Podcast
Questions and Answers
What is the five-year survival rate associated with Dukes A classification?
What is the five-year survival rate associated with Dukes A classification?
Which of the following treatment approaches is aimed primarily at symptom control?
Which of the following treatment approaches is aimed primarily at symptom control?
For which cases is post-operative chemotherapy indicated?
For which cases is post-operative chemotherapy indicated?
What surgery is typically performed for middle and lower third rectal cancers?
What surgery is typically performed for middle and lower third rectal cancers?
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Which classification is considered more comprehensive than Dukes classification for staging cancer?
Which classification is considered more comprehensive than Dukes classification for staging cancer?
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What is the peak incidence age range for colorectal cancer?
What is the peak incidence age range for colorectal cancer?
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Which risk factor has the highest associated risk for developing colorectal cancer?
Which risk factor has the highest associated risk for developing colorectal cancer?
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What stool characteristics are typical of left-sided lesions in colorectal cancer?
What stool characteristics are typical of left-sided lesions in colorectal cancer?
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What is the most essential investigation required for diagnosing colorectal cancer?
What is the most essential investigation required for diagnosing colorectal cancer?
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Which of the following is NOT considered a common symptom of colorectal cancer?
Which of the following is NOT considered a common symptom of colorectal cancer?
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Which imaging technique is essential for staging colorectal cancer?
Which imaging technique is essential for staging colorectal cancer?
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What percentage of colorectal cancer cases have raised CEA levels useful for monitoring disease?
What percentage of colorectal cancer cases have raised CEA levels useful for monitoring disease?
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What type of lesion typically causes blood on the stool surface?
What type of lesion typically causes blood on the stool surface?
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What is the peak incidence age range for colorectal cancer?
What is the peak incidence age range for colorectal cancer?
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Which of the following is NOT a risk factor for colorectal cancer?
Which of the following is NOT a risk factor for colorectal cancer?
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Which of the following genetic conditions is associated with an increased risk of colorectal cancer?
Which of the following genetic conditions is associated with an increased risk of colorectal cancer?
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Which tumor site accounts for 30% of colorectal cancers?
Which tumor site accounts for 30% of colorectal cancers?
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What is the most likely presentation of a right-sided colorectal lesion?
What is the most likely presentation of a right-sided colorectal lesion?
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Which of the following is essential for the diagnosis of colorectal cancer?
Which of the following is essential for the diagnosis of colorectal cancer?
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What is the most common emergency presentation of colorectal cancer?
What is the most common emergency presentation of colorectal cancer?
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What is the 5-year survival rate for Dukes' A classification of colorectal cancer?
What is the 5-year survival rate for Dukes' A classification of colorectal cancer?
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Which of the following is part of the treatment for unresectable colorectal cancer metastases?
Which of the following is part of the treatment for unresectable colorectal cancer metastases?
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What is the primary purpose of the fecal immunochemical test (FIT) in colorectal cancer screening?
What is the primary purpose of the fecal immunochemical test (FIT) in colorectal cancer screening?
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Which of the following statements is true about the incidence of colorectal cancer?
Which of the following statements is true about the incidence of colorectal cancer?
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Which of the following is the MOST significant genetic risk factor for colorectal cancer?
Which of the following is the MOST significant genetic risk factor for colorectal cancer?
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What is the male to female ratio for colorectal cancer incidence?
What is the male to female ratio for colorectal cancer incidence?
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Which of the following is NOT a symptom of a left-sided colorectal lesion?
Which of the following is NOT a symptom of a left-sided colorectal lesion?
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Which of the following describes the presentation of rectal colorectal cancer?
Which of the following describes the presentation of rectal colorectal cancer?
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What percentage of colorectal cancers present as an emergency (e.g., obstruction or perforation)?
What percentage of colorectal cancers present as an emergency (e.g., obstruction or perforation)?
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Which of the following is an appropriate imaging technique for staging colorectal cancer?
Which of the following is an appropriate imaging technique for staging colorectal cancer?
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Which of the following tumor sites has the highest incidence in colorectal cancer?
