Colorectal cancer

Question 1

What conditions causes 100% incidence of bowel cancer?

Answer 1

Familial Adenamatous Polyptosis

Question 2

Refer using a suspected cancer pathwya referral within 2 weeks for colorectal cancer if:

Answer 2

-aged 40+ unexplained weight loss and abdominal pain
-age 50+ with unexplained rectal bleeding
-aged 60+ with iron deficiency anaemia or changes in their bowel habit or tests that show positive FIT test (blood in faeces)

Question 3

When consider referral to cancer pathway colorectal

Answer 3

rectal or abdominal mass
-under 50 years with rectal bleeding and any following unexplained:
-abdo pain, change in bowel habit, iron deficiency anaemia

Question 4

Who to offer FIT to assess for colorectal cancer without rectal bleeding

Answer 4

50+ with
-unexplained abdo pain or weight loss
under 60 with
-changes in bowel habit or IDA or
Over 60 and have anaemia (even if not iron defieiency)

Question 5

When to consider an urgent cancer referral for anal cancer

Answer 5

Unexplained anal mass or ulceration

Question 6

Risks for colorectal cancer

Answer 6

• Lack of fibre: it is thought that reduced speed of transit exposes gut mucosa to potential carcinogens
• High fat Diet: thought to favour bacterial flora which can degrade bile salts into carcinogens
• Obesity(especially in men)
• Inflammatory bowel disease: chronic ulcerative, Crohn’s disease
• Family history of benign/malignant colorectal tumour
• Pelvic irradiation
• Colon polyps

Question 7

Rectal tumour presentation

Answer 7

Bleeding
Change in bowel habit
Tenesmus
Palpable rectal mass

Question 8

L colon tumour presentation

Answer 8

Constipation and obstruction
Abdo pain and perforation
More overt bleeding and bleeding PR

Question 9

R colon tumours

Answer 9

Altered (dark) blood PR
Occult and asymptomatic often
Obstruction in advanced tumours

Question 10

Symptoms of colorectal cancer

Answer 10

• Tenesmus - tumor signals to brain still something to pass
• PR Rectal bleeding - obvious or occult
• Weight loss - very late sign - metastases
• Abdominal mass
• Tired - anaemia - blood loss
• Blockage/obstruction
• Altered bowel habit - consistency
• Life style change
• Nocturnal/incontincence

Question 11

Family hisotry qs for colorectal cancer

Answer 11

Colorectal cancer, FAP, lynch syndrome

Question 12

Past medical history questions for Colorectal cancer

Answer 12

Preve CRC,
BCSP
colonscopy
DM
HPTN
CVA
MI

Question 13

What to look for on GI exam for colorectal cancer

Answer 13

Signs of anaemia
Presence of palpable mass - abdo or rectal
Evidence of intestinal obstruction - abdo distension, reduced bowel sounds, vomit/hixxups
Evidence of metastatic disease - hepatomegaly, ascites, jaundice, enlarged lymph nodes
Weight loss

Question 14

Investgiations for colorectal cancer first line

Answer 14

Bloods - FBCs, U+Es, LFTs, clotting screen
Coeliac serology
Endoscopy, colonoscopy
Barium enema
MRI scan for rectum

Question 15

Staging investigations

Answer 15

CT thorac, abdo, pelvis = TAP
MRI scan for rectum

Question 16

Screening for colorectal cancers

Answer 16

Faecal immmunochemistry test - FIT testing

Question 17

Who is FIT testing currently offered to?

Answer 17

60-74 years

Question 18

What screening tool will be offered for over 55yrs?

Answer 18

Colonoscopy

Question 19

What are the positives?

Answer 19

High sensitivity + can remove polyps
Lower patient acceptability
Degree of risk

Question 20

Management of Colorectal cancer

Answer 20

Surgical resection - radial, local
Adjuvant/palliative chemotherapy

Question 21

What is the marker for colorectal cancer?

Answer 21

Colonic embryonic antigen - CEA

Question 22

Staging colorectal cancer

Answer 22

TNM - tumour, node, metastases
T1-T4
NX-N3
MX-M1

Question 23

2 week wait criteria CRC

Answer 23

Refer adults using asuspected cancer pathway referral(for an appointment within 2weeks) for colorectal cancer if:

• they are aged 40 and over withunexplainedweight loss and abdominal painor
• they are aged 50 and over with unexplained rectal bleedingor
• they are aged 60 and over with:
  
  • iron‑deficiency anaemiaor
  • changes in their bowel habit,or
• tests show occult blood in their faeces.

Consider a suspected cancer pathway referral (for an appointment within 2weeks) for colorectal cancer in adults with a rectal or abdominal mass.

Consider a suspected cancer pathway referral (for an appointment within 2weeks) for colorectal cancer in adults aged under 50 with rectal bleedingandany of the following unexplained symptoms or findings:

• abdominal pain
• change in bowel habit
• weight loss