Surgical approach to CRC Flashcards
2 methods used in CRC screening in the NHS
- Faecal occult blood testing
* Flexible sigmoidoscopy – ‘Bowel scope’
What does the NHS bowel cancer screening offer?
The NHS Bowel Cancer Screening Programme offers screening every two years to all men and women aged 60 to 75 (can opt in)
What is used for the NHS screening?
FOBT
When is a flexible sigmoidoscopy offered?
One off flexible sigmoidoscopy at 55 years
2 risks of flexi sigmoidoscopy?
Bleeding and perforation
8 investigations used to establish a diagnosis of CRC
Blood tests Tumour markers Sigmoidoscopy (flexible) Colonoscopy CT colography Barium enema MR colography BIOPSY
2 methods for staging CRC
Dukes’ – Dukes didn’t define Dukes’ stage D!
TNM- 1-4a (peritoneum)/b (other organ)
5 staging investigations for CRC
CXR Liver US CT chest/abdo/pelvis MRI rectum Endoanal US
5 methods of tumour spread
- Direct- from structure to structure
- Lymphatic
- Blood-borne
- Transcoelomic- spread within abdominal cavity
- Implantation- cancer cells may be implanted into abdominal wound- unusual
Define malignant polyp
An adenoma that appears benign macroscopically but in which there is invasion through the muscularis mucosae into the submucosa
What is a pedunculated polyp?
They grow on a stalk up from the tissue.
What is a sessile polyp?
A sessile polyp is one that is flat and does not have a stalk.
3 aspects of follow up post-polyp/CRC surgery
• Endoscopy;
o Site check – 3 months & 9 months (BSG & ACP Guidelines)
o Polyp / Cancer dependent on number & size (BSG & ACP Guidelines)
• CEA
• CT TAP +/- MRI rectum
How do they mark up the area of the bowel that needs to be operated on?
Tattoo with Indian ink
Where can Indian ink not be used? (2)
Caecum and rectum
4 aspects of preop care
- Informed consent
- Preparation for stoma
- Group & Save or Cross match blood
- Bowel preparation (+/- oral antibiotics)
4 aspects of perioperative care
- Thrombo-embolism prophylaxis (28 days)- standard is heparin (lmw) injections OD for 28 days
- Antibiotic prophylaxis
- Warming
- Fluid balance
Benefits of laparoscopic resection
shorter hospital stay
quicker return to normal activities
avoidance of incisional hernias
fewer intra-abdominal adhesions
Complications of CRC surgery (11)
- Visceral injury (spleen, ureter)
- Anastomotic leakage
- Wound infection
- Urinary / sexual dysfunction
- Defaecatory disturbances
- Local recurrence
- Death
- Pneumonia
- Myocardial infarction
- DVT / PE
- Distant recurrence
Local and systemic factors affecting wound healing
• Systemic factors o Age and Sex o Nutrition o Vitamin and trace element deficiencies - vitamin C, vitamin A, zinc o Drugs – steroids, chemotherapy, immunosuppression o Systemic disease – diabetes, jaundice, malignancy o Hypoxia • Local factors o Infection o Foreign bodies o Surgical techniques o Blood supply o Tension
Which Duke’s stage has the best response to adjuvant chemotherapy
C
What is the only cure for liver mets
Resection
5 aspects of palliative care
- Information
- Symptom control
- Psychological support
- Social support
- Spiritual support
3 symptoms of emergency presentation of CRC
- Obstruction - Overall up to 85% of colonic obstruction is due to malignancy
- Peritonitis
- Bleeding
