[Surgery] Colorectal Cancer

Question 1

what are the modifiable risk factors for colorectal cancer?

Answer 1

• smoking
• red meat consumption
• low fibre diet

Question 2

what are the non-modifiable risk factors for colorectal cancer?

Answer 2

• male
• age
• FHx
• IBD

Question 3

what are the genetic risk factors for colorectal cancer?

Answer 3

• FAP
• HNPCC (Lynch syndrome)
• Peutz-Jehgers syndrome

Question 4

what is the 1st line ix for colorectal cancer?

Answer 4

colonoscopy

Question 5

what is needed once a Dx of colorectal cancer is made?

Answer 5

staging CT thorax and referral for resection

Question 6

what is used for staging in rectal cancer?

Answer 6

MRI

Question 7

how to pts with colorectal cancer present?

Answer 7

• change in bowel habit
• palpable mass
• iron deficiency anaemia
• PR bleeds (clots or fresh)
• acute (obstruction or perforation)

Question 8

what does T1 mean in TMN staging?

Answer 8

T1 = no muscular involvement

Question 9

what does T2 mean in TMN staging?

Answer 9

T2 = involves muscularis propria

Question 10

what does T3 mean in TMN staging?

Answer 10

T3 = involves serosa / adventitia

Question 11

what does T4 mean in TMN staging?

Answer 11

T4 = invades local structures

Question 12

how do you treat T1-3 stage colon cancer?

Answer 12

colonic resection

Question 13

how do you treat T4 stage (locally advanced) colon cancer?

Answer 13

neoadjuvant treatment

Question 14

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?

Answer 14

adjuvant chemotherapy

Question 15

how do you treat T1-T2N0M0 stage rectal cancer?

Answer 15

transanal excision

Question 16

how do you treat T3-4 stage rectal cancer?

Answer 16

neoadjuvant treatment → colonic resection → T3+ or nodal disease → adjuvant chemotherapy

Question 17

in the UK, who is bowel screening offered to?

Answer 17

everyone age 60-74

Question 18

what is used in bowel screening?

Answer 18

1 stool sample (FIT) or several smears (FOB)

if abnormal → colonoscopy

Question 19

what is the resection done for tumours in: proximal colon to the hindgut?

Answer 19

right hemicolectomy*

*can be extended to reach transverse colon tumours

Question 20

what is the resection done for tumours in: left colon up to sigmoid?

Answer 20

left hemicolectomy*

*can be extended to reach transverse colon tumours

Question 21

what is the resection done for tumours in: sigmoid?

Answer 21

sigmoid colectomy / Hartmann’s (in emergencies)

Question 22

what is the resection done for tumours in: rectal tumours >5cm from anal verge?

Answer 22

anterior resection

Question 23

what is the resection done for tumours in: rectal tumours <5cm from anal verge?

Answer 23

abdomino-perineal resection (APR)

Question 24

what is resected in right hemicolectomy?

Answer 24

ascending colon and caecum

Question 25

what is resected in left hemicolectomy?

Answer 25

descending colon and splenic flexure

Question 26

what is resected in sigmoid colectomy / Hartmann’s?

Answer 26

sigmoid colon

Question 27

what is resected in anterior resection?

Answer 27

rectum, sparing the sphincters

Question 28

what is resected in abdomino-perineal resection (APR)?

Answer 28

rectum, sphincters and anus

Question 29

in which type of resections is a stoma likely?

Answer 29

• Hartmann’s

- APR

Question 30

if a stoma is needed, it will most likely be a colostomy except in?

Answer 30

right hemicolectomy (ileostomy)

Question 31

thousands of colonic polyps and autosomal dominant APC gene mutation. dx?

Answer 31

FAP

Question 32

autosomal dominant mutation in the mismatch repair gene (MMR). dx?

Answer 32

HNPCC (Lynch syndrome)

Question 33

small bowel polyps, melanotic macules in lips or genitals and autosomal dominant mutation in STK11 gene. dx?

Answer 33

Peutz-Jehgers syndrome