Colorectal - UNFINISHED Flashcards
Colorectal cancer is the most common type of cancer in the UK
false
- third most common
Location of cancer (averages)
rectal: 40%
sigmoid: 30%
descending colon: 5%
transverse colon: 10%
ascending colon and caecum: 15%
Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 40 years with
unexplained weight loss AND abdominal pain
Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 50 years with
unexplained rectal bleeding
Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 60 years with
iron deficiency anaemia OR change in bowel habit
Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation includes tests showing
occult blood in their faeces
NHS screening program for colorectal cancer
every 2 years to all men and women aged 60 to 74 years. Patients aged over 74 years may request screening.
Faecal occult blood testing
most cancers develop from
adenomatous polyps
Screening for colorectal cancer has been shown to reduce mortality by 16%
true
colorectal cancer screening includes (specific tests)
the NHS offers home-based, Faecal Immunochemical Test (FIT) screening to older adults
another type of screening is also being rolled out - a one-off flexible sigmoidoscopy
Faecal Immunochemical Test (FIT) tests through the post
a type of faecal occult blood (FOB) test which uses
antibodies that specifically recognise human haemoglobin (Hb)
used to detect, and can quantify, the amount of human blood in a single stool sample
FIT advantages over conventional FOB tests includes
only detects human haemoglobin, as opposed to animal haemoglobin ingested through diet
only one faecal sample is needed compared to the 2-3 for conventional FOB tests
FIT patients with abnormal results are offered
colonoscopy
At colonoscopy, approximately:
5 out of 10 patients will have a normal exam
4 out of 10 patients will be found to have polyps which may be removed due to their premalignant potential
1 out of 10 patients will be found to have cancer
true
Flexible sigmoidoscopy screening aim
(other than to detect asymptomatic cancers) is to allow the detection and treatment of polyps, reducing the future risk of colorectal cancer
Flexible sigmoidoscopy screening this is being offered to people who are
55-years-old (one off)
Flexible sigmoidoscopy screening patients can self-refer for bowel screening with sigmoidoscopy up to the age of
60, if the offer of routine one-off screening at age 55 had not been taken up
An urgent referral (within 2 weeks) should be ‘considered’ if:
there is a rectal or abdominal mass
there is an unexplained anal mass or anal ulceration
patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
- → abdominal pain
- → change in bowel habit
- → weight loss
- → iron deficiency anaemia
Patients diagnosed as having colorectal cancer should be completely staged using
CT of the chest/ abdomen and pelvis.
Their entire colon should have been evaluated with colonoscopy or CT colonography.
Patients whose tumours lie below the peritoneal reflection should have which ix
mesorectum evaluated with MRI.
cancer - Once their staging is complete patients should be discussed within a dedicated colorectal MDT meeting and a treatment plan formulated.
true
Cancer of the colon is nearly always treated with surgery.
true
colorectal cancer palliative adjuncts. include?
Stents, surgical bypass and diversion stomas
option for cure in patients with colon cancer
Resectional surgery
The lymphatic drainage of the colon follows the arterial supply and therefore most resections are tailored around the resection of particular lymphatic chains (e.g. ileo-colic pedicle for right sided tumours)
true
tumour in a patient from a HNPCC family mx
panproctocolectomy
colorectal ca Following resection the decision has to be made regarding restoration of continuity. For an anastomosis to heal the key technical factors include
adequate blood supply, mucosal apposition and no tissue tension
may be safer to construct an end stoma rather than attempting an anastomosis.
When a colonic cancer presents with an obstructing lesion; the options are to
either stent it or resect
Following resection patients with risk factors for disease recurrence are usually offered
chemotherapy, a combination of 5FU and oxaliplatin is common.
Treatment of rectal cancer located in the rectum can be surgically resected with
either an anterior resection or an abdomino-perineal excision of rectum (APER).
Treatment of rectal cancer involvement of the sphincter complex or very low tumours require
abdomino-perineal excision of rectum (APER).
operating In the rectum a ?cm distal clearance margin is required
In the rectum a 2cm distal clearance margin is required
rectal cancer treatment and many patients will be offered neoadjuvent radiotherapy prior to surgery
true
Neoadjuvant therapy for rectal cancer relative to tumour staging:
Patients with T1 and 2 /N0 disease on imaging do not require irradiation and should proceed straight to surgery.
Patients with T4 disease will typically have long course chemo radiotherapy.
Those with T3 , N0 tumours may be offered short course radiotherapy prior to surgery.
rectal surgery is more technically demanding, the anastomotic leak rate is higher and the danger of a positive resection margin in an unstaged patient is high
true
e patients with obstructing rectal cancer should have a
defunctioning loop colostomy.
Caecal, ascending or proximal transverse colon resection and anastamosis
Right hemicolectomy
Ileo-colic
Distal transverse, descending colon resection and anastamosis
Left hemicolectomy Colo-colon
Sigmoid colon resection and anastamosis
High anterior resection Colo-rectal
Upper rectum resection and anastamosis
Anterior resection (TME) Colo-rectal
Low rectum resection and anastamosis
Anterior resection (Low TME) Colo-rectal (+/- Defunctioning stoma)
Anal verge resection and anastamosis
Abdomino-perineal excision of rectum
None
Diverticular disease is a common surgical problem. It consists of
herniation of colonic mucosa through the muscular wall of the colon
Diverticular disease usual site?
between the taenia coli where vessels pierce the muscle to supply the mucosa. For this reason, the rectum, which lacks taenia, is often spared.
Diverticular disease sx
Altered bowel habit
Bleeding
Abdominal pain
Diverticular disease complications
Diverticulitis Haemorrhage Development of fistula Perforation and faecal peritonitis Perforation and development of abscess Development of diverticular phlegmon
Diverticular disease Diagnosis
either a colonoscopy, CT cologram or barium enema
All tests can identify diverticular disease
Acutely unwell surgical patients should be investigated in a systematic way. Plain abdominal films and an erect chest x-ray will identify perforation. An abdominal CT scan (not a CT cologram) with oral and intravenous contrast
Diverticular disease classification
Hinchey
Describe Hinchey classification
I Para-colonic abscess
II Pelvic abscess
III Purulent peritonitis
IV Faecal peritonitis
Treatment Diverticular disease
Increase dietary fibre intake.
Mild attacks of diverticulitis may be managed conservatively with antibiotics.
Treatment Diverticular disease Recurrent episodes of acute diverticulitis
requiring hospitalisation are a relative indication for a segmental resection.
Treatment Diverticular disease Hinchey IV perforations
resection and usually a stoma.
This group have a very high risk of post operative complications
Less severe perforations may be managed by laparoscopic washout and drain insertion.
