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%