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Year Two - Gastroenterology System > Colorectal Cancer > Flashcards

Colorectal Cancer Flashcards

1
Q

What is another term for colorectal cancer?

A

Bowel cancer

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2
Q

What is colorectal cancer?

A

It is defined as a malignancy affecting the colon and rectum

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3
Q

How common is colorectal cancer?

A

It is the third most common cancer in the UK

It is the second most common cause of cancer deaths

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4
Q

What are the three main classifications of colorectal cancer?

A

Right Sided Colon Cancer

Left Sided Colon Cancer

Rectal Lesions

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5
Q

Is right sided colon cancer exophytic or annular? What does this mean?

A

Exophytic

This means that these lesions grow outwards beyond the surface epithelium from which it originates

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6
Q

What are the three clinical features of right sided colon cancer?

A

Abdominal Pain

Iron Deficiency Anaemia

Bowel Habit Changes, Diarrhoea > 6 Weeks

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7
Q

Is left sided colon cancer exophytic or annular? What does this mean?

A

Annular

This means that these lesions form around the lumen of the colon

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8
Q

What are the three clinical features of left sided colon cancer?

A

Abdominal Pain

Rectal Bleeding

Bowel Habit Changes, Diarrhoea > 6 Weeks

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9
Q

What are the three clinical features of rectal cancer?

A

Tenesmus

Fresh Rectal Bleeding

Incomplete Bowel Evacuation

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10
Q

What percentage of colorectal cancers are located in the rectum?

A

40%

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11
Q

What percentage of colorectal cancers are located in the sigmoid colon?

A

30%

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12
Q

What percentage of colorectal cancers are located in the descending colon?

A

5%

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13
Q

What percentage of colorectal cancers are located in the transverse colon?

A

10%

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14
Q

What percentage of colorectal cancers are located in the ascending colon and caecum?

A

15%

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15
Q

What are the seven risk factors of colorectal cancer?

A

Increased Age, 85 – 89 Years Old

Male Gender

Familial Adenomatous Polyposis (FAP)

Hereditary Non-Polyposis Colorectal Cancer (HNPCC)

Peutz-Jeghers Syndrome

Inflammatory Bowel Disease

Obesity

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16
Q

What is FAP?

A

It is a genetic condition in which individuals develop adenomatous polyps by the time they are 30-40 years old

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17
Q

What is the inheritance of FAP?

A

Autosomal dominant

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18
Q

What genetic mutation results in FAP? What chromosome is this gene located on?

A

A mutation affecting the tumour suppressor gene called adenomatous polyposis coli gene (APC)

Chromosome 5

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19
Q

How do we diagnose FAP?

A

We conduct genetic testing by analysing DNA from WBC’s

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20
Q

How do we manage FAP?

A

In their 20s, patients have a total colectomy with ileo-anal pouch formation

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21
Q

What is the most common inherited colorectal cancer?

A

HNPCC

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22
Q

What is another term for HNPCC?

A

Lynch syndrome

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23
Q

What is HNPCC?

A

It is a genetic condition in which a mismatch repair defect promotes the development of adenoma

The progression of adenoma to carcinoma is accelerated in these patients

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24
Q

What is the inheritance of HNPCC?

A

Autosomal dominant

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25
Q

What two genes are associated with HNPCC colorectal cancer?

A

MSH2

MLH1

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26
Q

What other seven cancers are HNPCC patients at risk of?

A

Gastric cancer

Small bowel cancer

Urothelial cancer

Prostate cancer

Pancreatic cancer

Endometrial cancer

Ovarian cancer

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27
Q

What is the second most common cancer associated with HNPCC > colorectal cancer?

A

Endometrial cancer

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28
Q

What criteria is used to help identify the risk of HNPCC related cancers?

A

Amsterdam criteria

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29
Q

What are the four components of the Amsterdam criteria?

