Colorectal tumours

Question 1

CR cancer: […] most common cancer in the UK. It is also the second most common cause of cancer death.

Answer 1

fourth

Question 2

Risk factors

Answer 2

Increasing age
Hereditary syndromes
Increased alcohol intake
Smoking tobacco
Processed meat
Obesity
Previous exposure to radiation
Inflammatory bowel disease

Question 3

Risk factors

Answer 3

Increasing age
Hereditary syndromes
Increased alcohol intake
Smoking tobacco
Processed meat
Obesity
Previous exposure to radiation
Inflammatory bowel disease

Question 4

Duke’s

Answer 4

A: limited to the bowel wall (i.e. not beyond the muscularis).
B: extending through the bowel wall (i.e. beyond the muscularis).
C: regional lymph node involvement.
D: distant metastases. It is important to learn the Duke’s staging for examinations.

Question 5

Screening
1. […] every […] years for men and women age […]. If positive patients are referred for […].

Answer 5

1. Faecal immunochemical test (FIT) 2 years, 60-74. colonoscopy.

Question 6

2ww referral
1. General principle
2. Aged > […] with unexplained […] AND […]
Aged > […] with […]
Aged > […] and over with any of:
- Iron–deficiency anaemia
- Changes in their bowel habit
Proven […] on testing (appointment within 2 weeks)
Rectal or abdominal mass
Aged […] with rectal bleeding AND any of the following unexplained symptoms:
- Abdominal pain
- Change in bowel habit
- Weight loss
- Iron-deficiency anaemia

Answer 6

1. unexplained rectal or abdominal mass is felt or there is any unexplained rectal bleeding

40, weight loss AND abdo pain

50, unexplained rectal bleeding

60

faecal occult blood

under 50

Question 7

Uses of Faecal Occult Blood Tests

Answer 7

Aged > 50 with either:
Unexplained abdominal pain
Unexplained weight loss weight loss
Aged > 60 with any form of anaemia
Aged under 60 with:
Changes in their bowel habit
Iron-deficiency anaemia

Question 8

Other features

Answer 8

tenesmus, change in stool form (thin, small stools) and abdominal distension.

Question 9

Emergency

Answer 9

Can present as large bowel obstruction

Question 10

Invx

Answer 10

1. Colonoscopy
   alt –> CT colonoscopy (no biopsy)

Question 11

Carcinoembryonic antigen (CEA)

Answer 11

not used as a diagnostic tool but can be used to monitor therapeutic response to interventions.

Question 12

Familial conditions related to colorectal cancer: Familial adenomatous polyposis (FAP) features

Answer 12

1. autosomal dominant
2. adenomatous polyps in their teens and are virtually guaranteed to develop colorectal cancer by their 20s, unless they undergo prophylactic proctocolectomy.

Question 12

Familial conditions related to colorectal cancer: Hereditary non-polyposis colorectal cancer (HNPCC)/Lynch syndrome
1. Genetics
2. inheritance pattern
3. Risk of developing CrC by 30

Answer 12

1. mutation in the mismatch repair genes MLH1/MSH2
2. autosomal dominant
3. 80%

Question 13

Familial conditions related to colorectal cancer: Peutz-Jeghers syndrome
1. Genetics
2. Inheritance pattern
3. Features

Answer 13

STK11 gene MUTATION
autosomal dominant
mucocutaneous pigmentaiton and hamartomatous polyps.