im a cancer

Question 1

what is colorectal cancer

Answer 1

malignancy of the bowels 
can be low or high grade dysplasia first 
colorectal carcinoma 
95% are adenocarcinomas
2/3 are in the large intestine 
1/3 are in the rectum
Most arise from adenomas/polyps

Question 2

what are risk factors for CRC

Answer 2

Family history of bowel cancer
Familial adenomatous polyposis (FAP)
Hereditary nonpolyposis colorectal cancer (HNPCC), also known as Lynch syndrome
Inflammatory bowel disease (Crohn’s or ulcerative colitis)
Increased age
Diet (high in red and processed meat and low in fibre)
Obesity and sedentary lifestyle
Smoking
Alcohol

Question 3

how does CRC present

Answer 3

Change in bowel habit (usually to more loose and frequent stools)
Unexplained weight loss
Rectal bleeding
Unexplained abdominal pain
Iron deficiency anaemia (microcytic anaemia with low ferritin)
Abdominal or rectal mass on examination
can present acutely with obstruction if tumour blocks bowel - vomiting, abdominal pain and absolute constipation

Question 4

what investigations could you do for CRC

Answer 4

FIT test if 0ver 50 with unexplained weight loss and no other symptoms or under 60 with a change in bowel habit
colonoscopy (+ biopsy)
sigmoidoscopy if there is only rectal bleeding
CT colonography (has contrast)
CT for TNM staging
CEA tumour marker

Question 5

how would you manage colorectal cancer

Answer 5

discuss patients wishes 
surgical resection - may need stoma 
chemotherapy 
radiotherapy 
palliative care