A
  • At least 3 family members with Lynch syndrome
  • One affected family member is a first degree relative
  • The cases span at least two successive generations
  • At least one cancer case diagnosed before the age of 50 years
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30
Q

What is Peutz-Jeghers syndrome?

A

It is a genetic condition resulting in the development of hamartomatous polyps

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31
Q

What is the inheritance of Peutz-Jeghers syndrome?

A

Autosomal dominant

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32
Q

What are the four clincial features of Peutz-Jeghers syndrome?

A

Hamatomatous Small Bowel Polyps

Small Bowel Obstruction

Gastrointestinal Bleeding

Pigmented Oral/Palm/Sole Lesions

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33
Q

How does IBD increase the risk of colorectal cancer?

A

This is due to the fact that this condition destroys the mucosa, which means the cells are being renewed more frequently compared to a none affected individual

This increases the chances of defects occurring

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34
Q

What are the eight clinical features of colorectal cancer?

A

Rectal Bleeding > 6 Weeks

Bowel Habit Changes, Diarrhoea > 6 Weeks

Abdominal Mass

Abdominal Pain

Abdominal Distension

Tenesmus

Weight Loss

Iron Deficiency Anaemia

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35
Q

What can the colour of rectal bleeding indicate?

A

The location of the colon cancer

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36
Q

What does black rectal blood indicate?

A

The cancer is present in the colon

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37
Q

What does fresh red rectal blood indicate?

A

The cancer is present in the rectum

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38
Q

What is tenesmus?

A

It refers to a patient feeling they need to have bowel movement, even if they’ve already had one

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39
Q

Why is unexplained iron deficiency anaemia a clinical feature of colon cancer?

A

This clinical feature is due to blood loss from rectal bleeding

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40
Q

How soon should patients recieve an appointment with colorectal services following urgent referral?

A

2 weeks

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41
Q

What two clinical features in > 40 year old patients requires an urgent referral to colorectal services?

A

Unexplained weight loss

AND

Abdominal pain

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42
Q

What clinical feature in > 50 year old patients requires an urgent referral to colorectal services?

A

Unexplained rectal bleeding

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43
Q

What two clinical features in > 60 year old patients requires an urgent referral to colorectal services?

A

Iron deficiency anaemia

OR

Change in bowel habit

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44
Q

In which three circumstances should an urgent referral be considered for investigation of colorectal cancer?

A

In cases where there is a rectal or abdominal mass

In cases where there is an unexplained anal mass or anal ulceration

In cases where patients are < 50 years old with rectal bleeding AND any one of the following unexplained symptoms: abdominal pain, bowel habit change, weight loss and iron deficiency anaemia

45
Q

What are the four investigations used to diagnose colorectal cancer?

A

Blood tests

Colonoscopy

CT Colongram

Barium Enema

46
Q

What three blood test results indicate a diagnosis of colorectal cancer?

A

Decreased Haemoglobin Levels

Increased Platelet Levels

Carcinoembryonic Antigen (CEA) Levels

47
Q

What is CEA?

A

It is the main tumour marker in colorectal cancer

48
Q

How are CEA levels used to investigate colorectal cancer?

A

It is not a diagnostic investigation due to the fact that it can be elevated in other conditions, such as IBD

It is however a marker for colorectal cancer once the diagnosis is made

49
Q

What is the gold standard investigation when diagnosing colorectal cancer?

A

Colonoscopy

50
Q

What is a colonoscopy?

A

It involves the placement of an endoscope into the colon

51
Q

In what three ways is a colonoscopy used to diagnose colorectal cancer?

A

It is used to provide visualisation of the mucosa

A colon biopsy can be taken for histological confirmation

It can be used to remove any polyps

52
Q

What three drugs do we administer to patients prior to the conduction of a colonoscopy?

A

Laxatives

Analgesia

Sedatives

53
Q

When should individuals take laxatives in order to prepare for colonoscopy?

A

They should take them the day before the procedure

54
Q

What is a CT colonogram?

