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Gastrointestinal > Colorectal cancer > Flashcards

Colorectal cancer Flashcards

1
Q

Colorectal cancer is the ______ most common cancer in the UK.

A

4th - 2nd most common cause of cancer death

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2
Q

Strong risk factors?

A

1) Increasing age
2) Hereditary
- -> familial adenomatous polyposis
- -> hereditary nonpolyposis colorectal cancer (Lynch syndrome)
- -> Juvenile polyposis
- -> Peutz-Jegher’s syndrome
3) alcohol
4) smoking
5) processed meat
6) obesity
7) IBD
8) prev. exposure to radiation

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3
Q

Weak risk factors?

A

1) lack of fibre in diet
2) limited physical activity
3) Asbestos exposure
4) red meat (non-processed)

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4
Q

Classification to stage colorectal cancer?

A

DUKE’S!
A - limited to bowel wall (not beyond muscularis)
B - extends through bowel wall (beyond muscularis)
C - regional lymph nodes involved
D - distant mets

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5
Q

Another classification system?

A

TNM (tumour, node, mets)

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6
Q

Outline Ts in TNM? (Tis to T4)

A

Tis - carcinoma in situe/intramucosal cancer
T1 - extends through mucosa into submucosa
T2 - extends through submucosa to muscularis
T3 - extends through muscularis to subserosa
T4 - extends to neighbouring tissue/organs

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7
Q

Outline Ns in TNM (N0 to N2)

A

N0 - no regional lymph node involvement
N1 - mets to 1-3 regional lymph nodes
N2 - mets to 4+ regional lymph nodes

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8
Q

Outline Ms in TNM (M0 to M1)

A 
M0 = no distant mets
M1 = distant mets
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9
Q

Which patients benefit from adjuvant chemotherapy?

A

1) Duke’s Stage C

2) TNM Stage III (t1-4, n1-2, m0)

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10
Q

NHS screening programme?

A
  • Faecal immunochemical test (FIT) every 2 years for men + women aged 60-74 years
  • -> if +ve refer for colonoscopy
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11
Q

Aim of colorectal screening programme?

A

Detect cancer at early/asymptomatic stage, when it’s easier to treat patients & higher rate of survival

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12
Q

Urgent 2 weeks wait referral for possible colorectal cancer?

A

1) >40 w/ unexplained weight loss AND abdo pain
2) >50 w/ unexplained rectal bleeding
3) >60 w/ iron-deficiency anaemia OR changes in bowel habit
4) Proven faecal occult blood

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13
Q

Who might you perform a faecal occult blood test prior to referring?

A

1) >50 w/ unexplained abdo pain OR weight loss
2) >60 w/ anaemia
3) <60 w/ change to bowel habit OR iron deficient

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14
Q

Features?

A
  • PR bleed
  • abdo pain
  • weight loss
  • iron deficiency
  • palpable mass
  • tenesmus
  • change in bowel habit/stool form (thin, small)
  • abdo distension
  • bowel obstruction
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15
Q

Initial diagnostic step?

A

Colonoscopy w/ biopsy

If risk of perforation then CT colonoscopy as alterantive

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16
Q

Investigation to stage?

A

CT chest, abdo, pelvis

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17
Q

Test to monitor response to interventions?

A

Carcinoembryonic antigen (CEA)

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18
Q

What imaging may be used if rectal disease suspected?

A

MRI or endorectal US > CT

19
Q

Surgical management of rectal cancer?

A
  • Anterior resection - if >8cm away from anal canal OR affects proximal 2/3 rectum
  • Abdomino-perineal (AP) resection if <8cm from anal canal OR affects distal 1/3 rectum
20
Q

Which rectal cancer patients receive chemo/chemoradio after surgery?

A

Stage III = post-op chemo

Stage IV = post-op chemoradio

21
Q

Other non-surgical management options?

A
  • chemo (if not suitable for surgery) –> FOLFOX
  • monoclonal antibodies –> cetuximab
  • stenting (as palliative if obstruction
22
Q

What gene is mutated in Familial adenomatous polyposis (FAP)? Inheritance?

A

Adenomatous polyposis coli (APC) gene –> Autosomal dominant

23
Q

Features of FAP?

A

1) develop hundreds of polyps in teens
2) develop colorectal cancer by their 20s
3) high risk of duodenal cancer
4) Gardener’s syndrome - also epidermal cysts, supernumerary teeth, osteomas, thyroid tumour

24
Q

Managing patient with high risk of colorectal and duodenal cancer (FAP)?

A
  • prophylactic proctocolectomy

- endoscopic surveillence

25
Q

What genes are mutated in Hereditary non-polyposis colorectal cancer (HNPCC)/Lynch syndrome? Inheritance?

A

MLH1/MSH2 –> autosomal dominant

26
Q

% risk of HNPCC/Lynch syndrome patient developing colorectal cancer?

A

80% by their 30s

27
Q

Other cancers associated with HNPCC/Lynch syndrome?

A
  • gastric
  • endometrial (2nd most common after colorectal)
  • breast
  • prostate
28
Q

How are HNPCC/Lynch syndrome patients managed?

A

Regular endoscopic surveillance

29
Q

Mutation and inheritance of Peutz-Jeghers syndrome?

A

STK11 gene –> autosomal dominant

30
Q

How do patients with Peutz-Jegher’s syndrome typically present? Managent?

A

Present in teens w/ mucocutanous pigmentation + haemartomatous polyps

Mange w/ regular endoscopic surveillence (risk is low)

31
Q

Management of colon cancer if stage I-III?

A

Surgical resection +/- post-op chemotherapy

Stage III will benefit

32
Q

Management of colon cancer if stage IV (mets)?

A

Pre-op chemo + surgical resection + post-op chemo

33
Q

Type of surgery for tumours of the caecum, ascending colon & proximal transverse?

A

Right hemicolectomy

34
Q

Type of surgery for tumours of the distal transverse & descending colon?

A

Left hemicolectomy

35
Q

Type of surgery for tumour affecting the sigmoid colon?

A

Sigmoid colectomy

36
Q

Colorectal cancer is most commonly associated with which IBD?

A

Ulcerative Colitis

37
Q

Strong family history of colorectal and endometrial cancer is associated with which what?

A

HNPCC/Lynch Syndrome

38
Q

What organism causing endocarditis is commonly assoc with colorectal cancer?

A

Streptococcus bovis

39
Q

Investigation to test anastomoses are not leaking (after surgery)?

A

Gastrografin enema

40
Q

What procedure would you perform if colorectal tumour and perforation occurs?

A

Hartmann’s procedure (which requires an end colostomy)

41
Q

Which is most common cause of colorectal cancer (a) FAP or (b) HNPCC?

A

HNPCC (5%), FAP (<1%)

42
Q

Most common histology of colorectal cancer?

A

Adenocarcinoma (90%)

43
Q

Risk factor for anal cancer?

A

HPV

44
Q

Why would you give a patient an epidural for abdo operations?

A

Accelerates the return of normal bowel function after surgery

Gastrointestinal (32 decks)

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