Gastroenterology Education and CPD for trainees and specialists

1. A 75 year old man presented with bleeding PR. A colonoscopy revealed a rectal adenocarcinoma at 10 cms from the dentate line. All the following tests are indicated except:

1. Staging CT scan
2. MRI pelvis for local staging (nodes and depth of invasion)
3. EUS rectum can also be used for local staging and is cheaper than MRI
4. CEA
5. All of the above

2. A 55 year old man is found to have isolated liver metastases at the time of primary surgery for colon cancer. Choose the most appropriate answer?

1. The liver metastases should be resected synchronously with colon cancer resection.
2. Liver biopsy should be obtained without liver resection
3. Liver resection is always done after adjuvant chemotherapy for colon cancer
4. Surgery for colon cancer should be abandoned as the cancer is now inoperable
5. None of the above

Explanation :Normally, colorectal cancer resection & liver resection would not be performed synchronously. Lesions discovered at operation should not be biopsied. Patients with potentially resectable liver disease and who have undergone radical resection of the primary tumour should be considered for liver resection before consideration of chemotherapy. Patients with unfavourable primary pathology such as perforated primary tumour or extensive nodal involvement should be considered for adjuvant chemotherapy prior to liver resection and be restaged at three months. It has been argued that the limiting factor to the number of lesions that can be resected is whether it is technically possible to remove all tumours. Patients with solitary, multiple and bilobar metastatic disease are candidates for liver resection. The surgeon should define the acceptable residual functioning volume, approximately one third of the standard liver volume, or the equivalent of a minimum of two segments.

3. Please choose the most appropriate answer for colorectal cancers?

1. Right sided cancers commonly present with iron deficiency anaemia and left sided tumours present with change in bowel habit
2. Streptococcus bovis bacteraemia and Clostridium septicum sepsis can be due to underlying colonic malignancies.
3. Synchronous cancer occur in up to 5 percent of patients
4. Serum CEA has prognostic utility in patients with newly diagnosed colorectal cancer
5. All of the above

Explanation :Synchronous CRCs are defined as two or more distinct primary tumors separated by normal bowel and not due to direct extension or metastasis. It occurs in up to 5 percent of patients with colon cancer. American Society of Clinical Oncology (ASCO) guidelines recommend that serum CEA levels be obtained preoperatively in patients with demonstrated colorectal cancer to aid in staging, surgical treatment planning, and in the assessment of prognosis

Gastroenterology training and education

MCQ On Colorectal cancer

Help in the growth of the Gastrotraining community by submitting your MCQ.

Submit a MCQ

MCQs