Staging and Treatment

Question 1

What is the Duke Criteria for CRC?

Answer 1

A - Confined to mucosa and part of the muscle of the bowel wall

B - Extending through the muscle of the bowel wall

C - Lymph node involvement

D - Metastatic disease

Question 2

What is the T stage of TNM 1-4?

Answer 2

T = size of tumour

o T1 = submucosal involvement

o T2 = involvement of muscularis propria

o T3 = involvement of the subserosa

o T4 = spread directly to other tissues/peritoneum

Question 3

What is the N stage of TNM 0-2?

Answer 3

N = lymph node involvement

o N0 = no lymph nodes containing cancer

o N1 = 1-3 lymph nodes

o N2 = cancer cells in 4+ lymph nodes

Question 4

What is the M stage of TNM 0-1?

Answer 4

M = metastases

o M0 = no metastasis

o M1 = metastasis

Question 5

How do you stage CRC?

Answer 5

• CT

- CXR if chest not included in CT

Question 6

What are the treatment options for CRC?

Answer 6

• Surgical resection
• Chemotherapy
• Radiotherapy
• Palliation

In combination

Question 7

What are the complications of CRC?

Answer 7

• Bleeding/infection/pain
• Damage to nerves, bladder, ureter or bowel
• Post op ileus
• Anaesthetic risks
• Conversion to open
• Anastomotic leak/failure
• Requirement for a stoma
• Failure to remove tumour
• DVT/PE
• Hernias
• Adhesions

Question 8

How do you follow up CRC?

Answer 8

CT TAP (Thorax, Abdomen, Pelvis)
o	1 and 2 yrs

Colonoscopy
o 1 and 5 yrs

CEA
o 6 monthly for 3 yrs

Question 9

What is a hemicolectomy?

Answer 9

• Right or left colon is removed

Question 10

What is an anterior resection?

Answer 10

• Part of the colon or rectum is removed via the anterior abdominal wall

Question 11

What is an abdomino-perineal resection?

Answer 11

• Pathology is in the lower rectum or anus
• After the pathology is excised there is not enough distal rectum and anus to be anastomosed onto, so the anus is excised completely, and the proximal resection margin is brought out through the anterior abdominal wall to form a permanent end colostomy

Question 12

What is an ileostomy?

Answer 12

• Connection of the ileum to the abdominal wall
• Often RIF
• Continuous effluent

Question 13

What is a colostomy?

Answer 13

• Connection of the colon to the abdominal wall
• Often LIF
• Periodic function

Question 14

What type of resection and anastomosis would caecal, ascending or proximal transverse colon get?

Answer 14

• Right hemicolectomy

- Ileo-colic

Question 15

What type of resection and anastomosis would distal transverse and descending colon get?

Answer 15

• Left hemicolectomy

- Colo-colon

Question 16

What type of resection and anastomosis would the sigmoid colon get?

Answer 16

• High anterior resection

- Colo-rectal

Question 17

What type of resection and anastomosis would the upper rectum get?

Answer 17

• Anterior resection

- Colo-rectal

Question 18

What type of resection and anastomosis would the low rectum get?

Answer 18

• Anterior resection

- Colo-rectal (+/- stoma)

Question 19

What type of resection and anastomosis would the anal verge get?

Answer 19

• Abdomino-perineal excision of rectum

- None