Colorectal carcinoma

Question 1

What are risk factors for colorectal carcinoma?

Answer 1

Polyps 
Inherited cancer syndromes
smoking
diet
IBD
increasing age
male

Question 2

What is HNPCC?

Answer 2

AD condition due to mutations in DNA mismatch repair genes (MSH2, MLH1) causing polyps. Also endometrial cancer.

Question 3

What is FAP

Answer 3

AD condition due to mutation in TSG APC. Total colectomy with ileo-anal pouch in their twenties.

Question 4

What is classification of colorectal carcinoma?

Answer 4

Dukes critera
1 = beneath muscularis proprira
2 = extension through muscularis propris
3 = involvement of regional lymph nodes
4 = distant mets

Question 5

What are Sx of colorectal carcinoma?

Answer 5

PR bleeding
Weight loss
Change in bowel habits
Abdominal pain

R side: less Sx, maybe a mass

L side: tenesmus, mass

If perforation, Sx of large bowel obstruction

Question 6

What criteria should prompt urgent investigation of suspected bowel carcinoma?

Answer 6

> 40 with weight loss + abdo pain
50 with rectal bleeding
60 year IDA or change in bowel habit
positive FOB

Any >55 with IDA should get colonosopy

Question 7

What are DDx for colorectal carcinoma?

Answer 7

IBD
Haemorrhoids
Other cancer
Diverticulitis

Question 8

What Ix in colorectal cancer?

Answer 8

Bloods: FBC show IDA
CEA is a tumour marker which can monitor progression and relapse

Colonoscopy with biopsy needed for diagnosis

For staging, do CTCAP, if rectal do rectal MRI of TRUS

Question 9

What is Rx of colorectal cancer?

Answer 9

Surgery: removal of tumour and draining lymph nodes, with anastamosis

Location will depend on tumour

Neoadjuvant chemo

Question 10

What Rx for caecal/ascending colon tumours

Answer 10

Right hemicolectomy with ileo-colic anastamosis

Question 11

What Rx for descending colon tumours

Answer 11

Left hemicolectomy with colo-colon anastamosis

Question 12

What Rx for rectal tumours?

Answer 12

if high, anterior resection with colorectal anastamosis

if low, abdominoperineal resection with colorectal anastamosis or defunctioning stoma

Question 13

What is bowel cancer screening programme?

Answer 13

Every 2 years people aged 50-75, sent FIT test

Question 14

What are complications of colorectal carcinoma?

Answer 14

Anastamotic leak: presents as fever, pain, tachycardia, needing laparotomy and maybe stoma formation. Fluids, analgesia, antibiotics.

Ischaemia

Death