Colorectal Cancer

Question 1

Aetiologies?

Answer 1

Many sporadic
Certain predisposing genetic factors: HNPCC and FAP syndromes
RF: polyps, IBD, Hx and FH of cancer, low fibre diet, smoking

Question 2

Pathology?

Answer 2

95% are adenocarcinoma
Duke staing: A - confined to mucosa, B - extends to muscularis, C - lymphatic spread, D - metastases
Common metastases - liver, lung

Question 3

Signs and Symptoms?

Answer 3

Clinical pattern points to location
RHS lesion - anaemia, weight loss, pain
LHS lesion - bleeding/mucous, altered bowel habit, obstruction, abdominal mass
Both - mass, perforation, haemorrhage, fistula
Hepatomegaly in metastatic disease

Question 4

Investigations and Findings?

Answer 4

Colon/sigmoidoscopy good standard - apple core stricture on imaging = cardinal finding, visualisation of polyps
Barium enema
CT colonography
CT pelvis/abdo

Question 5

Management?

Answer 5

A staging/polyps - endoscopic resection

B/C/D staging - radio/chemotherapy then resection

Question 6

Complications?

Answer 6

IN B,C and D staging, prognosis is small