Colorectal - UNFINISHED

Question 1

Colorectal cancer is the most common type of cancer in the UK

Answer 1

false

- third most common

Question 2

Location of cancer (averages)

Answer 2

rectal: 40%
sigmoid: 30%
descending colon: 5%
transverse colon: 10%
ascending colon and caecum: 15%

Question 3

Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 40 years with

Answer 3

unexplained weight loss AND abdominal pain

Question 4

Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 50 years with

Answer 4

unexplained rectal bleeding

Question 5

Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation
patients >= 60 years with

Answer 5

iron deficiency anaemia OR change in bowel habit

Question 6

Colorectal cancer: referral guidelines
The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation includes tests showing

Answer 6

occult blood in their faeces

Question 7

NHS screening program for colorectal cancer

Answer 7

every 2 years to all men and women aged 60 to 74 years. Patients aged over 74 years may request screening.

Faecal occult blood testing

Question 8

most cancers develop from

Answer 8

adenomatous polyps

Question 9

Screening for colorectal cancer has been shown to reduce mortality by 16%

Answer 9

true

Question 10

colorectal cancer screening includes (specific tests)

Answer 10

the NHS offers home-based, Faecal Immunochemical Test (FIT) screening to older adults
another type of screening is also being rolled out - a one-off flexible sigmoidoscopy

Question 11

Faecal Immunochemical Test (FIT) tests through the post

a type of faecal occult blood (FOB) test which uses

Answer 11

antibodies that specifically recognise human haemoglobin (Hb)

used to detect, and can quantify, the amount of human blood in a single stool sample

Question 12

FIT advantages over conventional FOB tests includes

Answer 12

only detects human haemoglobin, as opposed to animal haemoglobin ingested through diet

only one faecal sample is needed compared to the 2-3 for conventional FOB tests

Question 13

FIT patients with abnormal results are offered

Answer 13

colonoscopy

Question 14

At colonoscopy, approximately:
5 out of 10 patients will have a normal exam
4 out of 10 patients will be found to have polyps which may be removed due to their premalignant potential
1 out of 10 patients will be found to have cancer

Answer 14

true

Question 15

Flexible sigmoidoscopy screening aim

Answer 15

(other than to detect asymptomatic cancers) is to allow the detection and treatment of polyps, reducing the future risk of colorectal cancer

Question 16

Flexible sigmoidoscopy screening this is being offered to people who are

Answer 16

55-years-old (one off)

Question 17

Flexible sigmoidoscopy screening patients can self-refer for bowel screening with sigmoidoscopy up to the age of

Answer 17

60, if the offer of routine one-off screening at age 55 had not been taken up

Question 18

An urgent referral (within 2 weeks) should be ‘considered’ if:

Answer 18

there is a rectal or abdominal mass
there is an unexplained anal mass or anal ulceration

patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:

• → abdominal pain
• → change in bowel habit
• → weight loss
• → iron deficiency anaemia

Question 19

Patients diagnosed as having colorectal cancer should be completely staged using

Answer 19

CT of the chest/ abdomen and pelvis.

Their entire colon should have been evaluated with colonoscopy or CT colonography.

Question 20

Patients whose tumours lie below the peritoneal reflection should have which ix

Answer 20

mesorectum evaluated with MRI.

Question 21

cancer - Once their staging is complete patients should be discussed within a dedicated colorectal MDT meeting and a treatment plan formulated.

Answer 21

true

Question 22

Cancer of the colon is nearly always treated with surgery.

Answer 22

true

Question 23

colorectal cancer palliative adjuncts. include?

Answer 23

Stents, surgical bypass and diversion stomas

Question 24

option for cure in patients with colon cancer

Answer 24

Resectional surgery

Question 25

The lymphatic drainage of the colon follows the arterial supply and therefore most resections are tailored around the resection of particular lymphatic chains (e.g. ileo-colic pedicle for right sided tumours)

Answer 25

true

Question 26

tumour in a patient from a HNPCC family mx

Answer 26

panproctocolectomy

Question 27

colorectal ca Following resection the decision has to be made regarding restoration of continuity. For an anastomosis to heal the key technical factors include

Answer 27

adequate blood supply, mucosal apposition and no tissue tension may be safer to construct an end stoma rather than attempting an anastomosis.

