Rectum

Question 1

epidemiology

Answer 1

60+
4th most common
decrease by 11% by 2035

Question 2

aetiology

Answer 2

high BMI
ulcerative colitis
high red meat consumption

Question 3

presentation

Answer 3

changes in bowel habits
blood/ mucus in stools
abdominal pain
physical lumps
fistula in vagina [LATE]
liver mets [LATE]

Question 4

what are the diagnosis steps

Answer 4

CT/MRI
coloscopy
biopsy
physical exam
surgery
endorectal ultrasound

Question 5

what are the type of spread

Answer 5

local, lymphatics, blood

Question 6

describe local spread

Answer 6

sigmoid colon, bladder, prostate, cervix

Question 7

describe lymphatics

Answer 7

iliac, inguinal, sacral

Question 8

describe the haematological spread

Answer 8

liver, lung, bone

Question 9

what is the patients choice of treatment dependent on

Answer 9

size and site

Question 10

what stage is for surgery alone

Answer 10

T1-T2, N0 M0

Question 11

when is pre-op RT or chemo RT found

Answer 11

for more extensive tumours

Question 12

what is patient prep

Answer 12

full bladder, pushes the bladder to minimise ulceration, pushes urinary bladder anteriorly out of the field.
oral laxative/ enema

Question 13

what treatment does NICE recommend

Answer 13

TMN (Total Mesorectal Excision), which includes surrounding lymph nodes, recurrence rates have fallen to 5%

Question 14

give the dose for pre-op RT

Answer 14

25Gy in 5 fractions, daily

Question 15

give the dose with concurrent chemo

Answer 15

45Gy in 25 (5.4Gy optional boost to smaller volume, therefore 50.4Gy in 28 fractions) - can also be given to chemo unfit patients

Question 16

what dose does elderly recieve

Answer 16

25 Gy in 5

Question 17

what is the post-op dose

Answer 17

60Gy in 2 weekly fractions followed by EBRT

Question 18

what is the radical, unfit for chemo

Answer 18

110Gy in 4 fractions, over 6 weeks (30Gy every 2 weeks x 3 + final boost of 20Gy)

Question 19

concurrent chemo agents

Answer 19

5-FU
cape
ARISTOLE

Question 20

why is chemo sometimes given become RT

Answer 20

makes the tumour more radiosensitive

Question 21

when is BT applicable

Answer 21

<3cm with no lymph spread
for no surgery patients

Question 22

what plan is used

Answer 22

VMAT: allows for less dose to normal tissues, reducing late effects

Question 23

what is the prognosis

Answer 23

53% survive for more than 10 years
survival has doubled in the last 40 years