FN: Colorectal Carcinoma: Ix, Mx and Prevention

Question 1

Bloods show

Answer 1

FBC: Hb
LEFTs: mets
Tumour Marker: CEA (carcinoembryonic Ag)

Question 2

Imaging

Answer 2

CXR: lung mets
Us liver: mets
CT and MRI
-staging
- MRI best for rectal Ca and liver mets
Endoanal US: staging rectal tumuors
Ba/gastrogaffin enema: apple-core lesion

Question 3

endoscopy + biopsy

Answer 3

Flexi sig: 65% of tumours accessible

Colonoscopy

Question 4

Staging

Answer 4

Dukes (spread)

TNM

Question 5

Grading

Answer 5

Grading from low to high
Based on cell morphology
Dysplasia, mitotic index, hyperchromatism

Question 6

Management

Answer 6

1. Manage in an MDT
2. Confirmation of Dx
3. Stage with CT or MRI
4. 60% amenable to redical surgery

Question 7

Surgery

Answer 7

1. Use ERAS pathway
2. Pre-operative bowel prep (except R sided lesions)
3. Consent: discuss stomas
4. stoma nurse consult for siting

Question 8

Bowel prep type

Answer 8

Kleen prep (Macrogol: osmotic laxative) the day before and phosphate enema in the AM

Question 9

Principals

Answer 9

1. excision depends on lymphatic drainage which follows arterial supply
2. Mobility of bowel and blood supply at cut ends is also important
3. Hartmanns often used if obsruction
4. Laparoscopic approach is the standard of care

Question 10

Rectal Ca

Answer 10

1. Neo-adjuvant radiotherapy may be used to reduced local recurrence and increased in 5yrs
2. Anterior resection: tumour 4-5cm from anal verge: defunction with loop ileostomy
3. AP resection:

Question 11

Sigmoid tumours management

Answer 11

Sigmoid: high anterior resection or sigmoid colectomy

Question 12

Left tumour mx

Answer 12

Left hemicolectomy

Question 13

Transverse tumour mx

Answer 13

extended right hemicolectomy

Question 14

Caecal/right mx

Answer 14

Right hemicolectomy

Question 15

Other Rx

Answer 15

1. Local excision e.g. transanal endoscopic Microsurg
2. Bypass surgery: palliation
3. Hepatic resection: if single lobe mets only
4. Stentin: palliation or bridge to surgery in obstruction
5. Chemo

Question 16

chemo

Answer 16

Adjuvant 5-FU for DUkes C reduced mortality by 25% i.e. LN +ve pts

High grade tumour
Palliation of metastatic disease

Question 17

NHS Screening for CRC 2

Answer 17

FOB

Flexi Sig

Question 18

FOB Testing

Answer 18

1. Introducing in 2006
2. 60-75yrs
3. Home FOB testing every 2yrs - 1/50 have +ve FOB
4. Colonoscopy if +ve 1/10 have Ca
5. Lindholm et al BJS 2008 - screening reduces the risk of dying form CRC by 25%

Question 19

Flexi sig

Answer 19

Introduced in 2011/2012
55-60yrs
Once only flexi sig
Atkin et l Lancet 2010
1. reduced CRC incidence by 33%
2. reduced CRC mortality by 43%