Colorectal Cancer

Question 1

Is colorectal cancer more common in the colon or rectum?

Answer 1

Colon

Question 2

What are the risk factors for CRC?

Answer 2

Age
Male 
Previous adenoma 
Diet/obesity 
lack of exercise 
smoking 
DM

Question 3

What is the significance of colorectal polyps?

Answer 3

Majority of CRC arise from pre-existing polyps

Question 4

What is the highest risk type of Colorectal polyp?

Answer 4

Adenomas

Question 5

What are adenomas

Answer 5

Pre-malignant, benign polyps

Question 6

What are the 3 main histological types of adenomas?

Answer 6

Tubular
Villous
Tubulovillous

Question 7

What are the clinical presentations of CRC?

Answer 7

Rectal bleeding
Altered bowel habit 
Iron deficiency 
Palpable rectal or right lower abdominal mass 
Weight loss 
Anorexia

Question 8

What are the investigations for suspected CRC?

Answer 8

Colonoscopy
Biopsy
Barium swallowing
FOBT

Question 9

What is the main technique/investigation used for staging CRC?

Answer 9

CT
MRI
PET

Question 10

What 2 systems are used to stage CRC?

Answer 10

TNM

Duke Classification

Question 11

In TNM what does T mean?

Answer 11

The size, position and type of tumour

Question 12

In TNM what does N stand for?

Answer 12

Lymph node involvement

Question 13

In TNM what does M mean?

Answer 13

Any metastases?

Question 14

In Dukes Classification what does A mean?

Answer 14

Tumour is confined to the mucosa

Question 15

In Duke classification what does B mean?

Answer 15

Tumour has extended through mucosa to muscle layer

Question 16

In Dukes Classification what does C mean?

Answer 16

There is involvement of lymph nodes

Question 17

In Dukes Classification what does D mean?

Answer 17

There is metastatic spread

Question 18

What is the treatment for CRC?

Answer 18

Surgery

Question 19

Can metastasis to the liver be treated in CRC?

Answer 19

Yes with partial hepatectomy

Question 20

When removing the CRC why are lymph nodes also removed?

Answer 20

For histological analysis and staging of the CRC

Question 21

Apart from surgery which other treatment is given for CRC?

Answer 21

Chemotherapy

Question 22

Why is chemotherapy given as well as surgery?

Answer 22

To mop up any micro metastases

Question 23

Who is radiotherapy given to?

Answer 23

Those with rectal cancer only

Question 24

What is general advice given to prevent CRC?

Answer 24

30 mins exercise a day
Maintain healthy BMI (between 18-25)
Don’t smoke
Balance diet

Question 25

Which age group receives the bowel screening programme?

Answer 25

50-75

Question 26

How often is the bowel screening programme offered?

Answer 26

Every 2 years

Question 27

What does the screening programme look for?

Answer 27

Blood in stool sample

Question 28

If blood is detected in the sample what is the next stage?

Answer 28

Invited for colonosocopy

Question 29

Who are considered at high risk of developing CRC?

Answer 29

Familial history of CRC IBD Previous CRC Previous adenomas

Question 30

How often are those with first degree familial history of CRC invited for colonoscopy?

Answer 30

5 yearly

Question 31

How often are those with IBD invited for colonoscopy?

Answer 31

10 yearly

Question 32

How often are those with previous CRC history invited for colonoscopy?

Answer 32

5 yearly

Question 33

How often are those with previous adenomas invited for colonoscopy?

Answer 33

Dependant on number of polyps, size, degree of dysplasia

Question 34

What is FAP?

Answer 34

Autosomal dominant condition

Question 35

What will happen if FAP gene is left untreated?

Answer 35

Nearly everyone with the gene will have CRC by the 30-40 years

Question 36

How often are those with the FAP gene screened?

Answer 36

Yearly

Question 37

If you carry the FAP gene are develop polyps what is the treatment>

Answer 37

Prophylactic proctocolectomy

Question 38

What is HNPCC?

Answer 38

Autosomal dominant conditino

Question 39

What does the HNPCC affect??

Answer 39

Mutations that affect DNA repairment

Question 40

Which side of the colon is often affected in HNPCC?

Answer 40

Right side

Question 41

When is screening offered with those with HNPCC?

Answer 41

Biannually from the age of 25