Colorectal disease Flashcards
What is colorectal polyps?
Small growths or projections on the lining of the large intestine (colon).
These polyps may be benign, pre-cancerous, or cancerous.
How is colorectal polyps diagnosed?
Colonoscopy with biopsy/excision of polyp
IVx -colorectal cancer to see if the polyp is cancerous
Presentation of colorectal polyps?
- usually asymptomatic
- rectal bleeding
- bright red blood if polyp is further down the colon tract
- melaena if polyp is further up the colon tract as blood had time to coagulate
- mucus discharge (signs of inflammation)
- tenesmus (the feeling that you need to pass stools, even though your bowels are already empty)
- change in bowel habits
How are adenomatous polyps classified?
Adenomatous polyps can be further classified by shape:
- tubular
- serrated
- tubulovillous
- villous
What is familial adenomatous polyposis (FAP) syndrome?
It is an autosomal dominant and these pts develop 100-1000s of colorectal adenomas and are at a high risk of developing colorectal cancer.
Management of colorectal polyps?
Adenomatous polyps
- small chance of becoming malignant
- so endoscopical removalof polyp
- monitoring
Hyperplastic or metaplastic polyps
- no action required
Familial adenomatous polyposis syndrome
- colectomy (due to risk of colorectal cancer)
What is colorectal cancer?
Adenocarcinomas that develop in the colon from dysplastic adenomatous polyps.
Starts of as a polyp, then undergoes some pre-cancerous changes, then leads to malignancy and can become invasive.
Risk factors of colorectal cancer?
- increasing age (99% case >age 40; 85% case >age 60)
- genetic -familial polyposis syndrome
- FHx
- IBD -ulcerative colitis
- obesity
- moderate/heavy alcohol consumption
- smoking
- diet low in fruits and vegetables
When do you refer pts if suspecting colorectal cancer? Diagnosis and investigations?
Colonoscopy with biopsies
Faeacal immunochemical test (FIT test)
Urgent 2ww referral:
- positive faecal occult blood test (checks for blood/haemoglobin in the stool)
AND
- Age ≥40 with unexplained weight loss and abdominal pain
- Age ≥50 with unexplained rectal bleeding
- Age ≥60 with:
- iron deficiency anaemia or change in bowel habit
Urgent 2ww referral:
- abdominal or rectal mass
Urgent 2ww referral:
- age <50 with rectal bleeding and any of the following:
- abdominal pain
- change in bowel habit
- wt loss
- iron-deficiency
When is FIT test indicated?
Indicated for anyone with:
- Abdominal mass
- Change in bowel habit
- Iron-deficiency anaemia
- Age ≥40 with unexplained weight loss and abdominal pain
- Age <50 with rectal bleeding and either abdominal pain or weight loss
- Age ≥50 with rectal bleeding, abdominal pain or weight loss
- Age ≥60 with any anaemia
What do you do if the FIT test comes back positive or negative?
Positive, then refer under 2ww rule for a colonoscopy.
Negative but the pt still has unexplained symptoms and signs of possible malignancy, then refer to colorectal specialist.
How does colorectal cancer present?
- change in bowel habit (commonly increased frequency of loose stools)
- rectal bleeding
- abdominal pain, distention
- abdominal or rectal mass
- unexplained wt loss
- reduced appetite
- unexplained fever
- signs of anaemia (conjunctival pallor)
- palpable lymph nodes
How is colorectal cancer treated?
- Surgical resection
- Chemoradiotherapy
- Chemotherapy
What is the NHS Bowel Cancer Screening Programme?
Pt provides a stool sample, which is then sent to the lab to perform a FIT test.
Positive FIT test -colonoscopy offered, which aims to look for polyps and take biopsies to find out if they are cancerous.
FIT test done every 2 years to those age 60-74 or 50-74.
If pt has FHx of colorectal cancer, begin screening at age 50.
