FN: Colorectal Carcinoma: Ix, Mx and Prevention Flashcards Preview

Final Notes > FN: Colorectal Carcinoma: Ix, Mx and Prevention > Flashcards

Flashcards in FN: Colorectal Carcinoma: Ix, Mx and Prevention Deck (19):
1

Bloods show

FBC: Hb
LEFTs: mets
Tumour Marker: CEA (carcinoembryonic Ag)

2

Imaging

CXR: lung mets
Us liver: mets
CT and MRI
-staging
- MRI best for rectal Ca and liver mets
Endoanal US: staging rectal tumuors
Ba/gastrogaffin enema: apple-core lesion

3

endoscopy + biopsy

Flexi sig: 65% of tumours accessible
Colonoscopy

4

Staging

Dukes (spread)
TNM

5

Grading

Grading from low to high
Based on cell morphology
Dysplasia, mitotic index, hyperchromatism

6

Management

1. Manage in an MDT
2. Confirmation of Dx
3. Stage with CT or MRI
4. 60% amenable to redical surgery

7

Surgery

1. Use ERAS pathway
2. Pre-operative bowel prep (except R sided lesions)
3. Consent: discuss stomas
4. stoma nurse consult for siting

8

Bowel prep type

Kleen prep (Macrogol: osmotic laxative) the day before and phosphate enema in the AM

9

Principals

1. excision depends on lymphatic drainage which follows arterial supply
2. Mobility of bowel and blood supply at cut ends is also important
3. Hartmanns often used if obsruction
4. Laparoscopic approach is the standard of care

10

Rectal Ca

1. Neo-adjuvant radiotherapy may be used to reduced local recurrence and increased in 5yrs
2. Anterior resection: tumour 4-5cm from anal verge: defunction with loop ileostomy
3. AP resection:

11

Sigmoid tumours management

Sigmoid: high anterior resection or sigmoid colectomy

12

Left tumour mx

Left hemicolectomy

13

Transverse tumour mx

extended right hemicolectomy

14

Caecal/right mx

Right hemicolectomy

15

Other Rx

1. Local excision e.g. transanal endoscopic Microsurg
2. Bypass surgery: palliation
3. Hepatic resection: if single lobe mets only
4. Stentin: palliation or bridge to surgery in obstruction
5. Chemo

16

chemo

Adjuvant 5-FU for DUkes C reduced mortality by 25% i.e. LN +ve pts

High grade tumour
Palliation of metastatic disease

17

NHS Screening for CRC 2

FOB
Flexi Sig

18

FOB Testing

1. Introducing in 2006
2. 60-75yrs
3. Home FOB testing every 2yrs - 1/50 have +ve FOB
4. Colonoscopy if +ve 1/10 have Ca
5. Lindholm et al BJS 2008 - screening reduces the risk of dying form CRC by 25%

19

Flexi sig

Introduced in 2011/2012
55-60yrs
Once only flexi sig
Atkin et l Lancet 2010
1. reduced CRC incidence by 33%
2. reduced CRC mortality by 43%

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