L28: Diverticular Disease + Colorectal Cancer Flashcards
What is the most common type of colorectal cancer?
Adenocarcinoma
List the 4 macroscopic types of colorectal cancer
- Fungating Polypoid Tumour
- Annular Constricting Tumour
- Flat Ulcerated
- Mucinous
List the common tumour sites of colorectal cancer for most common to least
- Descending + Sigmoid
- Rectum
- Right-Sided
- Transverse
What is the most common site for colorectal cancer?
descending + sigmoid colon
What is CEA and what is it used for?
Carcinoembryonic Antigen
- used to monitor colorectal cancer + if treatment is working
What is the gold standard investigation to diagnose colorectal cancer?
Endoscopy
Which classification system is used to rate the severity of colorectal cancer? (hint: not TNM)
Dukes’ Classification
What is Dukes’ Classification?
used to rate severity of colorectal cancer + gives prognosis
What does Dukes A classification mean?
CRC confined to bowel wall
What does Dukes B classification mean?
CRC invades through muscularis propria
What does Dukes C classification mean?
CRC invaded regional lymph nodes
What does Dukes D classification mean?
CRC has distant mets
When is a right hemicolectomy done?
for right-sided CRC tumours
When is a left hemicolectomy done?
for left-sided CRC tumours
If there is CRC as well as positive lymph nodes and evidence of vascular invasion, what adjuvant therapy may be given?
adjuvant chemotherapy
If there is a rectal tumour in the upper 1/3 of the rectum, what surgery may be done?
a high anterior resection
If there is a rectal tumour in the middle and lower 1/3 of the rectum, what surgery may be done?
a low anterior resection
abdomino-perineal resection (APR)
- removes anus, rectum + sigmoid colon
If a kit test for faecal occult blood is positive, what should be done?
- kit screens for occult blood in faeces
- screening for CRC
- pt referred for full colonoscopic evaluation
What is diverticular disease mainly caused by?
constipation + increased colonic pressure
Which part of the colon does diverticular disease predominantly affect?
the sigmoid colon
What are the 2 types of diverticular disease?
- Diverticulosis
2. Diverticulitis
What is diverticulosis?
- presence of outpouchings in colon
- asymptomatic
- incidental finding
What is diverticulitis?
- presence of outpouchings in colon
- has associated inflammation
List some of the symptoms and signs of diverticulitis
- fever
- lower inguinal fossa pain
- diarrhea/constipation
- bleeding
- nausea + vomiting
- tachycardia
- guarding of area
List some of the complications of diverticular disease
- inflammation (diverticulitis)
- bleeding
- perforation ± peritonitis
- obstruction
- fistula (e.g. colovesical/enterovesical)
- stricture formation
- pericolic or paracolic abscess
How is inflammation of a diverticula managed?
with antibiotics
What is the Hinchey Classification used for?
acute diverticulitis
- is used to describe perforations of the colon due to diverticulitis
- helps in determining treatment
What is Hinchey Classication 1A?
paracolic phlegmon
What is Hinchey Classification 1B?
pericolic/mesenteric abscess
What is Hinchey Classification 2?
diverticulitis w/ walled-off abscess
What is Hinchey Classification 3?
purulent peritonitis (perforated abscess cavity)
What is Hinchey Classification 4?
faeculent peritonitis
- indication for surgery
According to the Hinchey Classification, what is considered UNCOMPLICATED diverticulitis?
Hinchey 1, 2 and 3
According to the Hinchey Classification, what is considered COMPLICATED diverticulitis?
Hinchey 4
What is the main treatment for UNCOMPLICATED diverticulitis?
IV antibiotics
What is the main treatment for COMPLICATED diverticulitis?
surgery
In regards to diverticular disease, when may an End Colostomy (Hartmann’s Procedure) be done?
if complicated diverticulitis + a complication (such as perforation)
- otherwise, affected parts removed and rest of colon anastomosed together
