Tumours: Colorectal Carcinoma

Question 1

It is usually a polypoid mass with ______. This spreads by ___ ____ . It involves ____ and ___ ___ .

Answer 1

It is usually a polypoid mass with ulceration. This spreads by direct infiltration through the bowel wall. It involves lymphatics and blood vessels.

Question 2

what do they look like histologically ?

Answer 2

adenocarcinoma with variably differentiated glandular epithelium with mucin production

Question 3

where are 75% of CRCs?

Answer 3

Left sided (rectum, sigmoid, descending)

Question 4

where are 25% of CRCs?

Answer 4

25% Right sided (Caecum, Ascending)

Question 5

what are the PCs for left sided? 3

Answer 5

p/c: Blood PR, Altered bowel habit, Obstruction

Question 6

what are the PCs for right sided? 2 and why?

Answer 6

p/c: Anaemia, Weight loss - get more generalised symptoms because the tumour can grow quite large

Question 7

what is in the centre of the glands? hallmark of CRC

Answer 7

dirty necrosis pattern

Question 8

what is dukes A?

Answer 8

Dukes A: confined by muscularis propria

Question 9

what is dukes B?

Answer 9

Dukes B: through the muscularis propria

Question 10

what is dukes C?

Answer 10

Dukes C: metastatic to lymph nodes

Question 11

what are some protective associations with colorectal cancer

Answer 11

vegetbles, fibre and EXERCISE

Question 12

what are some associated causes of CRC

Answer 12

red and processed meat, smoking, alcohol and OBSESITY

Question 13

how does exercise help?

exercise has a similar effect to the tumour suppressor gene ____ which stimulates the enzyme ____ responsible for a decrease in cell turnover and glucose uptake by muscle

Answer 13

LKB1, AMPK

Question 14

what are the three types of macroscopic CRC appearances

Answer 14

polypoidal

ulcrative

annular

Question 15

histologically it is an _______ with variably differentiated _____ epithelium with ____ production

Answer 15

is adenocarcinoma with variably differentiated glandular epithelium with mucin production

Question 16

the majority of CRC are _____ in type

Answer 16

polypoid

Question 17

what are some predisposing conditions for CRC ? 3

Answer 17

Adenomatous polyps
Ulcerative colitis
Crohn’s disease

Question 18

clinical features depend on where the cancer is, if it is in the rectum what are the symptoms?

Answer 18

Rectal bleeding and tenesmus

Question 19

if it is in the sigmoid what are the symptoms?

Answer 19

Pain,

change in bowel habit - stool become looser and get pseudo -diarrhoea

rectal bleeding

Question 20

if it is in the caecum and right side what are the symptoms?

Answer 20

Anaemia - Tend not to get rectal bleeding but they become anaemic as they lose small amounts of blood over a long period of time

Question 21

by far the most common cause of unexplained anaemia for both males and females is ____

Answer 21

CRC

Question 22

what are the general findings on clinical examination?

Answer 22

Anaemia, cachexia and lymphadenopathy

Question 23

what are the abdomen findings on clinical examination?

Answer 23

Mass, hepatomegaly and distension

Question 24

what are the rectum findings on clinical examination?

Answer 24

mass and blood

Question 25

what investigations are done?

Answer 25

FBC

• liver biochemistry
• renal function
• colonoscopy
• barium
• CT colography
• MRI scan - because CT scan of rectum is not great

Question 26

how is it screened for?

Answer 26

FOBT

Question 27

what are the emergency complications of CRC

Answer 27

obstruction
bleeding
perforation

Question 28

what are the symptoms of obstruction

Answer 28

distension, constipation, pain and vomiting - the exact symptoms out of these 4 may vary depending on where the obstruction is

Question 29

what are the treatment options for obstruction?

Answer 29

colostomy alone, resection and colostomy, resection and anastomosis but the commonest way nowadays is through stenting

Question 30

what treatment may reduce local recurrence after a rectal excision?

Answer 30

radiotherapy

Question 31

radiotherapy can be used ______

Answer 31

palliatively

Question 32

examples of chemo

Answer 32

5 -fluorouracil or capecitabine

Question 33

chemo is used for ____ disease

Answer 33

advanced