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PPS - cancer > Staging investigations > Flashcards

Staging investigations Flashcards

1
Q

What is the major way in which colon cancer is diagnosed?

A

Following a colonoscopy

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2
Q

How long do colonoscopy biopsies take to come back?

A

72 hours

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3
Q

Why is staging a critical process?

A

Tells the biology of the tumour and whether patients will respond to treatment

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4
Q

What are key radiology techniques involved in colon cancer?

A

CT

MRI

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5
Q

Characteristics of CT scan

A

Key for colorectal cancer

Take images of chest, abdomen and pelvis

Take images of chest, abdomen and pelvis

Good test - good resolution but high radiation

Amount of radiation coming down as technology advances

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6
Q

Characteristics of MRI

A

Used less often

Only for rectal tumour

Image in pelvis is better in MRI due to boney skeletal structure surrounding the rectum

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7
Q

What are the two systems to stage a tumour?

A

TNM - Tumour-Nodes-Metastasis

The Duke’s system

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8
Q

Why is staging important?

A

Guides the types of treatment employed for the patient

Tells how advanced the tumour is, how it spreads and the biology of the tumour

Tells if the tumour will respond to treatment at hand

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9
Q

What is the TNM staging system?

A

Adapted for specificities of various cancers

Determine

  • How much the tumour has spread
  • If infected the lymph nodes
  • If spread to other organs
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10
Q

What are the different stages of TNM staging?

A

TX - Primary tumour cannot be assessed

T0 - No evidence of primary tumour

T1 - One layer, localised

T2 - Invade adjacent layers

T3 - Invaded up to the peritoneum

T4 - Invaded outside of the organ, beyond and distant

NX - Regional lymph nodes cannot be assessed

N0- No regional lymph nodes metastasis

N1 - Metastasis in 1-3 regional lymph nodes

N2 - Metastasis in 4 or more regional lymph nodes

MX - Distant metastasis cannot be assessed

M0 - No distant metastasis

M1 - Distant metastasis present

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11
Q

How is the TNM system important?

A

Determines treatment used

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12
Q

What is the Duke’s system?

A

Older

Usually also stated on staging reports

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13
Q

Staging in Duke’s system

A

Duke’s A - tumour in the epithelium

Duke’s B - tumour in the mucosa, submucosa and muscle

Duke’s C - tumour spread to the lymph nodes

Duke’s D - tumour spread far in the body. Invaded other organs.

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14
Q

Does biopsy indicate staging of cancer?

A

No information

Only tells us if it is cancer or not

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15
Q

What other investigations are needed to determine the stage of the cancer?

A

CT or PET scan

Tell about metastasis of nodes.

Sometimes nodes are indeterminate - approximation.

Fine detail of invasion of the layers by the cancer is normally approximated in radiology.

Once had idea and ruled out metastasis = surgery

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16
Q

Why is surgery necessary in colorectal abnormalities?

A

Needed regardless to improve symptoms

The cancer is resected out - sigmoid colectomy in sigmoid cancer

The lymph nodes in the mesentery are also taken

The samples taken out can be used to accurately determine the level of infiltration of the cancer into the mucosal walls as well as its invasion of the lymphoid system

17
Q

What is the only accurate way of staging colorectal cancer?

A

Accurate staging only happens after surgery

Based on this we can determine treatment methods

18
Q

What are the different radiological investigations that can be done during colorectal cancer treatments?

A

Staging CT

PET scans

Follow-up CT

MRI

Abdominal ultrasound and chest X-rays

19
Q

What is a staging CT?

A

Chest, abdomen and pelvis

Imaged to assses the etent of the tumour within the abdomen and for the presence of distant metastases

20
Q

What is a PET scan?

A

May be performed if the CT scan is ambiguous

21
Q

What is a follow-up CT?

A

Of chest, abdomen and pelvis

Typically carried out after surgery and or chemotherapy

22
Q

When is a MRI performed?

A

Specifically for rectal cancers

23
Q

When are abdominal ultrasounds and chest x-rays performed?

A

Used as staging investigations

24
Q

How are treatment options for a patient discussed?

A

At multidisciplinary team meeting

Working hub of how patients are managed

Bring prespectives together since so many disciplines are involved to decide treatment options

25
Q

What are the 3 steps of deciding treatment options for colorectal cancer sufferers?

A
  1. Diagnosis with an endoscope
  2. CT - reviewed in meeting. together with histopathologies
  3. Decisions - need more information? How do the bits tie together?
26
Q

What are ways to confirm the lymph nodes are positive for cancer?

A

Nodes are difficult to determine whether definitively positive for cancer using only size

PET scans

MRI - for rectal cancer

27
Q

Members of MDT meetings

A

Specialist team made of surgeons, physicians, oncologists, histopathologists, radiologists, nurses

Represent patient’s wishes

28
Q

How often do MDT meetings happen?

A

Meet once a week

29
Q

Characteristics of MDTs

A

Specific MDTs for different conditions

Meet once a week to discuss newly referred patients with suspected or confirmed colorectal cancer

Plans a treatment programme specific to individual patient needs

Treatment options are discussed with patients or their family at a subsequent appointment

30
Q

What are the advantages of MDTs?

A

Represent different opinions

Decisions are made in collegiate way

Things can be reviewed appropriately

Ensures mistakes are not made

Follow strict timeline

31
Q

What is a colectomy?

A

Surgical resection of the affected colon

Curative treatment in colorectal cancer

Aims to excise

  • the tumour with at least 5 cm clearance
  • the entire mesentery
  • the blood vessels supplying the tumour
32
Q

What happens if the cancer is located in the anal canal?

A

Requires removal of the entire rectum and anus

A permanent colostomy opening is made in the abdomen

33
Q

What is the margin for removal of the anal canal?

A

If the tumour allows for a 2 cm margin of clearance from the anal canal an anterior resection is possible

This prevents anal function

Tumours lower than this margin require abdominal perineal resection where the distal sigmoid, rectum and anus are all removed

Colostomy bag is required

34
Q

What is the role of clinical and medical oncologists?

A

Decide on the chemotherapy and/ or radiotherapy treatment to give the patient

35
Q

What is the difference between clinical and medical oncologists?

A

Clinical oncologists differ from medical oncologists in that they can also send a patient for adjuvant radiotherapy

May be used to treat rectal cancer

Not usually used to treat colon cancer

36
Q

What is a medical oncologist?

A

Specialises in the administration of systemic therapies

37
Q

What is a clinical oncologist?

A

Assesses the patient for radiotherapy and systemic therapies

38
Q

What are common chemotherapy drugs used for the treatment of colon cancer?

A

5-fluorouracil

Capecitabine

Oxaliplatin

Irinotecan

Tagefur-uracil

PPS - cancer (6 decks)

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