Question 28

When a colonic cancer presents with an obstructing lesion; the options are to

Answer 28

either stent it or resect

Question 29

Following resection patients with risk factors for disease recurrence are usually offered

Answer 29

chemotherapy, a combination of 5FU and oxaliplatin is common.

Question 30

Treatment of rectal cancer located in the rectum can be surgically resected with

Answer 30

either an anterior resection or an abdomino-perineal excision of rectum (APER).

Question 31

Treatment of rectal cancer involvement of the sphincter complex or very low tumours require

Answer 31

abdomino-perineal excision of rectum (APER).

Question 32

operating In the rectum a ?cm distal clearance margin is required

Answer 32

In the rectum a 2cm distal clearance margin is required

Question 33

rectal cancer treatment and many patients will be offered neoadjuvent radiotherapy prior to surgery

Answer 33

true

Question 34

Neoadjuvant therapy for rectal cancer relative to tumour staging:

Answer 34

Patients with T1 and 2 /N0 disease on imaging do not require irradiation and should proceed straight to surgery. Patients with T4 disease will typically have long course chemo radiotherapy. Those with T3 , N0 tumours may be offered short course radiotherapy prior to surgery.

Question 35

rectal surgery is more technically demanding, the anastomotic leak rate is higher and the danger of a positive resection margin in an unstaged patient is high

Answer 35

true

Question 36

e patients with obstructing rectal cancer should have a

Answer 36

defunctioning loop colostomy.

Question 37

Caecal, ascending or proximal transverse colon resection and anastamosis

Answer 37

Right hemicolectomy | Ileo-colic

Question 38

Distal transverse, descending colon resection and anastamosis

Answer 38

Left hemicolectomy Colo-colon

Question 39

Sigmoid colon resection and anastamosis

Answer 39

High anterior resection Colo-rectal

Question 40

Upper rectum resection and anastamosis

Answer 40

Anterior resection (TME) Colo-rectal

Question 41

Low rectum resection and anastamosis

Answer 41

``` Anterior resection (Low TME) Colo-rectal (+/- Defunctioning stoma) ```

Question 42

Anal verge resection and anastamosis

Answer 42

Abdomino-perineal excision of rectum None

Question 43

Diverticular disease is a common surgical problem. It consists of

Answer 43

herniation of colonic mucosa through the muscular wall of the colon

Question 44

Diverticular disease usual site?

Answer 44

between the taenia coli where vessels pierce the muscle to supply the mucosa. For this reason, the rectum, which lacks taenia, is often spared.

Question 45

Diverticular disease sx

Answer 45

Altered bowel habit Bleeding Abdominal pain

Question 46

Diverticular disease complications

Answer 46

``` Diverticulitis Haemorrhage Development of fistula Perforation and faecal peritonitis Perforation and development of abscess Development of diverticular phlegmon ```

Question 47

Diverticular disease Diagnosis

Answer 47

either a colonoscopy, CT cologram or barium enema All tests can identify diverticular disease Acutely unwell surgical patients should be investigated in a systematic way. Plain abdominal films and an erect chest x-ray will identify perforation. An abdominal CT scan (not a CT cologram) with oral and intravenous contrast

Question 48

Diverticular disease classification

Answer 48

Hinchey

Question 49

Describe Hinchey classification

Answer 49

I Para-colonic abscess II Pelvic abscess III Purulent peritonitis IV Faecal peritonitis

Question 50

Treatment Diverticular disease

Answer 50

Increase dietary fibre intake. | Mild attacks of diverticulitis may be managed conservatively with antibiotics.

Question 51

Treatment Diverticular disease Recurrent episodes of acute diverticulitis

Answer 51

requiring hospitalisation are a relative indication for a segmental resection.

Question 52

Treatment Diverticular disease Hinchey IV perforations

Answer 52

resection and usually a stoma. This group have a very high risk of post operative complications Less severe perforations may be managed by laparoscopic washout and drain insertion.