Bowel Cancer

Question 1

Risk Factors for Bowel Cancer?

Answer 1

Family History

Familial Adenomatous Polyposis

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) - lynch Syndrome

IBS

Diet: High in Red/Processed Meat and Low Fibre

Obese

Smoke

Alcohol

Question 2

What is Familial Adenomatous Polyposis

Answer 2

Autosomal Dominant

Malfunctioning of tumour suppressor genes (APC)

Results in many polyps along large intestine

Annual Flexisigmoidoscopy

Treat: panproctocolectomy (remove large intestine to prevent development of bowel cancer)

Question 3

What is HNPCC/Lynch Syndrome?

Answer 3

Autosomal Dominant

Mutations in DNA Mismatch Repair Genes

Risk of Bowel Cancer, Endometrial Cancer, Gastric Cancer

Colonoscopy every 1-2 years

Question 4

Red Flags for Bowel Cancer

Answer 4

Change in Bowel Habit

Weight Loss

Rectal Bleed

Iron Deficiency Anaemia (Microcytic Anaemia with Low Ferritin)

Mass

Obstruction

Question 5

What is FIT Testing?

Answer 5

Looking for Human Haemoglobin in Stool

Over 50 with Unexplained Weight Loss and no other symptoms

Under 60 with change in bowel habit

Screening: 60-74 years Old every 2 years

Question 6

Bowel Cancer Testing?

Answer 6

Colonoscopy Gold Standard

CT Colonography

Stage CT

Cardioembryonic Antigen (CEA) Tumour Marker: predict relapse

Question 7

Classification of Bowel Cancer?

Answer 7

Dukes

• A: Confined to mucosa and part of muscle of bowel wall

b: extend through muscle of bowel wall

c: lymph node involve

d: metastatic

Question 8

Treating Bowel Cancer

Answer 8

Surgery
Chemo
Radiotherapy

Question 9

Surgical options for Bowel Cancer

Answer 9

Right Hemicolectomy: remove caecum, ascending and proximal transverse colon

left hemicolectomy: distal transverse and descending colon

high anterior resection: sigmoid colon

low anterior resection: sigmoid colon and upper rectum

hartmann’s: remove of rectosigmoid colon and create colostomy used for obstruction or sig diverticular disease