Reference: OHCM 506, Lec Not Onc 100
2nd most common cause of death due to cancer in the UK.
Neoplastic polyps (tubular or villous adenomas)
Familial Adenomatous Polyposis/Hereditary Non-Polyposis
(↓fibre diet is a controversial risk factor)
95% are adenocarcinomas.
Melaena, change in bowel habit, obstruction, tenesmus, mass felt PR.
Anaemia, abdminal pain, (constipation is not a feature because faeces
still watery in this part of the bowel).
loss/anorexia, mass, perforation, haemorrhage, fistula, jaundice
Diverticular disease, Inflammatory bowel disease, infective GI disease
NB: screening has been proposed but is not currently underway.
(simplest and least sensitive first): Faecal
occult blood → PR → proctoscopy → sigmoidoscopy → colonoscopy + biopsy
FBC (microcytic anaemia), LFTs (metasteses to liver), CEA (for
CXR, CT abdomen/lungs, PET scan
Local (colon, viscera), lymphatic, blood (liver, lung, bone),
Dukes Staging Criteria
wall (90% 5 year survival)
wall (65% 5 year survival)
nodes (30% 5 year survival)
(<10% 5 year survival)
Just surgery for A and B.
Surgery + chemotherapy for C.
Surgery even possible with 3-5 liver metasteses together with
Radiotherapy used only for rectal cancer to ↓recurrence.
Details of Management
Liver/lymph node metasteses resected.
Left hemicolectomy for distal transverse or descending colon
Right hemicolectomy for caecal, ascending or proxima
Sigmoid colectomy for sigmoid.
Anterior resection for low sigmoid/high rectal tumours and
Abdomino-perineal resection for low rectum, permanent
60% amenable to radical surgery. See also the Dukes criteria (above)