What is the staging classification of Ben's bowel cancer?
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pT4aN2bM0.
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What is the staging classification of Ben's bowel cancer?
pT4aN2bM0.
What chemotherapy regimen did Ben start after surgery?
Infusional fluorouracil and oxaliplatin.
What organization published clinical practice guidelines for colorectal cancer management?
Cancer Council Australia.
What is hereditary nonpolyposis colorectal cancer?
A genetic condition associated with an increased risk of colorectal cancer.
What is the likelihood of receiving a positive faecal occult blood test result during bowel cancer screening?
About one in 14 people will receive a positive result.
What is Megan Barnet's area of expertise?
Medical Oncologist and Senior Scientist.
What is the focus of Domain 3 in general practice?
Population health and the context of general practice.
What further investigations would be important for Carrick?
Colonoscopy and possibly imaging studies.
What are common characteristics of early-onset colorectal cancer?
It is more often left-sided and more advanced at the time of diagnosis compared to later-onset disease.
What symptoms should be assessed for red flags in Ben's case?
Previous episodes, recent travel, known exposures, fever, weight loss, night sweats, bowel habit, and stool color.
What is haematochezia?
The passage of bright red blood in stool.
What is the recommended aspirin therapy for colorectal cancer prevention?
A daily dose of 100 mg for individuals aged 45–70 years at average or higher risk for at least 2.5 years.
What does Domain 2 of general practice focus on?
Applied professional knowledge and skills.
What is the purpose of the National Cancer Screening Register?
To provide a healthcare provider portal for accessing information related to cancer screening.
What significant family history does Carrick have?
His father was diagnosed with bowel cancer at age 68.
What does the pathology report indicate about Ben's tumor?
The tumor has penetrated to the visceral peritoneum with 16 of 40 lymph nodes involved.
What surgical procedure did Ben undergo for his bowel cancer?
Left hemicolectomy.
Which colorectal surgeon is also a Senior Lecturer at the University of New South Wales?
Rohan Gett.
How often should surveillance colonoscopy be performed if there are no advanced adenomas?
Every 3–5 years.
What procedures is Carrick referred for?
Gastroscopy and colonoscopy.
What is Cancer Australia's definition of moderate risk for colorectal cancer?
A lifetime relative risk of 3–6 times higher than the average population.
What did Ben's colonoscopy reveal?
A circumferential ulcerated mass in the left (descending) colon.
What framework can be used for communicating a cancer diagnosis to a patient?
The SPIKES framework (setting, perception, invitation, knowledge, empathy, summary).
What is required for doctors to complete the CPD activity?
Read all cases, complete questions, score >80% on linked multiple-choice questions, and complete an evaluation form online.
What is the recommended colonoscopy schedule for individuals in Category 2 risk?
Every five years, starting at 10 years younger than the earliest age of colorectal cancer diagnosis in a first-degree relative or at age 50, whichever comes first.
What is the significance of aspirin in relation to colorectal cancer?
Aspirin use is being studied for its potential to prevent colorectal cancer.
Who is the colorectal surgeon associated with Prince of Wales Hospital?
Shing Wai Wong.
What has been shown to improve overall survival in patients with resected localized colorectal cancer?
Intensive post-operative surveillance.
What fertility preservation option did Ben choose after surgery?
Sperm banking.
What are the differential diagnoses for Carrick's symptoms?
Bowel cancer, gastrointestinal bleeding, and other causes of anaemia.
What can provide valuable insights into family history regarding colorectal cancer?
Details about which relatives have had colorectal cancer and their ages at diagnosis.
What does Domain 4 of general practice emphasize?
Professional and ethical role.
What symptoms does Carrick present with?
Tiredness and altered bowel habits.
What are the recommended surveillance schemes for colorectal cancer?
History, physical examination, carcinoembryonic antigen testing every 3–6 months; CT scans every 12 months; surveillance colonoscopy at one year.
What is the risk level for Ben's first-degree relatives regarding colorectal cancer?
Moderately increased risk due to a relative diagnosed before age 55.
What did Ben's blood test results indicate?
Hypochromic, microcytic anemia consistent with iron deficiency.
What is covered in Domain 5 of general practice?
Organisational and legal dimensions.
What initial blood test result indicates a concern for Carrick?
Evidence of microcytic hypochromic anaemia.
Why is germline genetic screening indicated for Ben?
Because he has early-onset colorectal cancer and is under the age of 50 years.
What should a post-treatment surveillance strategy be based on?
The patient’s risk of recurrence and functional status.
What investigations should be organized for suspected bowel cancer?
Full blood count, iron studies, liver function tests, faecal occult blood test, electrocardiogram, and chest X-ray.
What does the histopathology confirm about Carrick's condition?
Moderately differentiated adenocarcinoma with all lymph nodes clear of metastatic disease.
What dietary habit does Carrick have that is relevant to his condition?
He eats red meat 2–3 times weekly.
What is Domain 1 of general practice?
Communication skills and the patient–doctor relationship.
What bowel cancer screening option does Tom want to start with?
An initial colonoscopy, with a plan for a repeat colonoscopy every five years.
What genetic testing and services would you suggest for Tom given his age and family history?
