Bowel Cancer Flashcards
Bowel cancer
Colorectal cancer One of the most common types of cancer in NZ Diagnosed & treated early survival rate of 5 years + is approx. 50% Often undetected in early stages as asymptomatic Prevention & early screening
Cause
◦ Exact cause unknown
Risk factors include:
History of intestinal polyps, inflammatory bowel disease Hereditary Aged 50+ Obesity, sedentary lifestyle Diet high in animal fat Smoking
Signs & symptoms
Vary with the anatomic location of the tumour ◦ Initially may be asymptomatic ◦ Fatigue ◦ Weakness ◦ Loss of appetite ◦ Weight loss ◦ Blood in stool
Ascending colon & caecum tumours symptoms
Abdominal pain R) lower quadrant ◦ Iron deficiency anaemia ◦ Occult blood in stool ◦ Palpateable mass ◦ Weakness ◦ Weight loss ◦ Tumours may be large before causing changes in bowel habit
Transverse colon tumours
Including the R) & L) flexures ◦ Occult blood in the stool ◦ Constipation ◦ Altered frequency bowel movements ◦ Abdominal fullness ◦ Cramp abdominal pain
Descending colon
Bright red rectal bleeding
◦ Ribbon shaped stools
◦ Colicky abdominal pain
◦ Alternating constipation & diarrhoea
◦ Nausea/vomiting
◦ These tumours may be ulcerative & infiltrate the
bowel
Sigmoid colon & rectum
◦ Dull or aching pain in sacrum or rectum
◦ Feeling of rectal fullness
◦ Bright red blood from rectum
◦ Narrow stools
◦ Tenesmus (painful, ineffective straining to empty
bowel)
◦ Anaemia
Diagnostic
History & physical examination ◦ Rectal examination (PR) ◦ Sigmoidoscopy ◦ Colonoscopy ◦ Barium enema ◦ Faecal occult blood specimen ◦ Blood tests (FBC’s & U&E's, LFT’s) ◦ CXR ◦ Abdo USS
Duke’s modified classification & prognosis
◦ Duke’s A Confined to the bowel wall 72% survive 5yrs ◦ Duke’s B Extended through bowel wall 56% survive 5yrs ◦ Duke’s C Regional lymph node involvement 35% survive 5yrs ◦ Duke’s D Distant metastases 0% survive 5yrs
Treatment
◦ Surgery: first line
◦ Type depends on the location & extent of tumour
◦ R) Hemicolectomy: tumours of the caecum &
ascending colon
◦ L) Hemicolectomy: tumours of the descending &
sigmoid colon
◦ Transverse colectomy: middle or L) transverse colon
Surgery
◦ Anterior resection: proximal & mid rectal tumours
◦ Anterior-posterior resection: advanced disease
◦ Abdominoperineal resection: malignant tumours of
the lower sigmoid colon, rectum & anus. Too low
for anastomosis
