[Surgery] Colorectal Cancer Flashcards
what are the modifiable risk factors for colorectal cancer?
- smoking
- red meat consumption
- low fibre diet
what are the non-modifiable risk factors for colorectal cancer?
- male
- age
- FHx
- IBD
what are the genetic risk factors for colorectal cancer?
- FAP
- HNPCC (Lynch syndrome)
- Peutz-Jehgers syndrome
what is the 1st line ix for colorectal cancer?
colonoscopy
what is needed once a Dx of colorectal cancer is made?
staging CT thorax and referral for resection
what is used for staging in rectal cancer?
MRI
how to pts with colorectal cancer present?
- change in bowel habit
- palpable mass
- iron deficiency anaemia
- PR bleeds (clots or fresh)
- acute (obstruction or perforation)
what does T1 mean in TMN staging?
T1 = no muscular involvement
what does T2 mean in TMN staging?
T2 = involves muscularis propria
what does T3 mean in TMN staging?
T3 = involves serosa / adventitia
what does T4 mean in TMN staging?
T4 = invades local structures
how do you treat T1-3 stage colon cancer?
colonic resection
how do you treat T4 stage (locally advanced) colon cancer?
neoadjuvant treatment
for T1-3 stage colon cancer, once colonic resection is done and it shows T3+ or nodal disease, what is the next step in mx?
adjuvant chemotherapy
how do you treat T1-T2N0M0 stage rectal cancer?
transanal excision
how do you treat T3-4 stage rectal cancer?
neoadjuvant treatment → colonic resection → T3+ or nodal disease → adjuvant chemotherapy
in the UK, who is bowel screening offered to?
everyone age 60-74
what is used in bowel screening?
1 stool sample (FIT) or several smears (FOB)
if abnormal → colonoscopy
what is the resection done for tumours in: proximal colon to the hindgut?
right hemicolectomy*
*can be extended to reach transverse colon tumours
what is the resection done for tumours in: left colon up to sigmoid?
left hemicolectomy*
*can be extended to reach transverse colon tumours
what is the resection done for tumours in: sigmoid?
sigmoid colectomy / Hartmann’s (in emergencies)
what is the resection done for tumours in: rectal tumours >5cm from anal verge?
anterior resection
what is the resection done for tumours in: rectal tumours <5cm from anal verge?
abdomino-perineal resection (APR)
what is resected in right hemicolectomy?
ascending colon and caecum
what is resected in left hemicolectomy?
descending colon and splenic flexure
what is resected in sigmoid colectomy / Hartmann’s?
sigmoid colon
what is resected in anterior resection?
rectum, sparing the sphincters
what is resected in abdomino-perineal resection (APR)?
rectum, sphincters and anus
in which type of resections is a stoma likely?
- Hartmann’s
- APR
if a stoma is needed, it will most likely be a colostomy except in?
right hemicolectomy (ileostomy)
thousands of colonic polyps and autosomal dominant APC gene mutation. dx?
FAP
autosomal dominant mutation in the mismatch repair gene (MMR). dx?
HNPCC (Lynch syndrome)
small bowel polyps, melanotic macules in lips or genitals and autosomal dominant mutation in STK11 gene. dx?
Peutz-Jehgers syndrome
