Colorectal carcinoma Flashcards
What is the most common histological type?
adenocarcinoma
What age does it typically present?
> 60yrs
What are the predisposing factors?
- neoplastic polyps
- IBD
- genetic predisposition e.g. HNPCC, FAP
- diet - low fibre, red + processed meat
- alcohol
- smoking
- previous cancer
What is the presentation of left sided ca?
bleeding/mucus PR
altered bowel habit or obstruction
tenesmus
mass PR
How does R-sided present?
WL
Low Hb
Abdo pain
Obstruction less likely
How can either side present?
abdo mass
perforation
haemorrhage
fistula
What tests would u do?
FBC - microcytic anaemia Faecal occult blood Sigmoid/colonoscopy LFT + liver MRI/US CEA (monitor disease)
How is disease staged?
TNM Stage 1 - T1/T2 Stage 2 - T3/T4 Stage 3 - N1/N2 Stage 4 - M1
How does it spread?
local
lymphatic
blood - liver lung bone
Transcolaemic
What areas of the bowel are right hemicolectomies reserved for?
caecal
ascending
proximal transverse colon
What areas of the bowel are left hemicolectomies reserved for?
distal transverse
descending colon
How are sigmoid tumours managed surgically?
sigmoid colectomy
What is an abdominal-perineal resection?
permanent colostomy and removal of rectum and anus
When is hartmanns procedure indicated?
emergency bowel obstruciton
perforation
palliation
When is radiotherapy indicated in the management of colorectal canceR?
palliation
sometimes pre-op in rectal cancer to allow resection
post-op in those w rectal tumours at high risk of local recurrence
