Surgical Tut - colorectal tut Flashcards
APC controls what?
B-catenin production
FAP is? why does it happen?
familial adenomatous polyposis
>100 polyps
has two hits already
HNPCC
Hereditary non polyposis colon cancer is what?
lynch syndrome
HNPCC caused by what?
microsatellite instability
DNA mismatch repair
HNPCC, lynch can cause what cancers?
small bowel
gall bladder
colon
endometrial
gardener syndrome is?
subtype of FAP: skin tags all over
different polyps?
pedunculated
sessile
FAP vs. HNPCC polyps different?
FAP - clear polyp
HNPCC - subtle, not as obvious
symptoms of bowel cancer?
PR bleeding
iron deficiency
constipation/diarrhoea
abdo pain, obstipated (no farts)
how much iron in a litre of blood?
500mg of iron
how much iron do you absorb a day?
10mg per day
what is obstipated?
not passing wind
obstruction symptom
stop passing wind
distension
empty PR
what causes gasses in large bowel
Nitrogen
swallowing air
bacteria gas production
why does caecum perforate?
thinner wall
open and close loop
more tension on wall: ischaemia
how can bowel perforate re: cancer?
gas distention
ulcerated cancer
how to investigate bowel cancer?
colonoscopy
when does adenoma become adeno-carcinoma?
invasion past lamina propria
3 places colon cancer spreads
liver
lungs
nodes
ways to scan for colon
CT c/a/p
MRI
difference in rectal and colon cancer rx?
rectal are fixed
radiotherapy has better chance to
neoadjuvant
what does neo-adjuvant mean?
chemo and radio before a surgery to decrease size
TMN staging for colon cancer?
T- depth stage T1 - not through muscularis T2- low rate T3 - 20% mets T4 - almost definitely mets M - metastasis N - Nodes
what chemo for bowel cancer?
Folfox