Which of the following tumor sites has the highest incidence in colorectal cancer?
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What is the Dukes' C classification of colorectal cancer characterized by?
What is the Dukes' C classification of colorectal cancer characterized by?
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What is the purpose of the Carcinoembryonic Antigen (CEA) test in colorectal cancer management?
What is the purpose of the Carcinoembryonic Antigen (CEA) test in colorectal cancer management?
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Which of the following is a recommended screening method for colorectal cancer in Ireland for people aged 60-69?
Which of the following is a recommended screening method for colorectal cancer in Ireland for people aged 60-69?
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What is the typical surgical procedure for a right-sided colon tumor?
What is the typical surgical procedure for a right-sided colon tumor?
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Which of the following is a treatment option for unresectable tumors or metastases?
Which of the following is a treatment option for unresectable tumors or metastases?
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What is the 5-year survival rate for Dukes' D colorectal cancer with distant metastasis?
What is the 5-year survival rate for Dukes' D colorectal cancer with distant metastasis?
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Which colorectal cancer treatment involves the removal of the rectum and creation of a permanent colostomy?
Which colorectal cancer treatment involves the removal of the rectum and creation of a permanent colostomy?
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Which of the following conditions is a greater risk factor for colorectal cancer?
Which of the following conditions is a greater risk factor for colorectal cancer?
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Which imaging technique is used to diagnose caecal carcinoma with circumferential involvement of the caecal wall?
Which imaging technique is used to diagnose caecal carcinoma with circumferential involvement of the caecal wall?
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What do contrast-enhanced CT scans often show in advanced colorectal cancer cases with liver metastases?
What do contrast-enhanced CT scans often show in advanced colorectal cancer cases with liver metastases?
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Which Dukes' stage is characterized by colorectal cancer confined to the bowel wall, with a 90% 5-year survival rate?
Which Dukes' stage is characterized by colorectal cancer confined to the bowel wall, with a 90% 5-year survival rate?
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Which surgical procedure is appropriate for right-sided colon cancer?
Which surgical procedure is appropriate for right-sided colon cancer?
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What is the correct surgical treatment for a tumor located in the sigmoid colon or upper rectum?
What is the correct surgical treatment for a tumor located in the sigmoid colon or upper rectum?
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Which surgical procedure is typically performed for low rectal cancers that require removal of the rectum and a permanent colostomy?
Which surgical procedure is typically performed for low rectal cancers that require removal of the rectum and a permanent colostomy?
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What is the typical presentation of diverticulosis?
What is the typical presentation of diverticulosis?
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Diverticulitis is the inflammation of which of the following?
Diverticulitis is the inflammation of which of the following?
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According to the Hinchey classification, what is a paracolic inflammatory mass or mesenteric abscess classified as?
According to the Hinchey classification, what is a paracolic inflammatory mass or mesenteric abscess classified as?
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Which stage of the Hinchey classification involves a walled-off abscess?
Which stage of the Hinchey classification involves a walled-off abscess?
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What is the appropriate management for uncomplicated diverticulitis (Hinchey 1 or 2)?
What is the appropriate management for uncomplicated diverticulitis (Hinchey 1 or 2)?
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In the case of complicated diverticulitis (Hinchey 3 or 4), which of the following is a possible surgical option?
In the case of complicated diverticulitis (Hinchey 3 or 4), which of the following is a possible surgical option?
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What is the surgical procedure called that involves resecting a portion of the colon and creating a colostomy for Hinchey 4 diverticulitis?
What is the surgical procedure called that involves resecting a portion of the colon and creating a colostomy for Hinchey 4 diverticulitis?
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Which of the following is a potential complication that may require radiologically guided drainage in diverticulitis?
Which of the following is a potential complication that may require radiologically guided drainage in diverticulitis?
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Which clinical presentation is associated with Hinchey 3 diverticulitis?
Which clinical presentation is associated with Hinchey 3 diverticulitis?
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What is the hallmark of Hinchey 4 diverticulitis?
What is the hallmark of Hinchey 4 diverticulitis?
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Which of the following is a characteristic symptom of left-sided colorectal lesions?