A

It is an imaging scan that produces a cross sectional image of the colon and rectum

55
Q

When do we select a CT colongram as the first line investigation for diagnosing colorectal cancer? Why?

A

Patients > 80 years old

No bowel preparation is needed

56
Q

What is a barium enema?

A

It involves the administration of barium contrast via the rectum to visualise the colon better on x-ray

57
Q

What is the sign of colorectal cancer on barium enema?

A

The apple core sign, which is constriction of the colon lumen

58
Q

What two staging systems are used to stage colorectal cancer?

A

TNM

Duke’s

59
Q

What two imaging scans are used to stage colorectal cancer?

A

CT chest abdomen and pelvis

CT colonograms

60
Q

Define Duke’s Stage A

A

Confined To The Muscularis Mucosa

61
Q

Define Duke’s Stage B

A

Extends Through The Muscularis Mucosa

62
Q

Define Duke’s Stage C

A

Lymph Node Involvement

63
Q

Define Duke’s Stage D

A

Distant Metastasis

64
Q

In which individuals do we conduct standard colorectal cancer screening in? How often do we conduct screening in these individuals?

A

50-74 years old

Every 2 years

65
Q

What screening investigation is used in colorectal cancer?

A

Faecal immunochemical test (FIT)

66
Q

What is FIT?

A

It involves checking stool samples for the presence of microscopic blood

It uses antibodies that specifically recognise human haemoglobin

67
Q

What FIT result indicates further investigation? What is the next screening investigation used?

A

80mg/ml of blood in stool

Colonoscopy

68
Q

What screening test was used before FIT? Why is FIT favourable?

A

Faecal Occult Blood Test (FOBT)

FIT is more specific for haemoglobin and it is therefore a more reliable investigation

69
Q

Which five high risk patient groups also undergo colorectal cancer screening?

A

FAP

HNPCC

IBD

Previous Colorectal Cancer

Family History

70
Q

What colorectal cancer screening is offerred to FAP patients?

A

A colonoscopy annually > 12 years old

71
Q

What colorectal cancer screening is offerred to HNPCC patients?

A

A colonoscopy every 6 months > 25 years old

72
Q

What colorectal cancer screening is offerred to IBD patients?

A

A colonoscopy 10 years > diagnosis

73
Q

What colorectal cancer screening is offerred to previous colorectal cancer patients?

A

A colonoscopy one year > surgery

THEN

A colonoscopy every three years

74
Q

When is surgical management of colorectal cancer recommended?

A

It is the first line management option

75
Q

What are the six surgical procedures used to treat colorectal cancer?

A

Right Hemicolectomy

Left Hemicolectomy

High Anterior Resection

Hartmann’s Procedure

Anterior Resection

Abdomino-Perineal Excision of Rectum (APER)

76
Q

When is a right hemicolectomy used to manage colorectal cancer?

A

It is used to manage colorectal cancer affecting the caecal, ascending or proximal transverse colon

77
Q

What is a right hemicolectomy?

A

It involves removing the right side of the colon – including the caecum, ascending colon, hepatic flexure, first third of the transverse colon and part of the terminal ileum, along with fat and lymph nodes

78
Q

How is bowel function restored following a right hemicolectomy?

A

Ileo-colic anastomosis

79
Q

When is a left hemicolectomy used to manage colorectal cancer?

A

It is used to manage colorectal cancer affecting the distal transverse and descending colon

80
Q

What is a left hemicolectomy?

A

It involves removing the left side of the colon – including the transverse colon to the level of the upper rectum

81
Q

How is bowel function restored following a left hemicolectomy?

A

Colo-colon anastomosis

82
Q

When is a high anterior resection used to manage colorectal cancer?

A

It is used to manage colorectal cancer affecting the sigmoid colon

83
Q

What is a high anterior resection?

A

It involves removing the sigmoid colon and the upper section of the rectum

84
Q

How is bowel function restored after a high anterior resection?

