Treatment Of Colorectal Cancer

Question 1

What percentage of patients with colorectal cancer undergo surgery?

Answer 1

80%

It is the gold standard treatment

Question 2

What are the main treatments for colon cancer?

Answer 2

Surgery

Chemotherapy

Question 3

What are the main treatments for rectal cancer?

Answer 3

Surgery
Radiotherapy
Chemotherapy
Chemoradiotherapy

Question 4

What is the mainstay of curative management for localised malignancy in bowel?

Answer 4

Suitable regional Colectomy- removal of primary tumour with adequate margins and lymphatic drainage

Followed by primary anastomosis or formation of a stoma

Question 5

What surgical approach is taken for caecal or ascending colon tumours?

Answer 5

Right hemicoloctomy or extended right hemicolectomy (if transverse colon tumour)

During the procedure the ileocolic, right colic and right branch of middle colic vessels divided and removed with their mesenteries

Question 6

What is the surgical approach for descending colon tumours?

Answer 6

Left hemicoloectomy

Question 7

What surgical approach is taken for sigmoid tumours?

Answer 7

Sigmoidectomy

IMA fully dissected out with tumour

Question 8

What is an anterior resection?

Answer 8

The surgical approach for high rectal tumours, typically if >5cm for anus.
Leaves rectal sphincter intact if an anastomosis is performed (unlike AP resection)

Often a defunctioning loop ileostomy performed to protect the anastomosis - can be reversed 4-6 months later

Question 9

What is an abdominoperineal (AP) resection?

Answer 9

The surgical approach for low rectal tumours, typically < 5cm from anus. Involves excision of distal colon, rectum and anal sphincters, resulting in permanent colostomy

Question 10

What is Hartmann’s procedure?

Answer 10

Used in emergency bowel surgery e.g obstruction or perforation.
Involves complete resection of recto-sigmoid colon with formation of end colostomy and closure of rectal stump.

Question 11

When is chemotherapy indicated?

Answer 11

Patients with advanced disease - adjuvant chemotherapy

In Dukes’ C colorectal cancer found to reduce mortality by 25%

Question 12

What is an example chemotherapy regime for patients with metastatic colorectal cancer?

Answer 12

FOLFOX
Folinic acid
Fluorouracil
Oxaliplatin

Question 13

Why is radiotherapy rarely given in colon cancer?

Answer 13

Risk of damage to small bowel

Question 14

When is RT given?

Answer 14

Rectal cancer most often as adjuvant treatment.
Especially in those whose cancers which look on MRI to have threatened circumferential resection - can undergo pre operative long course chemoradiotherapy to shrink tumour - increase chance of complete resection and cure

Question 15

What surgical options can be offered in palliative care?

Answer 15

Endoluminal stenting - relive acute bowel obstruction in those with left sided tumours
Defunctioning stoma formation or palliative bypass
Resection of secondaries

Question 16

What are the advantages of minimal access surgery?

Answer 16

Less post op pain
Faster recovery 
Reduced surgical site infection risk 
Reduced complication and readmission
Less blood loss
Smaller scar

Question 17

What are the disadvantages of minimal access surgery?

Answer 17

Skills needed
Time needed
Perforation risk 
Vision system errors 
Port site metastases

Question 18

How are elective colectomies often performed?

Answer 18

Laparoscopically

Question 19

Is there a difference in disease recurrence and overall survival rates between laparoscopic and open surgery?

Answer 19

No