Which of the following is a characteristic symptom of left-sided colorectal lesions?
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Which symptom is more commonly associated with right-sided colorectal lesions?
Which symptom is more commonly associated with right-sided colorectal lesions?
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What type of bleeding is commonly seen in left-sided colorectal cancer?
What type of bleeding is commonly seen in left-sided colorectal cancer?
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Iron deficiency anemia is more likely to occur with which of the following?
Iron deficiency anemia is more likely to occur with which of the following?
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Which of the following is a common change in bowel habits seen in left-sided colorectal cancer?
Which of the following is a common change in bowel habits seen in left-sided colorectal cancer?
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Which of the following findings is least likely with right-sided colorectal cancer?
Which of the following findings is least likely with right-sided colorectal cancer?
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What is the recommended surgical procedure for cancers located in the upper third of the rectum?
What is the recommended surgical procedure for cancers located in the upper third of the rectum?
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For rectal cancers located in the middle or lower third, which procedure is usually performed if the lesion is less than 5 cm from the anal verge?
For rectal cancers located in the middle or lower third, which procedure is usually performed if the lesion is less than 5 cm from the anal verge?
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What is the primary goal of Total Mesorectal Excision (TME) in rectal cancer surgery?
What is the primary goal of Total Mesorectal Excision (TME) in rectal cancer surgery?
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In which situation might a colonic J pouch be considered?
In which situation might a colonic J pouch be considered?
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What is a key consideration in the surgical management of rectal cancer regarding pedicle vessels?
What is a key consideration in the surgical management of rectal cancer regarding pedicle vessels?
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Which surgical technique is rarely used in rectal cancer surgery but can be considered in specific cases?
A) High anterior resection
B) Total mesorectal excision (TME)
C) Coloplasty
D) Abdomino-perineal resection (APR)
Which surgical technique is rarely used in rectal cancer surgery but can be considered in specific cases? A) High anterior resection B) Total mesorectal excision (TME) C) Coloplasty D) Abdomino-perineal resection (APR)
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Study Notes
Colorectal Cancer
Introduction
- Second most common cause of cancer death in the UK and Ireland, third in Bahrain.
- Highest incidence in the Western world.
- Male to Female Ratio: 3:1.
- Peak incidence: Ages 55-75 years.
- Type of cancer: Adenocarcinoma.
Risk Factors
-
Genetic: Family history (HNPCC 5%, FAP 1%, Juvenile Polyposis).
- Two first-degree relatives = 1 in 6 lifetime risk.
- Colonic Polyps.
- Diet: Low fiber, fruits, and vegetables.
- Obesity, Male gender, Age (55-75).
- Smoking.
- Chronic ulcerative colitis or Crohn's disease (UC has higher risk than Crohn's).
- Other syndromes: Gardner’s, Peutz-Jeghers Syndrome.
Presentation
Symptoms
-
Right-sided lesions:
- Liquid stools.
- Iron deficiency anemia symptoms.
-
Left-sided lesions:
- Semi-solid stools.
- PR bleeding (blood mixed with stool).
- Change in bowel habits.
-
Rectal lesions:
- Solid stools.
- Blood on stool surface.
- Tenesmus (incomplete evacuation sensation).
-
Constitutional symptoms:
- Weight loss.
- Lower abdominal pain.
- Emergency presentation in 40% of cases: Large bowel obstruction, perforation/peritonitis, or acute PR bleed.
Signs
- Most patients: No specific signs.
-
Possible findings:
- Anemia.
- Blood per rectum or on stools.
- Abdominal mass.
- Rectal lesion on PR exam.
- Hepatomegaly (indicating metastasis).
- Cachexia (weight loss, muscle wasting).
Tumor Sites
- Rectum (30%)
- Descending and sigmoid colon (45%)
- Right-sided colon (20%)
- Transverse colon (5%)
Workup and Investigations
Initial Bedside Investigations
- History and examination.
- Vital signs: O2 saturation, BP, HR, RR, temperature.
- Digital rectal exam and fecal occult blood (FOB) test.
