3rd most common cancer (behind lung, breast/prostate) - TNM (was previously Dukes’)
Most common moderately well differentiated adenocarcinoma (mucious in 10-20%) in rectum. Mets to lymph, lung, liver, peritoneal
- FAP 1% - APC TSG mutation
- Lynch syndrome 3% (MLH1 DNA repair gene)
- Other 20%
Protective - fibre/folate, Aspirin (NSAIDs), oral contraceptives
Bad - fat/red meat, Obesity, alcohol, either IBD
Red flags
- Change in bowel habit (usually to more loose and frequent stools)
- Unexplained weight loss
- Rectal bleeding
- Unexplained abdominal pain
- Iron deficiency Anaemia - 2 week wait referral if unexplained
- Abdo or rectal mass on exam
Faecal immunmochemical tests (FIT)
Look specifically at the amount of human haemoglobin in the stool - very good specificity and sensitivity. If negative review diagnosis and consider alternative