What is the most common form of bowel cancer
Colonic Adenocarcinoma
What groups of people are more likely do develop a colonic adenocarcinoma
Europe and USA 10x more common than Africa
50+ years
Men
What are the symptoms of colonic carcinoma (6)
None Anaemia Unexplained weight loss Extreme tiredness A pain or lump in your tummy Rectal blood loss
Describe the aetiology of colonic carcinoma
Most arise in polyps within the surface of the lumen
Over years these will grow and eventually progress into tumours
If removed at an early stage, cancer will not develop
Describe the kind of diet that puts a patient at the most risk of developing bowel cancer
Low in fibre
High in fat
High in meat
Low in veg
What patient controlled factors can contribute to bowel cancer
Smoking
Alcohol
Exercise
What medical and familial factors can contribute to the development of bowel cancer
Genetics - p53 in 75%
Ulcerative Colitis
Intestinal polyps
Why is stool testing important for detecting bowel cancer
Testing stool sample can often give warning of a cancer before any clinical signs are present
Describe Peutz-Jehgers Syndrome
Patient gets perioral melanosis but gets polyps in the small intestine
Low risk
Which syndromes can put patients at risk of large intestinal bowel cancer
Gardeners Syndrome
Cowden’s Syndrome
Describe Cowden’s syndrome
Mucosal polyposis where polyps are present throughout the mouth as well as the bowel
The polyps in the mouth do not progress to oral cancer
High risk
Describe the staging of colonic carcinoma including the change of survival after 5 years
A - Submucosal - 80%
B - Muscularis - 65%
C - Lymph nodes - 45%
D - Liver - 5%
How is the staging of colonic carcinomas classed
According to the level of invasion of the bowel wall
What are the different treatment options for colonic carcinomas
Surgery
Hepatic Metastases
Radiotherapy
Chemotherapy
What is the most effective treatment for colonic carcinomas
Surgical removal
Describe colon cancer surgery
Through resection of the bowel tissue
Bowel can either be anastomosed/joint together or brought out onto the surface of the patients abdomen as a stoma
Describe a stoma due to colon cancer surgery
Can be temporary or permanent
Stoma has the mucosal surface of the bowel so that the lumen empties into a bag which is placed over the stoma
The patient can empty the bag as needed
What is used for colonic carcinoma screening
FiT test - Faecal immunochemical test
Who in the UK is invited for colonic carcinoma screening
Over 50s in Scotland
Over 60s in the rest of the UK
What are a patients chance of surviving colonic carcinoma if diagnosed at stage 1 compared to stage 4
Stage 1 - 9/10 people survive more than 5 years
Stage 4 - >1/10 people survive more than 5 years
What other screening modalities can be used for colonic carcinomas
Barium Enema
Endoscopy
CT/MRI Scan
Carcinoembryonic Antigen (CEA)
