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CLINICAL LAP SERIES COLON CANCERS Mr. Sreekar Devarakonda, CT1 MBBS, MRCSEd dvsreekar@gmail.com Hosted by – LapsocUpcoming sessions! • Bowel diseases – 22/03/22 • Liver diseases – 29/03/22 • ATLS – 05/04/22 • Appendicitis / Hernias – 12/04/22 • Biliary tree pathologies – 19/04/22Housekeeping/Disclaimer! ■ This teaching series is delivered by Students/Doctors for students and is meant to be supplementary to your anatomy and TCD sessions, not a replacement! (So you still have to go through OneMed ) ■ It is not comprehensive and is designed to provide a high-yield overview of conditions. ■ If you have any questions drop them in the chat box during the talk and (if we have time!) we can go through some at the end as well.Anatomy of Large Bowel - Taenia coli - Appendices epiploicae - HaustraLayers of large bowel Blood Supply Marginal artery of Drummond – SMA < - - - - > IMA (close to the bowel wall) Arc of Riolan – Middle colic artery < - - - - > IMA (root of the mesentery) Areas of Critical Blood Supply ■ Griffith’s Point – Splenic flexure - Marginal artery of Drummond + Left colic artery ■ Sudeck’s Point – Rectosigmoid junction – Sigmoid + Superior rectal artery Most Common Cancer in the UK? ■ Breast (15%) ■ Prostate (14%) ■ Lung (13%) ■ Bowel (11%) Common Site for Bowel Cancer? ■ Colorectal ■ 1 in 15 males and 1 in 18 females in the UK are diagnosed with bowel cancer in their lifetime Risk Factors ■ Age over 50 ■ Family history of bowel cancer ■ History of polyps ■ Longstanding Crohn’s disease or Ulcerative colitis ■ Type 2 diabetes ■ Modifiable risk factors: Smoking, alcohol, low fibre diet, processed meats Presenting Complaints ■ Bleeding ■ Change in bowel habit ■ Tenesmus – feeling of incomplete evacuation ■ Iron deficiency anemia ■ Weight loss ■ Tiredness ■ Pain or lump in the abdomen ■ Bowel obstruction Differential Diagnoses ■ Constipation ■ Diarrhoea ■ Hemorrhoids ■ Anal fissures ■ IBS ■ Diverticular disease ■ Crohn’s disease ■ Ulcerative colitis Family history ■ A close relative diagnosed with bowel cancer before the age of 50 years ■ Two or more close relatives diagnosed with bowel cancer at any age ■ A relative with a known genetic condition linked to bowel cancerFamilial Colorectal Syndromes ■ Around 5-10% of all bowel cancer cases are thought to be caused by a change in a known gene ■ Familial Adenomatous Polyposis – thousands of colonic polyps, osteomas, sebaceous cysts, stomach/duodenal polyps, desmoid tumours ■ Lynch Syndrome (HNPCC) – stomach, small bowel, HPB, endometrial, ovarian cancers Bowel Cancer Screening ■ FIT testing – Faecal Immunochemical Test ■ People aged 50-74 years every 2 years ■ Risks and benefits Pathology ■ More than 90% of colorectal cancers are adenocarcinomas ■ Other types – squamous, adeno squamous, spindle cell, undifferentiated ■ Degree of differentiation – Well, Moderate (70%) and PoorAdenoma-carcinoma sequence Right vs. Left Sided Colon Cancers RSCC LSCC Caecum, ascending, hepatic flexure, transversSplenic flexure, descending, sigmoid colon colon Older age / females Younger age / males Larger tumours – flat morphology Smaller tumours – polypoid Present with bleeding and weight loss Present with obstruction Poorly differentiated Well differentiated Advanced stage Early stage Poor prognosis Better prognosis Complications of Colorectal cancers Local ■ Obstruction ■ Perforation ■ Bleeding (and/or iron deficiency anaemia) ■ Fistulas Distant ■ Metastasis Common Sites of Metastasis ■ Liver ■ Peritoneum ■ Lungs ■ Bone ■ Brain Investigations ■ Colonoscopy – Gold standard ■ CT TAP – Full workup ■ Bloods – FBC, U/E, LFTs, PT/INR ■ MRI - sometimes for operative planning Staging and Prognosis ■ Dukes’ ■ TNM Management ■ Neo adjuvant / Adjuvant chemotherapy ■ SurgerySurgeries for Colon CancersHartmann’s Resection Quiz Time!! ■ A 75-year-old male presents with complaints of altered bowel habits for the past 2 months. He noticed blood in his stools and says that he has a feeling of incomplete evacuation. There is a significant loss of weight and appetite. What is the most likely diagnosis? a) Haemorrhoids b) IBS c) Colorectal cancer d) Diverticular disease e) IBD■ A 35-year-old female presents with complaints of severe pain while opening the bowels and blood is seen on wiping. She also has long standing constipation. What is the most likely diagnosis? a) IBD b) Haemorrhoids c) IBS d) Anal fissure e) Colorectal cancer■ A 60-year-old female presented to ED with an ongoing left sided abdominal pain for 3 days along with bleeding per rectum. She last opened her bowels yesterday. There is no loss of weight or appetite. CT scan showed outpouchings of the sigmoid colon with surrounding fat stranding. What is the most likely diagnosis? a) Bowel obstruction b) Diverticulosis c) Diverticulitis d) Colorectal cancer e) IBD■ A 25-year-old male presents to the outpatient clinic with complains of painless fresh bleeding per rectum. There is no loss of weight or appetite. On PR examination, prominent anal cushions are felt at 3,7 and 11 o’clock positions. What is the most likely diagnosis? a) Diverticular disease b) Haemorrhoids c) Anal fissure d) Colorectal cancer e) IBD■ A 40-year-old female with long standing ulcerative colitis presents to the clinic with abdominal distention, jaundice, loss of weight and appetite. What is the most likely diagnosis? a) Flare of Ulcerative colitis b) Colorectal cancer with metastasis c) IBS d) Ovarian cyst e) Diverticular disease Where did the cancer metastasize to? ■ Liver / peritoneumAny Questions ? Thank you for joining! ■ Please fill out the feedback forms – slides will be sent out to those who do! ■ Please check our socials for upcoming events! ■ Any further questions? – Lapsoc@outlook.com, dvsreekar@gmail.com – Socials – Insta/FB/Twitter ■ Resources used • bowelcanceruk.org.uk • Bailey & Love’s short practice of surgery 27 e