A

Colo-rectal anastomosis

85
Q

When is an anterior resection used to manage colorectal cancer?

A

It is used to manage colorectal cancer affecting the rectum

86
Q

What is an anterior resection?

A

It involves removing the upper/mid section of the rectum and the mesorectal fat and lymph nodes

87
Q

How is bowel function restored after an anterior resection?

A

Colo-rectal anastomosis

88
Q

When is a Hartmann’s procedure recommended?

A

It is recommended to treat sigmoid colorectal cancers which are perforated or obstructive

They are therefore demmed as unsafe for a primary anastomosis due to the high risk of anastomotic leak

89
Q

What are three clinical features of bowel performation?

A

Abdominal Pain

Peritonism

Fever

90
Q

What is a Hartmann’s procedure?

A

It involves complete resection of the rectum and sigmoid colon with the formation of an end colostomy and the closure of the rectal stump

This can be revised later, with anastomosis of the two stumps

91
Q

When is an abdomino-perineal excision of the rectum (APER) used to manage colorectal cancer?

A

It is used to manage colorectal cancer affecting the anal verge – typically those close to the sphincter complex or very low rectal cancers

92
Q

What is APER?

A

It involves removing the distal colon, rectum and anal sphincter

93
Q

How is bowel function restored following an APER?

A

A permanent stoma bag

94
Q

What is an important factor to establish prior to the undertaking of colorectal cancer surgery?

A

Whether an attempt will be made to restore intestinal continuity, via anastomosis of bowel ends, or whether stoma formation is favourable

95
Q

What is a stoma?

A

An opening in the abdomen that is connected to the gastrointestinal system

A colostomy bag is then placed over this opening to collect waste products that would normally pass through the rectum and anus

96
Q

When is a temporary stoma recommended to manage colorectal cancer?

A

In emergency settings, where the bowel has perforated

97
Q

What are the two types of stomas?

A

Ileostomy

Colostomy

98
Q

In which location do we place an ileostomy? What type of stools are removed from these stoma bags? How do these stomas looks?

A

Right Iliac Fossa

Liquid, Looser Stools

Spouted

99
Q

In which location do we place an colostomy? What type of stools are removed from these stoma bags? How do these stomas looks?

A

Left Iliac Fossa

Solid Stools

No Spout, Flush With Skin

100
Q

Following colorectal cancer surgery, which form of analgesia is recommended? Why?

A

Epidural

It enables a faster return of normal bowel function

101
Q

What are two post-operative complications following colorectal cancer surgery?

A

Post-Operative Ileus

Anastomotic Leak

102
Q

What are the four clinical features of ileus?

A

Abdominal Pain

Abdominal Bloating

Nausea & Vomiting

Absent Bowel Sounds

103
Q

What investigation is used to screen for anastamostic leak following colorectal cancer surgery?

A

Gastrografin Enema

104
Q

What are the two management options of post-operative ileus?

A

Insert NG Tube

Nil by Mouth

105
Q

What are the six clinical features of an anastomotic leak?

A

Fever

Abdomen Distension

Absent Bowel Sounds

Feculent Material In Wound Drain

Atrial Fibrillation

Hypertension

106
Q

What feeding option should be selected following colorectal cancer surgery?

A

Normal Oral Intake

107
Q

In which two circumstances do we use chemotherapy to manage colorectal cancer?

A

In individuals who are unfit for surgical management

It can be used as a neoadjuvant or adjuvant with surgical management in those with a high risk of reoccurrence

108
Q

When is neoadjuvant radiotherapy used to manage colorectal cancer? Why?

A

Rectal cancer T3, T4

This is due to the fact that it is an extraperitoneal structure and therefore it is possibile to irradiate it

109
Q

Which screening investigation is used to monitor individuals with colorectal cancer?

A

CEA levels

Year Two - Gastroenterology System (33 decks)

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