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Gastroentrology > 1: Colorectal Cancer > Flashcards

1: Colorectal Cancer Flashcards

(66 cards)

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1
Q

How common is colorectal cancer

A

Third most common UK cancer

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2
Q

How does incidence of colorectal cancer change

A

Increases with age.

Familial associated colorectal cancer may occur at a younger age.

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3
Q

How do the majority of colorectal cancers develop

A

adenoma-carcinoma sequence

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4
Q

Explain adenoma-carcinoma sequence

A

normal mucosa evolves to colonic adenoma (polyp) then progresses to invasive adenocarcinoma

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5
Q

what percentage of adenomas progress to adenocarcinomas

A

10%

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6
Q

What are two genetic syndromes that lead to colorectal cancer

A

HNPCC (Lynch)

Familial Adenomatous Polyposis

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7
Q

What gene is mutated in familial adenomatous polyposis

A

APC

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8
Q

What type of gene is APC

A

Tumour suppressor gene

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9
Q

What is Lynch syndrome also called

A

HNPCC

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10
Q

What genes are mutated in Lynch syndrome

A

DNA mismatch repair genes: MLH1 and MSH2

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11
Q

In HNPCC which side of the colon are tumours more likely to be

A

Right

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12
Q

What criteria is used to diagnose to identify lynch syndrome

A

Amsterdam

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13
Q

What is the amsterdam criteria for Lynch syndrome

A

3 Family members (one first generation)

2 Successive generations

1 Family member under 50-years

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14
Q

What are 5 risk factors for colorectal cancer

A 
Age 
FH
IBD
Low Fibre Diet 
High processed meat intake 
Smoking 
Alcohol
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15
Q

How do symptoms of colorectal cancer vary

A

Depending on location

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16
Q

What are 5 symptoms of left-sided colorectal cancer

A
  • Change bowel habbit
  • Rectal bleeding
  • Tenesmus
  • Mass LIF
  • Mass on PR
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17
Q

What are 3 symptoms of right-sided colorectal cancer

A
  • Abdominal pain
  • Occult bleed
  • Mass in RIF
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18
Q

How may colorectal bleeding on either side present

A
  • Change bowel habit
  • Rectal bleed
  • Weight loss
  • Abdominal pain
  • IDA
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19
Q

When should individuals >40y be sent for urgent investigation for bowel cancer

A

Unexplained weight loss

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20
Q

When should individuals >50y be sent for urgent investigation for bowel cancer

A

Rectal Bleeding

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21
Q

When should individuals >60y be sent for urgent investigation for bowel cancer

A

IDA

Or, change bowel habit

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22
Q

When should any individual be sent for bowel cancer assessment

A

+ve faecal occult blood test

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23
Q

When should a 2W referral for bowel cancer be made

A

If individuals have

  1. Abdominal mass
  2. Or, anal mass
  3. Or, <50 with rectal bleeding

AND one of:

a. abdominal pain
b. change bowel habit
c. weight loss
d. IDA

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24
Q

What type of cancer are colorectal cancers

A

adenocarcinomas

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25
Where do 40% of colorectal cancers arise
rectum
26
Where do 30% of colorectal cancers arise
sigmoid colon
27
What stool test is ordered for colorectal cancer and what will it show
Faecal occult blood test - shows presence blood in stool
28
What blood tests are ordered in colorectal cancer
FBC | CEA
29
What will FBC show in colorectal cancer
microcytic anaemia (IDA) - especially if right-sided
30
What is CEA used for in colorectal cancer
it is not diagnostic! but used to monitor response to treatment
31
What is first-line imaging for colorectal cancer
colonoscopy and biopsy = gold-standard
32
If a patient has several co-morbidities what is used as an alternative to colonoscopy
flexible sigmoidoscopy and barium enema
33
What sign will be present on barium enema in colorectal cancer
apple core sign = construction lumen due to colorectal cancer
34
What imaging is used to stage the disease
CT CAP
35
Why may MRI be used in colorectal cancer
Assess risk of local recurrence
36
When is endo-anal US used in colorectal cancer
Asses depth invasion of rectal cancers
37
How is colorectal cancer staged
TNM Staging
38
What was used previously to stage colorectal cancer
Duke's staging
39
What is Duke's stage A
Confined to mucosa
40
What is Duke's stage B1
Extending to muscularis propria | No node involvement
41
What is Duke's stage B2
Penetrating through muscularis propria No node involvement
42
What is Duke's stage C1
Extending to muscularis propria Node involvement
43
What is Duke's stage C2
Penetrating through muscularis propria Node involvement
44
What is Duke's stage D
Metastses
45
What is the survival rate of Duke's stage A
90
46
What is the survival rate of Duke's stage B
65
47
What is the survival rate of Duke's stage C
30
48
What is the survival rate of Duke's stage D
10
49
Explain screening for bowel cancer
- 55y = offered one-off flexible sigmoidoscopy - 65-74 = offered FIT every 2-years - >75 = can request FIT every 2-years
50
If faecal immunochemical testing is positive what are individuals offered
Colonoscope
51
What is the aim of surgical intervention for bowel cancer
To remove location where tumour is (regional colectomy)
52
What surgery will someone with ascending or caecal tumour receive
Right hemi-colectomy
53
What surgery will someone with tumour in transverse colon receive
Extended right hemi-colectomy
54
What surgery will someone with descending colon cancer receive
Left hemicolectomy
55
What surgery will someone with sigmoid tumour receive
Sigmoidectomy
56
What are indications for anterior resection
High anal tumour: | - >5cm from anal sphincter
57
What is the advantage of anterior resection over AP resection
Anal sphincter remains intact
58
When is abdominalperineal resection indicated
Low anal tumour: | <5cm from anus
59
What does AP resection involve
Remove: Distal colon Rectum Anal sphincter
60
What does AP resection result in
Removal anal sphincter and permanent colostomy
61
What is a Hartmann procedure indicated for
Emergency bowel obstruction
62
What does a Hartmann procedure involve
Remove recto-sigmoid junction. Attach a colostomy and form a rectal stump.
63
When is chemotherapy indicated for colorectal cancer
metastatic disease
64
Why is radiotherapy not used for colon cancer
Damages the small bowel
65
When may radiotherapy be used
Adjuvant rectal cancers
66
What is used for palliation of colorectal cancer
- Endoluminal stenting = if obstruction - often left-side | - Stoma formation

Gastroentrology (18 decks)

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