Colorectal/Anal Disease

Question 1

Types of colorectal tumour?

Answer 1

Adenoma

Adenocarcinoma

Question 2

How do you differentiate/stage colorectal cancer?

Answer 2

Duke’s staging (5 year survival)
- based on depth of tumour formation

TNM staging

NEED BIOPSY

Question 3

What is the highest risk factor for colorectal cancer?

Answer 3

Smoking

Question 4

Specific symptoms of colorectal cancer? (4)

Answer 4

Anaemia (due to bleeding/malabsorption)
Change in bowel habits
Tenesmus
Abdo mass

Question 5

Investigation of colorectal cancer?

Answer 5

Colonoscopy
Pill endoscopy
CT colongraphy

Question 6

Treatment of colorectal cancer?

Answer 6

Colectomy (removal of affected area and anatomise the two regions)

Radiotherapy - adjuvant or neoadjuvant

Question 7

What is the only big difference between anorectal and colorectal cancer?

Answer 7

Anorectal cancers can be adenocarcinoma or SCC (from adjacent skin)
Colorectal - just adenocarcinoma

Question 8

Who gets bowel cancer screening (FOB test)?

Answer 8

Pts 50-75 yo with risk factors every 2 yrs

Question 9

What is diverticular disease? What is diverticulitis?

Answer 9

Diverticula which are symtpomatic

Diverticulitis - inflammation of diverticulum

Question 10

What causes diverticulum to form

Answer 10

Low fibre diet

Colon has to work harder to move faeces … ADD

Question 11

Signs and symptoms of diverticulitis

Answer 11

Symptoms like appendicits but on other side

Severe LIF pain
Fever
Tachycardia
Tenderness and guarding (muscle tenses around area of disease) of left side

Question 12

Symptoms and signs of diverticular disease

Answer 12

Similar to IBD

LIF pain - colic (coming and going)
Altered bowel habit

Question 13

Invx of diverticular disease

Answer 13

Colonscopy

Question 14

Invx of diverticulitis?

Answer 14

-CT (gold)
-Increased ESR and CRP
DO NOT SCOPE -> perforation

Question 15

Complications of diverticulitis (4)

Answer 15

Complications of diverticulitis = complicated diverticultis

Perforation
Haemorrhage
Fistula
Stricture

Question 16

When would you use hinchey classification?

Answer 16

For acute diverticulitis (based on CT findings - used to find best treatment in diverticulitis complicated with abscess formation/peritonitis)

Question 17

Treatment of diverticular disease

Answer 17

Balanced diet
Analgesia
Bulking laxative

Question 18

Treatment of Uncomplicated diverticulitis

Answer 18

Analgesia if necessary

Antibiotics if suspected infection

Question 19

Treatment of complicated diverticultis?

Answer 19

Precutatneous drainage of large abscess

Hartmann’s procedure (removal of sigmoid coloon)

Question 20

Where is diverticulum most likely to occur?

Answer 20

Sigmoid colon - due to narrowing

Question 21

What is a colonic polyp?

Answer 21

Abdnormal growth of tissue projecting from colonic mucosa

Question 22

What is the most important polyp to know about?

Answer 22

Adenoma - all dysplastic (potential to become cancerous)

Question 23

What inherited conditions put you at an increased risk of polyp formation?

Answer 23

Familial adenomatous polyposis (FAP)
- loads and loads of adenomas - very very high risk of cancer

Lynch syndrome - lots of adenomas on right side

Peutz-jeghers syndrome - Multiple benign intestinal hamartomas

Question 24

What gene is their a mutuation in FAP and Lynch syndrome?

Answer 24

FAP - APC gene (tumour suppressor disease)

Lynch - MSH2 gene (DNA mismatch repair))

Question 25

Signs and symtpoms of colonic polyps?

Answer 25

``` Asymptomatic mostly Rectal bleeding (often not frank) -> anaemia Mucus in stool Abdo pain Bowel change ```

Question 26

Invx of colonic polyps?

Answer 26

- Fam history (inhertited conditions and cancers) - Genetic testing - Colonscopy

Question 27

What is a haemorrhoid?

Answer 27

Enlargement of the vascular cushions in the wall of the anus and rectum due to increased pressure

Question 28

Treatment of haemorrohoid?

Answer 28

Increase fibre and fluid | ADD

Question 29

Where is the first site of metastasises of colorectal cancer?

Answer 29

Liver Due to haematological spread via portal system

Question 30

What is the difference between a true diverticulum and psudeo diverticulum?

Answer 30

Pseudo is missing muscularis externa

Question 31

Difference between hyperplastic polyp and adenoma

Answer 31

Hyperplastic polyp - v. v. low risk of becoming malignant Adenoma - high risk of malignancy (found in FAP)

Question 32

Most commonly used tumour marker in colorectal cancer?

Answer 32

CEA

Question 33

Pseudomembranous colitis (yellow plaques that are easily dislodged) is associated with what condition?

Answer 33

C.diff