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Year 2 Med > U10C5 Colorectal Cancer > Flashcards

U10C5 Colorectal Cancer Flashcards

1
Q

What are the genetic abnormalities in colorectal cancer cells?

A
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2
Q

How does cancer cause illness?

A
  • Interference with function

E.g Pancoast’s Tumour
• Tumour of the apex of the lung
• Pressure or direct invasion into the brachial plexus
• Severe Pain in Shoulder
• Weakness in the hand of the affected side
• Horner’s Syndrome
• Facial flushing on the side of the lesion
• Inability to sweat on the affected side
• Small constricted pupil
• Drooping eyelid.

  • Erosion - bleeding

E.g Gastro-intestinal Tumour (GIST)
• Rare tumour
• Commonly found in the stomach or small intestine
• Often presents as anaemia or upper GI haemorrhage

  • Obstruction

E.g Malignant large bowel obstruction secondary to stenosing colorectal cancer

  • Cachexia (wt loss)

• Unintentional weight loss
• Progressive muscle wasting
• Loss of appetite
• Caused by nausea, tumour metabolism, chronic inflammatory changes

  • Metabolic effect
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3
Q

What are the UK National Screening Programmes?

A
  • Bowel Cancer Screening
    • Men and women aged 60-74
    • 2 yearly
  • Cervical Cancer Screening
    • All women 25-64
    • 3 -5 yearly
  • Breast Cancer Screening
    • All women aged 50 -70 years
    • 3 yearly
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4
Q

When is a stoma necessary?

A

• To divert waste away from an obstruction which cannot be removed
(locally invasive,obstructing tumour)
• To allow time for a bowel anastomosis to heal
(Defunctioning ileostomy)
• Patient is at high risk from a leak from an anastomosis
(very unwell patient/poor blood supply)
• There is no distal bowel to connect to
(eg AP resection)

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5
Q

Colostomy vs ileostomy

A
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6
Q

How is colorectal cancer staged?

A
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7
Q

What is the Pathophysiology of colorectal cancer?

A
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8
Q

What are the risk factors for colorectal cancer?

A
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9
Q

What are the symptoms for colorectal cancer?

A
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10
Q

What are the differential diagnoses of colorectal cancer?

A
  • IBD
  • Piles
  • IBS
  • Diverticula diseases
  • Anal fissures
  • Ischaemic colitis
  • Pneumatosis colitis
  • Bright Red Blood -> Lower colon or rectum
  • Dark red/maroon Blood -> Small intestine or higher up in the colon (this dark red/maroon blood can mix with stool)
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11
Q

What are the different types of colorectal cancer?

A

Adenocarcinomas:

  • Adenocarcinoma of the Colon: This is the most common type of colorectal cancer, accounting for the majority of cases. It originates in the cells that line the inner surface of the colon.
  • Adenocarcinoma of the Rectum: Similar to colon adenocarcinoma but specifically located in the cells lining the rectum.

Other Rare Types:

  • Gastrointestinal Stromal Tumors (GISTs): These are rare tumors that can develop anywhere in the gastrointestinal tract, including the colon and rectum.
  • Lymphomas: Colorectal lymphomas are rare cancers that begin in the lymphatic tissue of the colon or rectum.
  • Carcinoid Tumors: These tumors are rare and usually slow-growing. They can develop in the hormone-producing cells of the colon or rectum. The hormone is serotonin.
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12
Q

What is the defecation reflex?

A
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13
Q

How do you prepare for a colonoscopy?

A

Bowel cleansing = use of laxatives the day before or the day of the colonoscopy (timings vary depending on when colonoscopy appointment is in the day)

If colonoscopy is in the morning (8am-12:30pm)- take laxatives at these timings on the day before colonoscopy

  • 12pm/midday = 10 senna tablets with water
  • 3pm = dissolve 1st sachet of Picolax into 200mL of cold water
  • 5pm = dissolve 2nd sachet of Picolax in 200mL of cold water
  • Drink another ~1.5L in evening (fluids stated in clear fluids list)

If colonoscopy is in the afternoon (1pm-5pm)- take laxatives at these timings on the day before & the day of the colonoscopy

Day before:

  • 4pm = 10 senna tablets with water
  • 7pm = dissolve 1st sachet of Picolax into 200mL of cold water

Day of:

  • 7am = dissolve 2nd sachet of Picolax in 200mL of cold water

Drink another ~1.5L in morning (fluids stated in clear fluid list)

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14
Q

What is the Faecal immunochemical test (FIT)?

A

• The FIT uses antibodies that specifically recognise human haemoglobin
• Test results in approx. 2 weeks
• A positive FIT result suggests that there may be bleeding within the
gastrointestinal tract that requires further investigation e.g. colonoscopy

Differential diagnoses of positive FIT:

  • Ulcers
  • Bulges
  • Polyps
  • IBD
  • Haemorrhoids
  • Bowel cancer
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15
Q

What are the diagnostic tests for colorectal cancer?

A
  • MRI
  • CT
  • biopsy (moderately differentiated adenocarcinoma and tubulovillous adenoma with mild dysplasia)
  • colonoscopy (diverticula which is outpouching of mucosa, fungating tumour, polyp)
  • barium enema
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16
Q

What is the treatment for colorectal cancer?

A
  • neoadjuvant therapy- delivered before the main treatment to help reduce the size of a tumour or to kill cancer cells that have spread with the goal of making the main treatment more successful
  • chemotherapy- The drugs include 5-fluorouracil (5FU), capecitabine, oxaliplatin and irinotecan
  • radiotherapy-
    Administration:
    • External beam radiation therapy- radiation delivered externally by machine aimed at the part of the body where the cancer is detected
    • Internal radiation therapy - concentrated doses of radiation are directly delivered to cancer cells using a process called brachytherapy - this type of therapy places the radioactive material inside the body
      Mechanism of Radiotherapy:
    • Oxidative stress occurs by cells being exposed to ionising radiation by targeting nuclear DNA by inhibiting DNA transcription which slows down growth
    • Also, direct damage to plasma membrane occurs by disrupting the electrical gradient and the rigidity of the two layers of phospholipids membrane affecting cell integrity leading to cell death
  • resection
17
Q

What is a stoma? What is the impact of a stoma?

A
  • Body Image and Self-Esteem: A colostomy or ostomy bag can have a profound impact on a patient’s body image and self-esteem. Coping with the physical changes and acceptance of the bag can be challenging.
  • Adjustment: Patients with colostomy bags often need time to adjust to their new way of life. Learning how to care for the stoma and manage the bag can be a complex process.
  • Social and Intimacy Challenges: Patients may feel self-conscious about their bags in social situations and intimate relationships. These concerns can affect their overall quality of life.
  • Support: Support from healthcare professionals, ostomy nurses, and support groups can be essential in helping patients adapt to and manage life with a colostomy or ostomy bag.

Year 2 Med (60 decks)

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