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home - Colon - Colorectal and Anal Cancer - Colorectal Cancer Treatment Written by Dr Sebastian Zeki
Knowledge

Knows the pathology of benign and malignant tumours of the colon
and rectum
Has awareness of the molecular genetics of colorectal
carcinogenesis and the adenoma-carcinoma sequence
Knows the range of predisposing conditions including inherited
syndromes and acquired colonic diseases
Knows the range of clinical presentation and the means of
diagnosis, investigation, management and follow-up
Knows the strategy for prevention including procedures for
screening

Skills
Uses clinical assessment and selects investigations to reach a rapid
conclusion as to whether a patient might have colorectal cancer and
arranges timely investigation.
Refers the patient to the multi-disciplinary team CbD, mini-CEX,

Behaviours
Shows ability to react to possible diagnosis of malignancy in a timely
manner

Communicates with patient and family in a sympathetic and
understanding manner, explains next steps, involves other health
professionals (including the GP) as appropriate

Colorectal Cancer Treatment

For Mets If have resectable liver/ lung mets either remove mets and primary with or without neoadjuvant chemo (FOLFOX/ FOLFIRI/ CapeOx +/- Bevacicumab) or two stage removal with chemo in the middleConsider hepatic artery infusion and 5FU for liver mets Further chemo? (not clear on this one)FOLFOX/FOLFIRI/CapeOX with B If progress consider one of the other chemos or I or C (in non K-ras mutated tumours only) Further progression treat with C (in non K-ras mutated tumours only) + I If unresectable, try FOLFIRI if had FOLFOX in previous 12 months If everything fails, then trial, reuse another chemo or C+B+I Colorectal Cancer Treatment Abdo/ peritoneal mets and unresectable liver/ lung get chemo only. If becomes resectable Monitor For Primary Tumour Treatment Recurrence Risk Factors:Perforation.Fistulization.Advanced T stage.Location in the hepatic flexure and sigmoid. 3-12% get recurrence 23% cure rate if resectable Recurrence sites:Perianastomotic.Lymphatic nodal basin.Peritoneum. Recurrence Postoperative surveillance:History and physical examination and CEA every 6m for 5yr for >T2 lesions.CT C/A/P every year for 3 yr if high risk.Colonoscopy at 1 year (6m if not done pre-op) then as per screening guidelines. Stage 1/ Low risk stage II- For stage III or high risk stage II (T1-4,N1-2):Criteria for being high risk stage 2:Fewer than 13 nodes in the surgical specimen.T4 lesion or Perforation/obstruction at presenta-tion.Poorly differentiated (including signet ring and mucinous) histology.Lymphovascular or neural invasion.T4 disease OR penetration to a fixed structure OR positive resection margins Curative resective only GIVE CHEMO (either FOLFOX/5FU/LV if oxaliplatin contraindication or Capcit-abine)- 32% mortality reduction Add radiotherapy (field should have been marked at the time of surgery and omentum mobilkized to protect small bowel Liver Mets Resection Indications:Adequate hepatic function.Plan to debulk.No unresectable sites of disease.Solitarylesionshaveabetterprognosisthanmultipleliver-metastases.Theprimarytumourmusthavebeenresectedforcure(R0).Re-resection canbeconsideredinselectedpatients.Resectableextra pulmonarymetastasesdonotprecluder-esection. Written by Dr Sebastian Zeki

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