Colorectal Malignancy

All you need to know about the pathology, diagnosis and treatment of bowel cancer - from a surgical perspective.

 

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Video Duration: 21 minutes

  • Colorectal Malignancy
    Created by Dr Ed Wallitt
    General
    Epidemiology

    Common (3rd most common malignancy)

    Elderly

    Western disease

    Pathology

    A malignant neoplasm of the colon or rectum, most commonly affecting the recto-sigmoid region.

    Top three causes

    Lifestyle: Western diet, smoking

    Familial: FAP

    IBD: UC

    Clinical Features
    Symptoms

    General:

    • Weight loss
    • Tiredness (anaemia)

    Specific:

    • Change in bowel habit: diarrhoea (right sided lesions), constipation (more distal lesions)
    • PR bleeding
    • Tenesmus
    • Large bowel obstruction: abdominal distension and absolute constipation
    • Mass
    Signs

    General: Usually patients with advanced metastatic disease are cachectic and anaemic

    Specific: Mass (abdominal/PR), Hepatomegaly (liver metastases)

    Investigations
    Cultures

    None

    Bloods

    FBC (anaemia of chronic disease)

    U&Es (diarrhoea)

    LFTs (liver metastases)

    Clotting/GS and cross match if surgery is required

    FOB (often a screening test for CRC)

    Imaging

    AXR (if presenting with symptoms of large bowel obstruction)

    CT chest, abdomen and pelvis (staging) +- MRI liver/rectum

    Barium enema - "apple core lesion"


    Scopic/Biopsy

    Colonoscopy and biopsy

    CT pneumocolon studies can be performed in those not fit enough to undergo a colonoscopy

    Functional

    None

    Treatment
    Conservative

    Palliative

    Medical

    Analgesia

    Chemotherapy for metastatic disease

    Radiotherapy for rectal tumours

    Surgical

    Resection