Colorectal cancer

• Colorectal cancer is the 4th most common cancer in the UK.

  2nd most common cancer death in the UK.
• What are the RFs of colorectal cancer?

  Older age

  Smoking

  Obesity/overweight

  Alcohol consumption

  Constipation/low-fibre diet

  FHx
• What hereditary syndromes can contribute to the development of colorectal cancer?

  HNPCC/Lynch Syndrome

  Familial Adenomatous Polyposis (FAP)
• What is Lynch Syndrome?

  Autosomal dominant

  Most common inherited cause (3%)

  Not just CRC -> endometrial, ovarian, small bowel, gastric

  Genetic mutations in mismatch repair genes -> MLH1, LSH2, MSH6, PMS2
• What is Familial Adenomatous Polyposis (FAP)?

  Autosomal dominant

  1% of CRC

  Mutation in APC

  Characterised by development of numerous adenomatous polyps -> some will undergo malignant change

  90% of ppl will develop CRC before 45

  Screening = annual colonoscopy

  Associated with -> duodenal polyps, upper GI malignancy (less common)
• What are polyps?

  Benign epithelial neoplasm

  Pre-malignant -> if adenomatous

  Risk of malignancy increases with size (more common in villous rather than tubular lesions)

  Mostly asymptomatic
• Which tumour marker is used to monitor response to therapy in CRC?

  Carcinoembryonic antigen (CEA)
• What are the red flag symptoms to make you think bowel cancer?

  Change in bowel habit

  Unexplained weight loss

  Rectal bleeding

  Unexplained abdominal pain

  Iron deficiency anaemia

  Abdominal or rectal mass on examination

  Can present with obstruction

  • partial obstruction = passing wind but not stool
  • complete obstruction = no passage of wind or stool
• What are the criteria for a '2 week wait' for bowel cancer?

  Over 40 with abdo pain AND unexplained weight loss

  Over 50 with unexplained rectal bleeding

  Over 60 with change in bowel habit or iron deficiency anaemia
• What is the screening for bowel cancer?

  Offered to everyone 54-74 (may be moving to lower age 50-74) every 2 years

  Sent FIT (faecal immunochemical test) -> looks for human Hb in stool

  If +ve -> colonoscopy
• How is the level in the FIT test different in screening (asymptomatic) vs symptomatic pts?

  Symptomatic = 10

  Asymptomatic = 120
• What are the Inx for colorectal cancer?

  Obs

  Full Hx & examination

  FIT

  Colonoscopy (gold standard)

  Sigmoidoscopy

  CT colonography (done in pts who are less fit for colonoscopy)

  Staging CT scan/PET scan

  CEA
• What staging is used in CRC?

  TNM staging
• What is the management of CRC?

  Surgery

  Neoadjuvant therapy

  Adjuvant therapy
• What surgery is shown in the image

  Right hemicolectomy

  
• What surgery is shown in the image?

  Left hemicolectomy

  
• What surgery is shown in the image

  Abdominoperineal resection

  
• What surgery is shown in the image?

  Anterior resection

  
• What surgery is shown in the image?

  Panproctocolectomy

  
• What surgery is shown in the image?

  Total colectomy

  
• What surgery is shown in the image?

  Hartmann's Procedure

  • sigmoid colectomy
  • stoma formation
  • emergency procedure
  • bowel perforation/obstruction

  
• What are the different types of stomas?

  Ileostomy

  • RIF
  • Spouted (as contents are still acidic)
  • liquid/mushy contents

  Colostomy

  • LIF
  • flush to skin
  • fairly solid contents