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Colorectal Cancer

Reference: OHCM 506, Lec Not Onc 100

Epidemiology

2nd most common cause of death due to cancer in the UK.

Risk Factors

Pathology

95% are adenocarcinomas.

Clinical

L-sided (75%): Melaena, change in bowel habit, obstruction, tenesmus, mass felt PR.
R-sided (15%): Anaemia, abdminal pain, (constipation is not a feature because faeces still watery in this part of the bowel).
Either side: weight loss/anorexia, mass, perforation, haemorrhage, fistula, jaundice

Differential

Diverticular disease, Inflammatory bowel disease, infective GI disease

Investigations

NB: screening has been proposed but is not currently underway.
  1. Diagnostic pathway (simplest and least sensitive first): Faecal occult blood → PR → proctoscopy → sigmoidoscopy → colonoscopy + biopsy
  2. Bloods: FBC (microcytic anaemia), LFTs (metasteses to liver), CEA (for monitoring purposes)
  3. Staging: CXR, CT abdomen/lungs, PET scan

Spread

Local (colon, viscera), lymphatic, blood (liver, lung, bone), transcoloemic

Dukes Staging Criteria

A: Bowel wall (90% 5 year survival)
B: Through wall (65% 5 year survival)
C: Lymph nodes (30% 5 year survival)
D: Distant (<10% 5 year survival)

Management

Curative

Just surgery for A and B.
Surgery + chemotherapy for C.
Surgery even possible with 3-5 liver metasteses together with chemotherapy
Radiotherapy used only for rectal cancer to ↓recurrence.

Palliative

Chemotherapy

Details of Management

Surgery:

Prognosis

60% amenable to radical surgery. See also the Dukes criteria (above)
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