L28: Diverticular Disease + Colorectal Cancer

Question 1

What is the most common type of colorectal cancer?

Answer 1

Adenocarcinoma

Question 2

List the 4 macroscopic types of colorectal cancer

Answer 2

1. Fungating Polypoid Tumour
2. Annular Constricting Tumour
3. Flat Ulcerated
4. Mucinous

Question 3

List the common tumour sites of colorectal cancer for most common to least

Answer 3

1. Descending + Sigmoid
2. Rectum
3. Right-Sided
4. Transverse

Question 4

What is the most common site for colorectal cancer?

Answer 4

descending + sigmoid colon

Question 5

What is CEA and what is it used for?

Answer 5

Carcinoembryonic Antigen

- used to monitor colorectal cancer + if treatment is working

Question 6

What is the gold standard investigation to diagnose colorectal cancer?

Answer 6

Endoscopy

Question 7

Which classification system is used to rate the severity of colorectal cancer? (hint: not TNM)

Answer 7

Dukes’ Classification

Question 8

What is Dukes’ Classification?

Answer 8

used to rate severity of colorectal cancer + gives prognosis

Question 9

What does Dukes A classification mean?

Answer 9

CRC confined to bowel wall

Question 10

What does Dukes B classification mean?

Answer 10

CRC invades through muscularis propria

Question 11

What does Dukes C classification mean?

Answer 11

CRC invaded regional lymph nodes

Question 12

What does Dukes D classification mean?

Answer 12

CRC has distant mets

Question 13

When is a right hemicolectomy done?

Answer 13

for right-sided CRC tumours

Question 14

When is a left hemicolectomy done?

Answer 14

for left-sided CRC tumours

Question 15

If there is CRC as well as positive lymph nodes and evidence of vascular invasion, what adjuvant therapy may be given?

Answer 15

adjuvant chemotherapy

Question 16

If there is a rectal tumour in the upper 1/3 of the rectum, what surgery may be done?

Answer 16

a high anterior resection

Question 17

If there is a rectal tumour in the middle and lower 1/3 of the rectum, what surgery may be done?

Answer 17

a low anterior resection

abdomino-perineal resection (APR)
- removes anus, rectum + sigmoid colon

Question 18

If a kit test for faecal occult blood is positive, what should be done?

Answer 18

• kit screens for occult blood in faeces
• screening for CRC
• pt referred for full colonoscopic evaluation

Question 19

What is diverticular disease mainly caused by?

Answer 19

constipation + increased colonic pressure

Question 20

Which part of the colon does diverticular disease predominantly affect?

Answer 20

the sigmoid colon

Question 21

What are the 2 types of diverticular disease?

Answer 21

1. Diverticulosis

2. Diverticulitis

Question 22

What is diverticulosis?

Answer 22

• presence of outpouchings in colon
• asymptomatic
• incidental finding

Question 23

What is diverticulitis?

Answer 23

• presence of outpouchings in colon

- has associated inflammation

Question 24

List some of the symptoms and signs of diverticulitis

Answer 24

• fever
• lower inguinal fossa pain
• diarrhea/constipation
• bleeding
• nausea + vomiting
• tachycardia
• guarding of area

Question 25

List some of the complications of diverticular disease

Answer 25

- inflammation (diverticulitis) - bleeding - perforation ± peritonitis - obstruction - fistula (e.g. colovesical/enterovesical) - stricture formation - pericolic or paracolic abscess

Question 26

How is inflammation of a diverticula managed?

Answer 26

with antibiotics

Question 27

What is the Hinchey Classification used for?

Answer 27

acute diverticulitis - is used to describe perforations of the colon due to diverticulitis - helps in determining treatment

Question 28

What is Hinchey Classication 1A?

Answer 28

paracolic phlegmon

Question 29

What is Hinchey Classification 1B?

Answer 29

pericolic/mesenteric abscess

Question 30

What is Hinchey Classification 2?

Answer 30

diverticulitis w/ walled-off abscess

Question 31

What is Hinchey Classification 3?

Answer 31

purulent peritonitis (perforated abscess cavity)

Question 32

What is Hinchey Classification 4?

Answer 32

faeculent peritonitis | - indication for surgery

Question 33

According to the Hinchey Classification, what is considered UNCOMPLICATED diverticulitis?

Answer 33

Hinchey 1, 2 and 3

Question 34

According to the Hinchey Classification, what is considered COMPLICATED diverticulitis?

Answer 34

Hinchey 4

Question 35

What is the main treatment for UNCOMPLICATED diverticulitis?

Answer 35

IV antibiotics

Question 36

What is the main treatment for COMPLICATED diverticulitis?

Answer 36

surgery

Question 37

In regards to diverticular disease, when may an End Colostomy (Hartmann's Procedure) be done?

Answer 37

if complicated diverticulitis + a complication (such as perforation) - otherwise, affected parts removed and rest of colon anastomosed together