Colorectal Carcinoma Flashcards
What are risk factors for colorectal carcinoma?
Genetic predisposiion FAB HNPCC - Lynch sydnrome Smoking Excess alcohol Ulcerative Colitis Crohn's Diet (low fibres, high red and processed meat) Previous cancer
Where are colorectal cancer most commonly located?
Mostly rectal and sigmoid
What are clinical features of left sided colorectal carcinoma?
Bleeding/mucus PR
Altered bowel habit or obstruction
Tenesmus
Mass PR
Abdominal mass
Perforation
Haemorrhage fistula
What are clinical features of right sided colorectal carcinoma?
Weight loss
Anaemia
Abdominal pain
Obstruction is LESS likely than left
Abdominal mass
Perforation
Haemorrhage
Fistula
What investigations in colorectal cancer?
Bloods:
FBC - microcytic anaemia
LFT
CEA to monitor disease and effectiveness of treatment
Imaging:
Colonoscopy or sigmoidoscopy
CT
Liver MRI/US
Faecal occult blood
How can colorectal cancer spread?
Local
Lymphatic
Blood - liver lung bone
Transcoelomic
How is colorectal cancer staged? Describe each.
Dukes:
Dukes A: limited to muscularis mucosae
Dukes B: extension through muscularis mucosae
Dukes C: Involvement of regional lymph nodes
D - distant mets
TNM:
CT- CAP
Who should be referred for 2WW?
Patentis >= 40 with unexplained weight loss and abdo pain
Patients >= 50 with unexplained rectal beleding
Patients >= 60 with IDA OR change in bowel habit and tests show occult blood in their faeces
Consider if:
rectal or abdo mass
Unexplained anal mass or anal ulceration
Rectal bleeding and abdo pain/change in bowel habit/weight loss/IDA
What is the screening programme for colorectal cancer?
60-74 (over 74 may request screening)
Every 2 years
Faecal occult blood test through post
Patients with abnormal results offered a colonoscopy
IF polyps are found, they may be removed due to premalignant potential
What management for caecal, ascending or proximal transverse colon cancer?
Right hemicolectomy
Ileo-colic anastamosis
What Mx for distal transverse or descending colon tumours?
Left hemicolectomy
Colo-colon anastamosis
What management for sigmoid tumours?
High anterior resection
This operation involves removing the sigmoid colon, which lies on the left side of your abdominal cavity (tummy), and the upper part of the rectum.
Colo-rectal anastamosis
What management for low sigmoid or upper rectal tumours?
Anterior resection
Colo-rectal anastamosis
What Mx for low rectum tumours?
Abdomino-perineal resection: Permanent colostomy and removal of rectum and anus
What management in bowel obstruction, perforation or palliation?
Hartmann’s procedure
Resection of sigmoid colon and end colostomy formed
