Colorectal cancer

Question 1

How common is colorectal cancer?

Answer 1

3rd most common cancer in the UK. 2nd most common cause of cancer deaths in the UK. Adenocarcinoma most common.

Question 2

What is the pathology of colorectal cancer?

Answer 2

• Mostly evolve from polyps – can be solitary/multiple, pedunculated/sessile/flat
• Cell dysplasia occurs
Most cancers on the left side of the colon

Question 3

What are the risk factors/aetiology of colorectal cancer?

Answer 3

• Neoplastic polyps – i.e. Peutz-Jeghers syndrome
• Inflammatory bowel disease
• Genetics – FAP, HNPCC
• Diet - ↓ fibre, ↑ red/processes meat, ↑ fat
• Alcohol
• Smoking
• Previous history of cancer
• Drugs: NSAIDs, HRT, oral contraceptive

Question 4

What are the signs/symptoms of colorectal cancer?

Answer 4

• Weight loss
• Anaemia - cancer of the caecum
• Mass is iliac fossa - cancer of the caecum
• Colicky pain – Left colon cancer
• Rectal bleeding – Left colon cancer
• Change in bowel habit – Left colon cancer

Question 5

What diseases present similarly to colorectal cancer?

Answer 5

• Diverticular disease
• Irritable bowel syndrome
• Inflammatory bowel syndrome
• Haemorrhoids
• Anal cancer
• Ischemic colitis

Question 6

What investigations should be carried out in suspected colorectal cancer?

Answer 6

• FBC, LFTs
Tumour marker CAE (cariconembryonic antigen)
• Colonoscopy – gold standard
• Flexible sigmoidoscopy/barium enema – alternative
• CT colongraphy
Screening for those at high risk e.g. family history

Question 7

What are the surgical treatments for colorectal cancer?

Answer 7

• Colonic stents

* Colectomy (which type depends on location/severity of cancer)

Question 8

What are the pharmacological treatments for colorectal cancer?

Answer 8

• Radiotherapy

* Chemotherapy