Colorectal Tumours

Question 1

Risk factors for bowel cancer

Answer 1

• family history
• inflammatory bowel disease
• increased age
• diet (high red/processed meat, low fibre)
• obese, sedentary, smoking, alcohol
• familial adenomatous polyposis (FAP)
• hereditary nonpolyposis colorectal cancer (HNPCC)(Lynch syndrome)

Question 2

Familial adenomatous polyposis (FAP)

Answer 2

• autosomal dominant condition
• malfunctioning tumour suppressor genes
• > 100 polyps (100% chance of bowel cancer)
• panproctocolectomy is treatment

Question 3

Hereditary nonpolyposis colorectal cancer (HNPCC)

Answer 3

• also called Lynch Syndrome
• autosomal dominant condition
• mutations in DNA mismatch repair genes
• higher risk of colorectal cancer

Question 4

Cancers related to Lynch syndrome

Answer 4

1. Colorectal
2. Endometrial
3. Ovarian

Question 5

Bowel cancer presentation

Answer 5

• change in bowel habit
• unexplained weight loss
• rectal bleeding
• unexplained abdominal pain
• iron deficiency anaemia
• abdominal or rectal mass

Question 6

Referral criteria for urgent 2 week wait in suspected bowel cancer

Answer 6

• > 40yrs with abdo pain and unexplaimed weight loss
• > 50yrs with unexplained rectal bleeding
• > 60yrs with a change in bowel habit or iron deficiency anaemia

Question 7

Investigating bowel cancer

Answer 7

• colonoscopy
• sigmoidoscopy
• CT colonopgraphy
• staging CT scan
• CEA tumour marker

Question 8

Tumour marker in bowel cancer

Answer 8

Carcinoembryonic antigen (CEA)

Question 9

Classification system for bowel cancer

Answer 9

TNM staging
TX - unable to assess size
T1 - submucosa
T2 - involves muscularis propria
T3 - involves subserosa and serosa
T4 - spread through serosa (4a), reaching other tissues/organs (4b)

Question 10

Management options in bowel cancer

Answer 10

• surgical resection
• chemotherapy
• radiotherapy
• palliative care

Question 11

Surgical procedures for bowel cancer

Answer 11

• right hemicolectomy
• left hemicolectomy
• high anterior resection
• low anterior resection
• abdomino-perineal resection
• Hartmanns procedure

Question 12

Right hemicolectomy

Answer 12

removal caecum, ascending proximal transverse colon

Question 13

Left hemicolectomy

Answer 13

remove distal transverse and descending colon

Question 14

High anterior resection

Answer 14

remove sigmoid colon

Question 15

Low anterior resection

Answer 15

Remove sigmoid colon and upper rectum

Question 16

Abdomino-perineal resection

Answer 16

Remove rectum and anus and suturing anus

Question 17

Hartmanns’ procedure

Answer 17

emergency procedure that involves removing rectosigmoid colon and creating a colostomy. rectal stump is sutured closed.