Colorectal tumours

Question 1

Top prevalence of cancers

Answer 1

Breast

Prostate

Lung

Bowel

Question 2

Risk factors

Answer 2

Family history of bowel cancer

Familial adenomatous polyposis

Hereditary nonpolyposis colorectal cancer (Lynch)

IBD

Increased age

High red and processed meat diet

Obesity and sedentary lifestyle

Smoking

Alcohol

Question 3

Familial adenomatous polyposis

Answer 3

Autosomal dominant

Malfunctioning of tumour suppressor gene called adenomatous polyposis coli

Results in many polyps in large intestines

Polyps have potential to become cancerous

Remove entier large intestine

Question 4

Hereditary nonpolyposis colorectal cancer

Answer 4

Lynch syndrome

Autosomal dominant

Mutations in DNA mismatch pair genes

Doesn’t cause adenomas, tumours develop in isolation

Question 5

Presentation

Answer 5

Change in bowel habit

Unexplained weight loss

Rectal bleeding

Unexplained abdominal pain

Iron deficiency anaemia

Abdominal or rectal mass on examination

Question 6

2 week wait referral

Answer 6

Over 40 with abdo pain and unexplained weight loss

Over 50 with unexplained rectal bleeding

Over 60 with a chnage in bowel habit or iron deficiency anaemia

Question 7

FIT test

Answer 7

Looks for the amount of human haemoglobin in the stool

Used to assess for bowel cancer in patients who don’t meet 2 week wait referral
- over 50 with unexplained weight loss and no other symptoms
- under 60 with a change in bowel habits

Question 8

Colonoscopy

Answer 8

Gold standard investigation

Endoscopy to visualise entire large bowel

Suspicious lesions can be biopsied to het histological diagnosis

Can tattoo in preparation for surgery

Question 9

Sigmoidoscopy

Answer 9

In cases where the only feature is rectal bleeding

Risk of missing cancers in other parts of the colon

Question 10

CT colonography

Answer 10

CT scan with bowel prep and contrast to visualise colon in more detail

Considered in patients less fit for colonoscopy

Less detailed and doesn’t allow for biopsy

Question 11

Staging CT scan

Answer 11

Full CT CAP

Used to look for metastasis and other cancers

Used after diagnosis of colorectal cancer or as part of initial workup in patients with vague symptoms

Question 12

Carcinoembryonic antigen

Answer 12

Tumour marker blood test for bowel cancer

Used in predicting relapse in patients previously treated for bowel cancer

Question 13

Right hemicolectomy

Answer 13

Removal of caecum, ascending and proximal transverse colon

Question 14

Left hemicolectomy

Answer 14

Removal of distal transverse and descending colon

Question 15

High anterior resection

Answer 15

Removal of sigmoid colon

Question 16

Low anterior resection

Answer 16

Removal of sigmoid colon and upper rectum but sparing lower rectum and anus

Question 17

Abdomino-perineal resection

Answer 17

Removal of rectum and anus (plus or minus sigmoid) and suturing over anus

Leaves patient with permanent colostomy

Question 18

Hartmaan’s procedure

Answer 18

Usually emergency procedure to remove rectosigmoid colon and creation of colostomy

Rectal stump sutured closed

Colostomy may be permanent or reversed later

Question 19

Indications for Hartmaan’s procedure

Answer 19

Acute obstruction by a tumour or significant diverticular disease

Question 20

Complications following surgery

Answer 20

Bleeding, infection and pain

Damage to nerves, bladder, ureter or bowel

Post-operative ileus

Anaesthetic risks

Leakage or failure of the anastomosis

Requirement for a stoma

Failure to remove the tumour

Change in bowel habit

VTE

Incisional hernias

Intra-abdominal adhesions

Question 21

Low anterior resection syndrome

Answer 21

Urgency and frequency of bowel movements

Faecal incontinence

Difficulty controlling flatulence