Colorectal tumours

Question 1

where does colorectal cancer arise from

Answer 1

epithelial lining of colon or rectum

Question 2

What is the prevelance of colorectal cancer

Answer 2

3rd most common in the world

Question 3

What is the most common type of colorectal cancer

Answer 3

adenocarcinoma

Question 4

What are the genes associated with colorectal cancer

Answer 4

-HNPCC ( lynch syndrome)
Family history of bowel cancer at young age
tumour without polyps on colonoscopy

-FAP

-Peutz-Jeghers syndrome

Question 5

What symptoms does a patient get

Answer 5

Change in bowel habits
rectal bleeding – not bright red
weight loss
tenesmus
anaemia
palpable mass, distension,ascites,lymphadenopathy

past medical history , family history

Question 6

What may physical examination show

Answer 6

abdominal tenderness
palpable masses
sign of metastatic disease– jaundice/ascites

Question 7

What things indicated a 2 week wait referral urgent colonoscopy

Answer 7

• over 40 years with unexplained weight loss and abdominal pain

-over 50 years with unexplained rectal bleeding

-less than 60 years with iron deficiency anemia or change in bowel habit

Question 8

What investigations are used

Answer 8

-Colonoscopy with biopsy is gold standard for diagnosis and can also be used for screening

-Imaging studies such as CT,PET and MRI

• abdominal /chest radiograph

-Blood tests such as CEA and CA 19-9 may be elevated in colorectal cancer but not specific
FBC- anemia
LFTs- metastatic

• Double contrast barium enema- but contraindicated in patients who are at risk of perforation

Question 9

What is used to stage the cancer

Answer 9

Dukes staging

Question 10

What is the management for colorectal cancer

Answer 10

choice of treatment depends on stage, patients health , comorbidities

Surgical resection is typically the mainstay of treatment for early stage disease -

chemo and radio used for more advanced disease

regional colectomy with stoma

adjuvant chemo

palliative care

Question 11

What are some common metastases sites

Answer 11

Liver, lung , bone,brain

Question 12

What are some risk factors

Answer 12

older age
black race
personal history of polyps
IBD
low fiber, high fat diet
diabetes
obesity

Question 13

What complications can colorectal cancer lead ro

Answer 13

large bowel obstruction

Question 14

Is ultrasound helpful in presence of bowel obstruction

Answer 14

no because the presence of the gas will degrade the images

Question 15

What is Dukes staging

Answer 15

Dukes A- tumour confined to bowel wall

Dukes B - tumour has gone through wall not nodes

Dukes C - tumour involves regional nodes

Dukes D- distant metastases present