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Colorectal tumours

Introduction
  • Colorectal tumours can be benign (e.g., polyps) or malignant (e.g., colorectal carcinoma).
  • The colon and rectum are common sites for cancer development, often from precursor adenomatous polyps.
Risk Factors
  • Age: Incidence increases over 50.
  • Family history of colorectal cancer or polyps.
  • Hereditary conditions: Familial adenomatous polyposis (FAP), Lynch syndrome.
  • Inflammatory bowel diseases: Ulcerative colitis, Crohn’s disease.
  • Diet: High in red/processed meat, low in fibre.
Classification
  • Adenomas: Precancerous polyps. Can be tubular, tubulovillous, or villous.
  • Colorectal Carcinoma: Most are adenocarcinomas (~95%).
Clinical Presentation
  • Change in bowel habits: Diarrhoea, constipation.
  • Rectal bleeding or melaena.
  • Abdominal pain.
  • Unintended weight loss and fatigue.
  • Iron-deficiency anaemia.
  • Palpable abdominal mass or rectal mass.
Investigations
  • Colonoscopy with biopsy: Gold standard.
  • Flexible sigmoidoscopy.
  • Faecal occult blood test (FOBT): Screening.
  • CT colonography.
  • CT, MRI for staging and assessing metastasis.
Management
  • Surgery: Primary treatment for localized tumours.
  • Chemotherapy: Adjuvant or for metastatic disease.
  • Radiotherapy: Particularly for rectal tumours.
  • Endoscopic removal for early, small tumours or polyps.
Prognosis
  • Depends on the stage at diagnosis and the presence of metastasis.
  • Regular monitoring and follow-up colonoscopies are essential.
Prevention
  • Regular screening, especially in those over 50 or with risk factors.
  • Dietary modifications: Increase fibre intake, reduce red/processed meat.

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