Give at least 3 risk factors for colorectal cancer
- increasing age
- FHx of colorectal cancer
- hereditary non-polyposis colorectal cancer (HNPCC) aka lynch syndrome
- Familial adenomatous polyposis (FAP)
- inflammatory bowel disease
- obesity
What is the most common form of inherited colon cancer
HNPCC (Lynch syndrome)
What gene mutations are associated with hereditary non-polyposis colorectal carcinoma
MSH2 (60% of cases)
MLH1 (30%)
What prophylactic management is recommended for the prevention of colorectal cancer in familial adenomatous polposis
total proctocolectomy with ileal pouch anal anastomosis (IPAA)
What are the presenting features of colorectal cancer
- change in bowel habit - diarrhoea and constipation
- rectal bleeding - bright red or melena
- abdo pain and discomfort
- unexplained weight loss
- iron-deficiency anaemia
What test should be done to determine the need for an urgent colorectal cancer oathway referral
Faecal Immunochemical Test (FIT) testing
When should a FIT be offered for suspected colorectal cancer
- abdominal mass
- change in bowel habit
- iron-deficiency anaemia, or
- ≥ 40 yrs with unexplained weight loss and abdominal pain
- ≤ 50 yrs with rectal bleeding and either of the following unexplained symptoms: abdominal pain or weight loss
- ≥ 50 yrs with any of the following unexplained symptoms: rectal bleeding, abdo pain or weight loss
- ≥ 60 yrs with anaemia even in the absence of iron deficiency
What FIT result would prompt using a suspected cancer pathway referral for colorectal cancer
≥ 10 micrograms of haemoglobin per gram of faeces
What are the next steps if a FIT test comes back negative
- safety netting
- refer to appropriate secondary care pathway if there’s clinical concern of cancer
What investigations should be done for suspected colorectal cancer
- GS: colonoscopy with biopsy
- flexible sigmoidoscopy w biopsy - if there’s only rectal bleeding
- CT colongraphy - for patients unfit for colonoscopy (doesn’t allow for a biopsy)
- staging CT scan - chest, abdo and pelvis
- tumour marker: carcinoembryonic antigen (CEA)
How is colorectal cancer managed
- surgical resection
- chemotherapy
- Radiotherapy
- palliative care
What part of the bowel is removed in a right hemicolectomy
Caecal, ascending and proximal transverse colon
What part of the bowel is removed in a left hemicolectomy
Distal transverse and descending colon
What part of the bowel is removed in a High anterior resection
Sigmoid colon
What part of the bowel is removed in a low anterior resection
Upper rectum and sigmoid colon
What procedure be done for rectalcancer on the anal verge
abdomino-perineal excision of rectum
If a colonic tumour is associated with perforation, what is there an increased risk of
anastomosis -> end colostomy needed
What is Hartmann’s procedure
When resection of the sigmoid colon is performed and an end colostomy is created
Give at least 3 complications of colorectal surgery
- minor and major bleeding
- Anastomotic dehiscence and leaks
- strictures
- fistulas
- change in bowel habit
Why is anastomotic dehiscence and leaks problematic
- A leak through a colorectal anastomosis allows feculent material into the peritoneal cavity
- This may result in peritonitis or colonic abscess formation
What are the features of anastomotic dehiscence and leaks
- typically occurs 5-7 days post-op
- abdominal pain
- pyrexia
- prolonged ileus
- abdominal findings consistent with peritonitis
- feculent/purulent drainage
What is the investigation of choice for a suspected anastomotic leak
CT abdomen and pelvis with contrast
How are anastomotic dehiscence and leaks managed
- IV fluids
- IV antibiotics
- small leaks - conservative
- larger leaks - exploratory laparotomy with possible further surgery/percutaneous drain insertion
Describe the bowel cancer screening programme in england
- screening is offered every 2 years to people aged 50-74 years
- FIT test is sent through the post
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Biliary tract disorders30
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Pancreatic disorders23
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Hepatitis47
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Colorectal & Anorectal Disorders59
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Oesophageal disorders27
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Stomach & Duodenal Disorders23
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Coeliac disease and Malabsorption27
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acute abdominal pathologies12
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Hepatic disorder (exc hepatitis)31
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malnutrition0
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IBS and IBD78
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Intestinal obstruction and ileus21
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GI Cancers25
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Hernias26
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Peritonitis8
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Genetic conditions17
