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4th year passmedicine by topic > Colorectal - UNFINISHED > Flashcards

Colorectal - UNFINISHED Flashcards

1
Q

Colorectal cancer is the most common type of cancer in the UK

A

false

- third most common

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2
Q

Location of cancer (averages)

A

rectal: 40%
sigmoid: 30%
descending colon: 5%
transverse colon: 10%
ascending colon and caecum: 15%

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3
Q

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

A

unexplained weight loss AND abdominal pain

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4
Q

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

A

unexplained rectal bleeding

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5
Q

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

A

iron deficiency anaemia OR change in bowel habit

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6
Q

Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation includes tests showing

A

occult blood in their faeces

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7
Q

NHS screening program for colorectal cancer

A

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

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8
Q

most cancers develop from

A

adenomatous polyps

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9
Q

Screening for colorectal cancer has been shown to reduce mortality by 16%

A

true

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10
Q

colorectal cancer screening includes (specific tests)

A

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

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11
Q

Faecal Immunochemical Test (FIT) tests through the post

a type of faecal occult blood (FOB) test which uses

A

antibodies that specifically recognise human haemoglobin (Hb)

used to detect, and can quantify, the amount of human blood in a single stool sample

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12
Q

FIT advantages over conventional FOB tests includes

A

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

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13
Q

FIT patients with abnormal results are offered

A

colonoscopy

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14
Q

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

A

true

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15
Q

Flexible sigmoidoscopy screening aim

A

(other than to detect asymptomatic cancers) is to allow the detection and treatment of polyps, reducing the future risk of colorectal cancer

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16
Q

Flexible sigmoidoscopy screening this is being offered to people who are

A

55-years-old (one off)

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17
Q

Flexible sigmoidoscopy screening patients can self-refer for bowel screening with sigmoidoscopy up to the age of

A

60, if the offer of routine one-off screening at age 55 had not been taken up

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18
Q

An urgent referral (within 2 weeks) should be ‘considered’ if:

A

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
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19
Q

Patients diagnosed as having colorectal cancer should be completely staged using

A

CT of the chest/ abdomen and pelvis.

Their entire colon should have been evaluated with colonoscopy or CT colonography.

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20
Q

Patients whose tumours lie below the peritoneal reflection should have which ix

A

mesorectum evaluated with MRI.

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21
Q

cancer - Once their staging is complete patients should be discussed within a dedicated colorectal MDT meeting and a treatment plan formulated.

A

true

22
Q

Cancer of the colon is nearly always treated with surgery.

A

true

23
Q

colorectal cancer palliative adjuncts. include?

A

Stents, surgical bypass and diversion stomas

24
Q

option for cure in patients with colon cancer

A

Resectional surgery

25
Q

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)

A

true

26
Q

tumour in a patient from a HNPCC family mx

A

panproctocolectomy

27
Q

colorectal ca Following resection the decision has to be made regarding restoration of continuity. For an anastomosis to heal the key technical factors include

A

adequate blood supply, mucosal apposition and no tissue tension

may be safer to construct an end stoma rather than attempting an anastomosis.

28
Q

When a colonic cancer presents with an obstructing lesion; the options are to

A

either stent it or resect

29
Q

Following resection patients with risk factors for disease recurrence are usually offered

A

chemotherapy, a combination of 5FU and oxaliplatin is common.

30
Q

Treatment of rectal cancer located in the rectum can be surgically resected with

A

either an anterior resection or an abdomino-perineal excision of rectum (APER).

31
Q

Treatment of rectal cancer involvement of the sphincter complex or very low tumours require

A

abdomino-perineal excision of rectum (APER).

32
Q

operating In the rectum a ?cm distal clearance margin is required

A

In the rectum a 2cm distal clearance margin is required

33
Q

rectal cancer treatment and many patients will be offered neoadjuvent radiotherapy prior to surgery

A

true

34
Q

Neoadjuvant therapy for rectal cancer relative to tumour staging:

A

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.

35
Q

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

A

true

36
Q

e patients with obstructing rectal cancer should have a

A

defunctioning loop colostomy.

37
Q

Caecal, ascending or proximal transverse colon resection and anastamosis

A

Right hemicolectomy

Ileo-colic

38
Q

Distal transverse, descending colon resection and anastamosis

A

Left hemicolectomy Colo-colon

39
Q

Sigmoid colon resection and anastamosis

A

High anterior resection Colo-rectal

40
Q

Upper rectum resection and anastamosis

A

Anterior resection (TME) Colo-rectal

41
Q

Low rectum resection and anastamosis

A 
Anterior resection (Low TME)	
Colo-rectal
(+/- Defunctioning stoma)
42
Q

Anal verge resection and anastamosis

A

Abdomino-perineal excision of rectum

None

43
Q

Diverticular disease is a common surgical problem. It consists of

A

herniation of colonic mucosa through the muscular wall of the colon

44
Q

Diverticular disease usual site?

A

between the taenia coli where vessels pierce the muscle to supply the mucosa. For this reason, the rectum, which lacks taenia, is often spared.

45
Q

Diverticular disease sx

A

Altered bowel habit
Bleeding
Abdominal pain

46
Q

Diverticular disease complications

A 
Diverticulitis
Haemorrhage
Development of fistula
Perforation and faecal peritonitis
Perforation and development of abscess
Development of diverticular phlegmon
47
Q

Diverticular disease Diagnosis

A

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

48
Q

Diverticular disease classification

A

Hinchey

49
Q

Describe Hinchey classification

A

I Para-colonic abscess
II Pelvic abscess
III Purulent peritonitis
IV Faecal peritonitis

50
Q

Treatment Diverticular disease

A

Increase dietary fibre intake.

Mild attacks of diverticulitis may be managed conservatively with antibiotics.

51
Q

Treatment Diverticular disease Recurrent episodes of acute diverticulitis

A

requiring hospitalisation are a relative indication for a segmental resection.

52
Q

Treatment Diverticular disease Hinchey IV perforations

A

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.

4th year passmedicine by topic (96 decks)

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