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Z Year3 Gastro Conditions > Colorectal Tumours > Flashcards

Colorectal Tumours Flashcards

1
Q

What are the risk factors for colorectal tumours?

A
  1. Increasing age
  2. Obesity
  3. Limited physical acitvity
  4. Poor fibre intake
  5. IBD (UC)
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2
Q

What genes are involved in colorectal tumours?

A
  1. HNPCC (Lynch syndrome): herediatary non-polyposis colorectal cancer
  2. FAP: famial adenomatous polyposis
  3. Peutz-Jegers syndrome
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3
Q

What is HNPCC?

A
  • FHx of bowel cancer at very young age
  • Symptomatic 30yo’s for example
  • Colonoscopy: tumor without polyps (so not FAP)
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4
Q

How common is colon cancer?

A
  • Most common cancer in western world

- 4th leading cause of death in US

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5
Q

Is there a screening programme for colonic cancer?

A

1 of 3 cancer screening programmes in UK: 60-74 every 2 years

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6
Q

What is the most common type of colonic cancer?

A
  • Most common type: adenocarcinoma

- Mostly arise from dysplastic adomatous polyps

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7
Q

What at home test can be done for suspected colonic cancer?

A
  1. FIT test (antibodies to check human Hb in stool)
  2. One off flexible sigmoidoscopy
  3. Only one sample needed
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8
Q

What is classic epi for colonic cancer?

A
  1. Western countries
  2. Young
  3. M>F
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9
Q

What is classic presentation of colonic cancer?

A
  1. Change in bowel habits
  2. Rectal bleeding
    - “mixed in the stool”
    - Not bright red
  3. Weight loss
  4. FLAWS
  5. Tenesmus
  6. Anemia symptoms
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10
Q

What may you find on examination of colonic cancer?

A
  1. Anaemia features
  2. Palpable mass
  3. Distention/ascites
  4. Lymphadenopathy
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11
Q

What type of anaemia is present in colonic cancer?

A

microcytic anaemia (iron deficiency)

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12
Q

What bloods are done in colonic cancer?

A
  1. FBC
  2. LFTs
  3. Renal function
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13
Q

What do you find on FBC and LFTs for colonic cancer?

A

anaemia and LFTs can show mets

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14
Q

What imaging is done for colonic tumour?

A
  1. Colonscopy and biopsy
  2. Double contrast Ba Enema
  3. Pre-op staging
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15
Q

What would you find on colonscopy and biopsy in colonic cancer?

A
  • Visualisation of lesion

* Diagnostic (bx)

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16
Q

What would you find on double contrast Ba enema in colonic cancer?

A

“apple core lesion” – cancer causes stricturing

17
Q

How may pre-op staging be done in colonic cancer?

A

CT Chest/Abdo/Pelvis (mets)

18
Q

What cancer is marker is used for colonic cancer?

A

Carcinoembryonic antigen (CEA)

19
Q

How is CEA used?

A
  • may be used to monitor for recurrence in patients post-operatively or to assess response to treatment in patients with metastatic disease
  • CEA tests can be used to assess other types of cancer, including: rectal cancer. lung cancer. breast cancer.
20
Q

What are possible DDx for colonic cancer?

A
  1. Irritable bowel syndrome (IBS)
  2. Ulcerative colitis
  3. Crohn’s disease
  4. Haemorrhoids
  5. Anal fissure
  6. Diverticular disease
21
Q

What staging is used for colonic cancer?

A

TNM + Dukes

22
Q

What is Duke’s A?

A

Tumour confined to the mucosa95%

23
Q

What is Duke’s B?

A

Tumour invading bowel wall80%

24
Q

What is Duke’s C?

A

Lymph node metastases65%

25
Q

What are the possible complications of colorectal cancer?

A
  1. Bone Marrow suppression during chemo
  2. Oxaliplatin-associated hepatoxicity
  3. Chemotherapy-associated gastrointestinal toxicity (diarrhoea, nausea, vomiting, abdominal pain)
  4. Chemotherapy-associated alopecia
  5. Cetuximab-associated rash
  6. radiotherapy-associated faecal incontinence
  7. bladder dysfunction after rectal excision
  8. erectile dysfunction after rectal excision
  9. low anterior resection syndrome after anterior resection
  10. oxaliplatin-associated pulmonary fibrosis
  11. oxaliplatin-associated neuropathy
26
Q

What is the 5 year survival rate for colorectal cancer?

A
  1. 93% to 97% for stage I disease
  2. 72% to 85% for stage II disease
    3, 44% to 83% (depending on nodal involvement) for stage III disease
  3. <8% for stage IV disease
27
Q

What is Duke’s D?

A

Distant metastases5% (20% if resectable)

28
Q

What is the management for colonic cancer>

A

surgical excision + adjuvant or neoadjuvant / radiotherapy

29
Q

What is most commonly affected are?

A

rectal

30
Q

What are common metastases sites?

A

liver lung, bone, brain

Z Year3 Gastro Conditions (48 decks)

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