Colorectal Cancer Flashcards
(34 cards)
Risk factors of colorectal cancer
- family history of bowel cancer
- familial adenomatous polyposis
- hereditary nonpolyposis colorectal cancer (Lynch syndrome)
- IBD
- increase age
- low fibre diet
- high red + processed meat
- obesity + sedentary lifestyle
- smoking
- alcohol
What is familial adenomatous polyposis?
- autosomal dominant condition
- malfunction of tumor suppressor gene - adenomatous polyposos coli
- casues many polyps in large intestine
- potential to become cancerous
What can be done in people with familial adenomatous polypopsis to prevent development of bowel ancer?
Panproctocolectomy + ileal pouch anal anastomosis
What is hereditary nonpolyposis colorectal carcinoma (Lynch syndrome)?
- autosomal dominant
- mutation in DNA mismatch repair genes
- higher risk of cancers esp colorectal + endometrial cancer
Presentation of colorectal cancer
- change in bowel habits > more loose + frequent stools
- blood in stools
- unexplained weight loss
- rectal bleeding
- unexplained abdominal pain
- iron deficiency anaemia
- abnormal or rectal mass
Who does NICE recommend suspected bowel cancer recognition + 2WW in?
- > 40 with abdominal pain AND unexplained weight loss
- > 50 with unexplained rectal bleeding
- > 60 with change in bowel habit or iron deficiency anaemia
What does FIT faecal immunochemical tests look at?
Amount of human haemoglobin in stool
Used in bowel cancer screening + assessment
Screening of bowel cancer
- People 60-74 sent a FIT test to do every 2 years
- If positive > colonoscopy
- people with risk factors e.g. IBD, FAP, HNPCC offered regular colonoscopies for screening
Investigations of colorectal cancer
- colonoscopy +/- biospy - gold standard
- sigmoidoscopy
- CT colongraphy
- CT TAP for staging
- CEA tumour marker
Tumour marker for bowel cancer
CEA
Carinoembyronic antigen
What classification is used in bowel cancer?
Previously Duke’s
Now TNM
Compare the presentation of right + left sided colon cancer
Right:
- occult bleeding
- bowel obstruction less likely
- mass in RIF
- more advanced at presentation
- late change in bowel habit
- fungating
.
Left:
- rectal bleeding
- bowel obstruction more likely
- mass in LIF
- less advanced at presentation
- early change in bowel habits
- stenosing
- tenesmus
Management options of colorectal cancer
- surgical resection
- chemotherapy
- radiotherapy
- palliative care
Surgical resection options for bowel cancer depending on location
- laparoscopic surgery over open surgery
- right hemicolectomy: caecum, ascending + proximal transverse colon
- left hemicolectomy: distal transverse + descending colon
- high anterior resection: sigmoid colon
- low anterior resection: sigmoid colon + upper rectum
- Abdomino-perineal resection: rectum + anus
- hartmann’s procedure: rectosigmoid colon + colostomy recreation
Indication for hartmann’s procedure
Bowel obstruction
Significant diverticula disease
Bowel perforation
Complications of bowel cancer surgery
- bleeding, infection, pain
- damage to nerves, baldder, ureter or bowel
- post op ileus
- anaesthetic risks
- converting to open surgery from laparoscopic surgery
- anatomical leak or failure
- failure to remove tumour
- stoma requirement
- change in bowel habits
- VTE
- incisional hernia
- intra-abdominal adhesions
What is removed in a right hemicolectomy?
Caecum
Ascending colon
Proximal transverse colon
What is removed in left hemicolectomy
Distal transverse colon
Descending colon
What is removed in high anterior resection?
sigmoid colon
What is removed in a low anterior resection?
Sigmoid colon
Upper rectum
What is removed in an abdomino-perineal resection?
Rectum
Anus
+/- sigmoid colon
What is low anterior resection syndrome?
Can occur after resection portion of bowel from rectum, with anastomosis between colon + rectum:
- urgency + frequency of bowel movements
- faecal incontience
- difficulty controlling flatulence
Follow up after bowel cancer surgery
Serum CEA
CT TAP
What is the most common type of colorectal cancers?
Adenocarcinoma
