Investigations

Question 1

What is the Dukes’ staging of bowel cancer?

Answer 1

• Dukes’ A: cancer is only in the mucosal lining of the colon or rectum or slightly growing into the muscle layer
• Dukes’ B1: cancer has grown through muscularis propria
• Dukes’ B2: tumour growth through muscularis propria and serosa (full thickness)
• Dukes’ C1: tumour spread to 1-4 regional lymph nodes
• Dukes’ C2: tumour spread to more than 4 regional lymph nodes
• Dukes’ D: distant metastasis (liver, lung, bone)

Question 2

How is diverticular disease diagnosed?

Answer 2

• Colonoscopy

- CT abdomen - identify extent and complications

Question 3

What investigations would be done for acute abdomen?

Answer 3

• FBC
• U+E, LFT
• CRP
• Serum amylase
• Serum glucose
• ABG including lactate
• Pregnancy test
• Urine dip
• CXR + AXR
• CT

Question 4

What are the features of a groin hernia?

Answer 4

• Single lump in groin region
• Positive cough impulse (unless incarcerated)
• Soft on palpation
• Reducible
• Unable to get above lump during palpation
• Painless
• Bowel sounds on auscultation

Question 5

When should inherited colorectal cancer suspects be referred to on a 2 week wait?

Answer 5

• 2 1st degree relatives with colorectal cancer at average age <60 yrs OR
• If criteria for autosomal dominant colorectal cancer syndrome is met

Question 6

What are the tests for colorectal cancer?

Answer 6

• FBC (microcytic anaemia)
• Faecal occult blood
• Sigmoidoscopy or colonoscopy (CT)
• LFT
• MRI/US