transverse tumours

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11
Q

When would you do a left hemi-colectomy?

A

Distal transverse and descending tumours

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12
Q

What operation would you do for a sigmoid tumour?

A

A sigmoid colectomy

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13
Q

When would you do an anterior resection?

A

In low sigmoid tumours and high rectal tumours

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14
Q

When would you do the anastamosis?

A

At the end of the first operation

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15
Q

When would you do an abdominal-perineal resection?

A

In rectal cancer

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16
Q

What is the problem with an AP resection?

A

Requires a per enact colostomy as patient will be incontinent

17
Q

If the bowel perforates what emergency surgical procedure is done?

A

Hartmann’s procedure

18
Q

The patient is unfit for major surgery and has a rectal tumour, what procedure would you do?

A

Transanal endoscopic microsurgery via protoscope

19
Q

What is the preferred method of conducting many of these procedures?

A

Laparoscopically

20
Q

What palliative procedure is done to relieve symptoms of obstruction/bowel habit change?

A

Endoscopic stenting

21
Q

When is radiotherapy used in colorectal cancer?

A

Mostly in palliative cases. (Sometimes pre-op rectal cancer or tumours with high recurrence rate)

22
Q

Is chemotherapy used?

A

Yes, it is used adjuvantly (decreases mortality by 25% in dukes stage C)

23
Q

What is the name of the chemotherapy regimen?

A

FOLFOX (folinic acid and oxaliplatin) (anti angiogenics may also be added)

24
Q

What is the staging system used in colorectal cancer?

A

Dukes staging system

25
Q

List the stages and their meaning…

A

A: limited to muscularis mucosae
B: extension through muscularis mucosae
C: involvement of regional lymph nodes
D: distant metastases

26
Q

5 year survival for dukes stage A?

A

93%

27
Q

5 year survival for dukes stage D?

A

6.6%

28
Q

At what age to men get offered colorectal screenings?

A

60-75

29
Q

How is colorectal screening done?

A

Faecal occult home testing kits

30
Q

Where do most colorectal tumours develop?

A

Sigmoid colon and rectum

31
Q

What gene mutation causes normal cells to become hyper proliferative?

A

APC gene mutation

32
Q

Hyper proliferation leads to an early Adenocarcinoma, what mutation progresses it to an intermediate adenoma?

A

K ras mutation

33
Q

What mutation leads to an intermediate adenoma devolving into a late adenoma?

A

DCC mutation

34
Q

What mutation leads to the late adenoma finally becoming a carcinoma?

A

p53 tumour suppressor mutation

35
Q

Oncogenes are dominant, true or false?

A

True

36
Q

What type of cancer are the majority of colorectal carcinomas?

A

Adenocarcinoma

GI (10 decks)

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