Colorectal Tumours Flashcards
What are the risk factors for colorectal tumours?
- Increasing age
- Obesity
- Limited physical acitvity
- Poor fibre intake
- IBD (UC)
What genes are involved in colorectal tumours?
- HNPCC (Lynch syndrome): herediatary non-polyposis colorectal cancer
- FAP: famial adenomatous polyposis
- Peutz-Jegers syndrome
What is HNPCC?
- FHx of bowel cancer at very young age
- Symptomatic 30yo’s for example
- Colonoscopy: tumor without polyps (so not FAP)
How common is colon cancer?
- Most common cancer in western world
- 4th leading cause of death in US
Is there a screening programme for colonic cancer?
1 of 3 cancer screening programmes in UK: 60-74 every 2 years
What is the most common type of colonic cancer?
- Most common type: adenocarcinoma
- Mostly arise from dysplastic adomatous polyps
What at home test can be done for suspected colonic cancer?
- FIT test (antibodies to check human Hb in stool)
- One off flexible sigmoidoscopy
- Only one sample needed
What is classic epi for colonic cancer?
- Western countries
- Young
- M>F
What is classic presentation of colonic cancer?
- Change in bowel habits
- Rectal bleeding
- “mixed in the stool”
- Not bright red - Weight loss
- FLAWS
- Tenesmus
- Anemia symptoms
What may you find on examination of colonic cancer?
- Anaemia features
- Palpable mass
- Distention/ascites
- Lymphadenopathy
What type of anaemia is present in colonic cancer?
microcytic anaemia (iron deficiency)
What bloods are done in colonic cancer?
- FBC
- LFTs
- Renal function
What do you find on FBC and LFTs for colonic cancer?
anaemia and LFTs can show mets
What imaging is done for colonic tumour?
- Colonscopy and biopsy
- Double contrast Ba Enema
- Pre-op staging
What would you find on colonscopy and biopsy in colonic cancer?
- Visualisation of lesion
* Diagnostic (bx)
What would you find on double contrast Ba enema in colonic cancer?
“apple core lesion” – cancer causes stricturing
How may pre-op staging be done in colonic cancer?
CT Chest/Abdo/Pelvis (mets)
What cancer is marker is used for colonic cancer?
Carcinoembryonic antigen (CEA)
How is CEA used?
- 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.
What are possible DDx for colonic cancer?
- Irritable bowel syndrome (IBS)
- Ulcerative colitis
- Crohn’s disease
- Haemorrhoids
- Anal fissure
- Diverticular disease
What staging is used for colonic cancer?
TNM + Dukes
What is Duke’s A?
Tumour confined to the mucosa95%
What is Duke’s B?
Tumour invading bowel wall80%
What is Duke’s C?
Lymph node metastases65%
What are the possible complications of colorectal cancer?
- Bone Marrow suppression during chemo
- Oxaliplatin-associated hepatoxicity
- Chemotherapy-associated gastrointestinal toxicity (diarrhoea, nausea, vomiting, abdominal pain)
- Chemotherapy-associated alopecia
- Cetuximab-associated rash
- radiotherapy-associated faecal incontinence
- bladder dysfunction after rectal excision
- erectile dysfunction after rectal excision
- low anterior resection syndrome after anterior resection
- oxaliplatin-associated pulmonary fibrosis
- oxaliplatin-associated neuropathy
What is the 5 year survival rate for colorectal cancer?
- 93% to 97% for stage I disease
- 72% to 85% for stage II disease
3, 44% to 83% (depending on nodal involvement) for stage III disease - <8% for stage IV disease
What is Duke’s D?
Distant metastases5% (20% if resectable)
What is the management for colonic cancer>
surgical excision + adjuvant or neoadjuvant / radiotherapy
What is most commonly affected are?
rectal
What are common metastases sites?
liver lung, bone, brain
