Colorectal cancer

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