Colorectal tumours Flashcards
Top prevalence of cancers
Breast
Prostate
Lung
Bowel
Risk factors
Family history of bowel cancer
Familial adenomatous polyposis
Hereditary nonpolyposis colorectal cancer (Lynch)
IBD
Increased age
High red and processed meat diet
Obesity and sedentary lifestyle
Smoking
Alcohol
Familial adenomatous polyposis
Autosomal dominant
Malfunctioning of tumour suppressor gene called adenomatous polyposis coli
Results in many polyps in large intestines
Polyps have potential to become cancerous
Remove entier large intestine
Hereditary nonpolyposis colorectal cancer
Lynch syndrome
Autosomal dominant
Mutations in DNA mismatch pair genes
Doesn’t cause adenomas, tumours develop in isolation
Presentation
Change in bowel habit
Unexplained weight loss
Rectal bleeding
Unexplained abdominal pain
Iron deficiency anaemia
Abdominal or rectal mass on examination
2 week wait referral
Over 40 with abdo pain and unexplained weight loss
Over 50 with unexplained rectal bleeding
Over 60 with a chnage in bowel habit or iron deficiency anaemia
FIT test
Looks for the amount of human haemoglobin in the stool
Used to assess for bowel cancer in patients who don’t meet 2 week wait referral
- over 50 with unexplained weight loss and no other symptoms
- under 60 with a change in bowel habits
Colonoscopy
Gold standard investigation
Endoscopy to visualise entire large bowel
Suspicious lesions can be biopsied to het histological diagnosis
Can tattoo in preparation for surgery
Sigmoidoscopy
In cases where the only feature is rectal bleeding
Risk of missing cancers in other parts of the colon
CT colonography
CT scan with bowel prep and contrast to visualise colon in more detail
Considered in patients less fit for colonoscopy
Less detailed and doesn’t allow for biopsy
Staging CT scan
Full CT CAP
Used to look for metastasis and other cancers
Used after diagnosis of colorectal cancer or as part of initial workup in patients with vague symptoms
Carcinoembryonic antigen
Tumour marker blood test for bowel cancer
Used in predicting relapse in patients previously treated for bowel cancer
Right hemicolectomy
Removal of caecum, ascending and proximal transverse colon
Left hemicolectomy
Removal of distal transverse and descending colon
High anterior resection
Removal of sigmoid colon
Low anterior resection
Removal of sigmoid colon and upper rectum but sparing lower rectum and anus
Abdomino-perineal resection
Removal of rectum and anus (plus or minus sigmoid) and suturing over anus
Leaves patient with permanent colostomy
Hartmaan’s procedure
Usually emergency procedure to remove rectosigmoid colon and creation of colostomy
Rectal stump sutured closed
Colostomy may be permanent or reversed later
Indications for Hartmaan’s procedure
Acute obstruction by a tumour or significant diverticular disease
Complications following surgery
Bleeding, infection and pain
Damage to nerves, bladder, ureter or bowel
Post-operative ileus
Anaesthetic risks
Leakage or failure of the anastomosis
Requirement for a stoma
Failure to remove the tumour
Change in bowel habit
VTE
Incisional hernias
Intra-abdominal adhesions
Low anterior resection syndrome
Urgency and frequency of bowel movements
Faecal incontinence
Difficulty controlling flatulence
