Colorectal Carcinoma

Epidemiology

2nd most common cause of UK cancer deaths - 16,000 a year

86% of presentations are in those >60 year olds

3rd most common cancer in UK

Predisposing Factors

Diet low in fibre, high in red/processed meat

Excess alcohol

Genetic predisposition

Smoking

IBD - UC + Crohn's

Previous cancer

Neoplastic polyps

Distribution

Caecum: 14%

Ascending colon: 7%

Sigmoid colon: 20%

Appendix: 1%

Rectum: 27%

Presentation

Right Sided

Either

Left Sided

Urgent Referral Criteria

Altered bowel habit/obstruction

Low Hb

Perforation

Any age with right lower abdominal mass

Haemorrhage

Abdominal mass

Tensemus

Bleeding + mucus PR

PR mass

Abdominal pain

Weight loss

Fistula

Palpable rectal mass

Over 40 with PR bleeding + bowel habit change

Men or non-menstruating women with unexplained iron deficiency anaemia

Investigations

Sigmoidoscopy

Colonoscopy

Faecal occult blood - used for UK screening programme

Liver ultrasound

FBC: microcytic anaemia

Staging

Spread can be local, lymphatic, blood or transcoelomic

TNM staging

Duke's Criteria

B - extension through muscularis mucosae, 77% 5 year survival

C - involvement of regional lymph nodes, 48% 5 year survival

A - limited to muscularis mucosae, 95% 5 year survival

D - distant mets, 6.6% 5 year survival

Treatment

Radiotherapy is used in palliation

Chemo is used in palliation

Surgery aims to cure and increases survival by up to 50%