Cancer Flashcards
1
Q
Colorectal cancer: risk factors
A
- Family history of bowel cancer
- Familial adenomatous polyposis(FAP)
- Hereditary nonpolyposis colorectal cancer(HNPCC), also known asLynch syndrome
- Inflammatory bowel disease (Crohn’s or ulcerative colitis)
- Increased age
- Diet (high in red and processed meat and low in fibre)
- Obesity and sedentary lifestyle
- Smoking
- Alcohol
2
Q
FAP
A
autosomal dominant condition causing malfunctioning of tumour suppressor gene resulting in polyps in the large intestine.
3
Q
Colorectal cancer symptoms
A
- Change in bowel habit (usually to more loose and frequent stools)
- Unexplained weight loss
- Rectal bleeding
- Unexplained abdominal pain
- Iron deficiency anaemia (microcytic anaemia with low ferritin)
- Abdominal or rectal mass on examination
- Bowel obstruction: severe abdominal pain, nausea and vomiting
4
Q
Criteria for two week wait for colorectal cancer
A
- Over 40 years with abdominal painandunexplained weight loss
- Over 50 years with unexplained rectal bleeding
- Over 60 years with a change in bowel habit or iron deficiency anaemia
- Test shows occult blood in their faeces
- Adults with rectal or abdominal mass
5
Q
Colorectal cancer investigations
A
- bedside:- full set of obs
- bloods:- FBC to look for anaemia- U+Es for baseline- LFTs to look for liver mets- CEA for baseline
- imaging:- colonoscopy is diagnostic, contrast CT chest abdo pelvis for staging
- special tests:- biopsy taken during colonoscopy
6
Q
Colorectal cancer management
A
- conservative:- MDT involvement esp post op (dietician, stoma nurse, physio)
- medical:- chemo- radiotherapy
- surgical:- hemi or total colectomy
7
Q
Colorectal cancer imaging
A
- Colonoscopy: gold standard, can get biopsies
- Sigmoidoscopy: endoscopy of rectum and sigmoid colon only, can miss cancer in other parts of the colon
- CT colonography: can be considered in patients unfit for colonoscopy, less detailed doesnt allow for biopsies
- Staging CT scan (CT thorax, abdomen and pelvis (CT TAP)): to look for metastasis and other cancer, can be used after diagnosis or for vague symptoms
- CEA: can predict relapse not helpful in treating
8
Q
Operations in colorectal cancer
A
- Right hemicolectomy: removal of thecaecum,ascendingandproximal transverse colon.
- Left hemicolectomy: removal of thedistal transverseanddescending colon.
- High anterior resection: removing thesigmoid colon(sigmoid colectomy).
- Low anterior resection: removing thesigmoid colonandupper rectumbut sparing the lower rectum and anus.
- Abdomino-perineal resection (APR)involves removing therectumandanus(plus or minus the sigmoid colon) and suturing over the anus. It leaves the patient with a permanent colostomy.
9
Q
Hartmanns procedure
A
Usually an emergency procedure that involves the removal of the rectosigmoid colon and creation of an colostomy. The rectal stump is sutured closed. The colostomy may be permanent or reversed at a later date. Common indications are acute obstruction by a tumour, or significant diverticular disease.
10
Q
Complications of surgery for bowel cancer
A
- Bleeding, infection and pain
- Damage to nerves, bladder, ureter or bowel
- Post-operative ileus
- Anaesthetic risks
- Laparoscopic surgery converted during the operation to open surgery (laparotomy)
- Leakage or failure of the anastomosis
- Requirement for a stoma
- Failure to remove the tumour
- Change in bowel habit
- Venous thromboembolism (DVT and PE)
- Incisional hernias
- Intra-abdominal adhesions
11
Q
Colorectal cancer: follow up
A
- Serum carcinoembryonic antigen (CEA)
- CT thorax, abdomen and pelvis
- Normally over 3 years
12
Q
Screening for bowel cancer
A
- The Faecal immunochemical test (FIT)
- People aged 60-74 are sent a home FIT test to do every 2 years- if positive referred for colonoscopy
- Patients with FAP, HNPCC or IBD are offered colonoscopy’s at regular intervals to screen for bowel cancer
13
Q
Other incidents to use FIT
A
- For patients who don’t meet the two week weight criteria
- Over 50 with unexplained weight loss and no other symptoms
- Under 60 with a change in bowel habit
14
Q
Treatment for different types of bowel cancer
A
- Caecal, ascending or proximal transverse colon: Right hemicolectomy - Ileo-colic anastomosis
- Distal transverse, descending colon: Left hemicolectomy - Colo-colon anastomosis
- Sigmoid colon: High anterior resection - Colo-rectal anastomosis
- Upper rectum: Anterior resection (TME) - Colo-rectal anastomosis
- Low rectum: Anterior resection (Low TME) - Colo-rectal anastomosis (+/- Defunctioning stoma)
- Anal verge: Abdomino-perineal excision of rectum- no anastomosis
15
Q
Types of lung cancer
A
- Small cell lung cancer (20%)
- Non small cell lung cancer (80%)
- Non small cell lung cancer can be split into: Adenocarcinoma (40%), squamous cell carcinoma (20%), Large cell carcinoma (10%)