-
Imaging:
- Erect CXR (perforation).
- Abdominal X-ray (if obstruction suspected).
- CT abdomen/pelvis.
-
Laboratory:
- Full blood count (FBC), U&E, CRP, LFTs, coagulation profile.
- CEA (carcinoembryonic antigen) – raised in 60% of colorectal cancer cases.
- Urine dipstick +/- beta hCG.
- VBG/ABG (lactate), glucose check.
Endoscopy (Essential for Diagnosis)
- Tissue diagnosis through biopsy:
- Rigid/Flexible sigmoidoscopy.
- Colonoscopy (essential to examine entire colon).
Imaging for Staging
- CT TAP (Thorax, Abdomen, Pelvis) to assess spread of the disease based on TNM classification (Tumor, Nodes, Metastasis).
Staging
Dukes’ Classification (Older)
- Dukes A: Confined to bowel wall (90% 5-year survival).
- Dukes B: Through muscularis propria (75% survival).
- Dukes C: Regional lymph nodes (30-60% survival).
- Dukes D: Distant metastasis (5% survival).
TNM Staging (Current)
- More comprehensive, based on tumor size (T), node involvement (N), and metastases (M).
Treatment
-
Goals:
- Symptom control (initially).
- Urgent intervention for obstruction or bleeding.
- Disease downstaging with chemotherapy or radiotherapy.
- Surgery if necessary.
Surgical Options
- Right-sided colon: Right hemicolectomy.
- Left-sided colon: Left hemicolectomy.
- Sigmoid/Upper rectum: Anterior resection.
- Low rectum: Abdomino-perineal (AP) resection + colostomy.
Additional Treatment
- Preoperative (Neoadjuvant) chemoradiotherapy: For rectal cancer to reduce local recurrence.
- Postoperative (Adjuvant) chemotherapy: If lymph node involvement or vascular invasion is present.
- Palliative treatment: For unresectable tumors or metastasis (chemotherapy, stents, surgery for obstruction/bleeding).
Colorectal Screening
-
Tests: Fecal occult blood (FOB), fecal immunochemical test (FIT).
- Routine screening in the USA.
- In Ireland: FIT offered every two years for those aged 60-69.
-
CEA Marker:
- Used for monitoring post-resection.
- Not specific to colorectal cancer.
Diverticular Disease
Definition
- Acquired sac-like mucosal projections (diverticula) through the colon wall, typically affecting the sigmoid colon.
Epidemiology
- Affects 30% of people aged 60+.
- More common in westernized countries.
- Associated with constipation and increased colonic pressure.
Presentation
- Diverticulosis: Usually asymptomatic, found incidentally.
- Diverticulitis: Inflammation of diverticula with symptoms such as left lower abdominal pain, diarrhea/constipation, PR bleeding, nausea/vomiting, fever, tachycardia, and tenderness in the left iliac fossa (LIF).
Complications of Diverticular Disease
- Inflammation (Diverticulitis).
- Bleeding, perforation, or obstruction.
- Fistula formation (e.g., colovesical).
- Strictures (narrowing of the colon).
Hinchey Classification (Based on CT findings)
- Stage I: Paracolic mass/mesenteric abscess.
- Stage II: Walled-off abscess.
- Stage III: Purulent peritonitis.
- Stage IV: Feculent peritonitis.
Treatment
Uncomplicated Diverticulitis (Hinchey I/II)
- Medical management: IV antibiotics, fluids, analgesia, and possible radiologically guided drainage.
- Surgery considered if medical management fails.
Complicated Diverticulitis (Hinchey III/IV)
-
Surgical management:
- Laparoscopy and washout (Hinchey III).
- Segmental colectomy or Hartmann’s procedure (Hinchey IV).
Hartmann’s Procedure
- Removal of diseased colon segment with colostomy.
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Description
Explore the critical insights into colorectal cancer, including its incidence, risk factors, and age demographics. This quiz delves into hereditary syndromes, lifestyle influences, and the typical presentations of symptoms associated with this prevalent cancer type. Test your knowledge and enhance your understanding of colorectal cancer today.
