Colon Cancer

Question 1

what are the risk factors for colon cancer?

Answer 1

age 
male sex
previous adenoma (CRC)
diet (low fibre, fruit and veg, Ca & high red meat and alcohol)
obesity
lack of exercise
diabetes mellitus 
HNCC
FAP
CRC syndromes
IBD

Question 2

what is the presentation of colorectal cancer?

Answer 2

rectal bleeding (mixed in with stool)
loose stool >4wks
iron deficiency in men
non-mestration in women
palpable rectal mass or right lower abdominal mass
acute colonic obstruction
weight loss
anorexia

Question 3

what are the investigations used to diagnose colon cancer?

Answer 3

colonoscopy
barium enema
CT colonography
CT abdomen/pelvis

Question 4

what are the main treatments for colon cancer?

Answer 4

surgery
chemotherapy
radiotherapy

Question 5

when is radiotherapy given?

Answer 5

only in rectal cancer

Question 6

how is colon cancer staged?

Answer 6

TNM

dukes

Question 7

describe how dukes staging criteria works.

Answer 7

A - only invasion of submucosa
B - invasion through muscularis but not lymph node involvement
C - lymph node involvement
D - metastasis

Question 8

what treatment would someone with dukes A stage colon cancer or someone with cancer polyps have?

Answer 8

endoscopic or local resection

Question 9

in what type of cancer is radiotherapy only used for?

Answer 9

rectal cancer

Question 10

what therapy is used neoadjuvant?

Answer 10

radiotherapy

may also be with chemo

Question 11

what therapy is adjuvant?

Answer 11

chemotherapy

Question 12

what treatment is given if there is positive lymph node involvement?

Answer 12

chemotherapy

+/- surgery

Question 13

name a chemotherapy drug.

Answer 13

5-FU (fluorouracil)

Question 14

what palliative care is given to someone with colon cancer?

Answer 14

chemotherapy and/or colonic stenting

Question 15

what is the prognosis of someone with Dukes stage A,B,C and D at 5 yrs?

Answer 15

A = 83%
B = 64%
C = 38%
D = 3%

Question 16

What is the most effective screening method for colorectal cancers?

Answer 16

faecal immunological test (FIT)

Question 17

what ways can we screen for colonic cancers?

Answer 17

faecal occult blood test 
faecal immunochemical test
flexible sigmoidoscopy 
colonoscopy 
CT colonoscopy

Question 18

at what age does someone qualify for the Scottish bowel screening programme?

Answer 18

age 50-74yrs

Question 19

why is the FIT test more reliable than the FOB test?

Answer 19

FIT is more accurate as it is specific for human haemoglobin
it is both automated and quantitative
reduced interval cancer rate

Question 20

what ‘high risk groups’ are screened for colorectal cancers?

Answer 20

FAP
HNCC
inflammatory bowel disease
previous adenomas/CRC
family history of CRC

Question 21

what type of mutation causes FAP?

Answer 21

mutation of the APC gene on chromosome 5

Question 22

is FAP dominant or recessive?

Answer 22

autosomal dominant

Question 23

when are people with FAP screened for colon cancer?

Answer 23

screened from 10-12 yrs annually

Question 24

what treatment can be given to people with FAP?

Answer 24

prophylactic protocolectomy

NSAIDS chemoprevention

Question 25

what role does NSAIDS have on the treatment of FAP?

Answer 25

reduces the no. if polyps and prevents recurrence of higher grade adenomas in the retained rectal segment

Question 26

what are the complications of FAP?

Answer 26

Extra colonic manifestations i.e. Gastric, cystic, funds, hyperplastic polyps & Periampullary cancer- 90% chance of developing duodenal adenomas Desmoid tumours CHRPE - congenital retinal hypertrophy of the pigment epithelium

Question 27

is HNPCC dominant or recessive?

Answer 27

autosomal dominant

Question 28

what is the mutation in HNPCC?

Answer 28

DNA mismatch repair (MRR) genes | i.e. MLH1 & MSH2

Question 29

what is the characteristic is HNPCC tumours?

Answer 29

micro satellite instability (MSI) | frequent mutations in short repeated DNA sequences

Question 30

when does screening in people with HNPCC begin ?

Answer 30

25 yrs old - every 2 yrs

Question 31

what side is HNPCC found in the colon?

Answer 31

right side

Question 32

what are associated cancers of HNPCC?

Answer 32

endometrial genitourinary stomach pancreas

Question 33

how is HNPCC diagnosed?

Answer 33

``` genetic testing clinical criteria (amsterdam / bethesda) ```