Recommend genetic counseling and testing for hereditary syndromes like Lynch syndrome or familial adenomatous polyposis (FAP).
What examination findings were noted during Carrick's assessment?
Evidence of pallor and no palpable abdominal mass.
What is Ben's age and occupation?
Ben is a 27-year-old business executive.
What is Matthew Grant's specialization?
Palliative Medicine Physician.
What findings were revealed in Carrick's gastroscopy and colonoscopy?
Antral gastritis and a right colon tumour.
What role do general practitioners play in colorectal cancer management?
They identify higher-risk patients, encourage bowel cancer screening, and facilitate earlier diagnosis.
What consideration should be given for patients aged 45 to 70 years?
Consideration of low-dose aspirin (100–300 mg daily).
What did the biopsy of the mass show?
Poorly differentiated adenocarcinoma.
How can general practitioners facilitate the bowel cancer screening process?
By simplifying the provision and collection of screening kits.
What proactive measures can Tom take to reduce his risk for colon cancer?
Discuss lifestyle changes such as a healthy diet, regular exercise, and avoiding tobacco and excessive alcohol, along with screening for polyps.
How should you explain the colonoscopy procedure and its risks to Tom?
Explain that a colonoscopy involves using a flexible tube with a camera to examine the colon, and discuss risks such as bleeding, infection, and perforation.
What is Carrick's age?
66 years old.
What is the role of Monika Dhamija?
General Practitioner at Jupiter Health CBD.
What is the immediate referral needed for Ben due to his condition?
Referral to a colorectal surgeon as soon as possible.
Who is a General Practitioner at Balcatta Medical Group?
Devaki Wallooppillai.
What does the absence of a genetic finding imply?
It does not rule out a genetic predisposition.
What was Ben's hemoglobin count?
82 g/L (normal range: 115–165 g/L).
What significant weight change did Ben report?
Approximately 5 kilograms of weight loss over the past two months.
What advice should be given to Carrick for bowel preparation before gastroscopy and colonoscopy?
Initial low-residue diet, clear fluids, stay hydrated, fast 2-4 hours prior, and withhold sitagliptin for three days.
What symptoms should be assessed for potential bowel cancer?
Change in bowel habits, dysphagia, rectal bleeding, and unintentional weight loss.
What further investigations would you consider for Ben?
Additional imaging studies or tumor marker tests.
What are the next steps in Ben's management after diagnosis?
Discuss treatment options, including surgery, chemotherapy, or referral to an oncologist.
What steps can your clinic take to improve bowel cancer screening participation?
Implement educational programs, reminders for screenings, and facilitate access to screening services.
What does Carrick's faecal occult blood test result indicate?
It is positive.
What symptoms did Ben present with?
Crampy abdominal pain, cramping, and vomiting.
Which expert is the Head of the Colorectal Oncogenomics Group at the University of Melbourne?
Daniel Buchanan.
What criteria must be met for a diagnosis of hereditary polyposis syndrome?
The Amsterdam criteria, which requires three relatives with relevant cancers across two generations, with at least one diagnosed before age 50.
What is a key consideration for family bowel cancer screening?
It should be based on a risk assessment done by the general practitioner.
What screening changes are being considered for bowel cancer in Australia?
Lowering the starting age for bowel cancer screening to 45 years.
What are some significant risks associated with colonoscopy?
Colonoscopic perforation, missed pathology leading to interval colon cancer, and post-polypectomy bleeding.
What is the focus of the guidelines by the Royal Australian College of General Practitioners?
Preventive activities in general practice.
What trial aimed to increase bowel cancer screening using SMS?
The SMARTscreen trial.
What is the increasing trend in colorectal cancer in developed countries?
The incidence and mortality from colorectal cancer are increasing, particularly early-onset colorectal cancer diagnosed under the age of 50.
What proactive strategies should be considered for bowel cancer prevention?
Lifestyle and dietary approaches, along with chemoprevention using aspirin.
Who is a Staff Specialist in Radiation Oncology at Chris O’Brien Lifehouse?
Raymond Wu.
What is the national participation rate for the National Bowel Cancer Screening Program?
Approximately 40%.
Where can health professionals find support for ordering genetic testing?
On the eviQ website.
What type of resources can be provided to educate patients about bowel cancer screening?
Educational materials, pamphlets, or seminars.
What is the prognosis for Stage I bowel cancer?
Excellent, with a five-year survival rate in excess of 90%.
What should patients with a positive faecal occult blood test result undergo?
A diagnostic colonoscopy.
What are some findings of concern in a patient suspected of having bowel cancer?
Cachexia, weight loss, pallor, jaundice, abdominal distension, ascites, abdominal mass, hepatomegaly, and enlarged left supraclavicular lymph node.
What lifestyle factors have been implicated in the increase of early-onset colorectal cancer?
Obesity and a sedentary lifestyle.
What is the updated recommendation for colonoscopy frequency for those at moderately increased risk?
Colonoscopy every five years, starting at 10 years younger than the earliest age of diagnosis in a first-degree relative or age 50, whichever is earlier, to age 74.
What is melaena?
Tarry, malodorous black stools due to digestion within the internal tract.
What is the age range for the National Bowel Cancer Screening Program in Australia?
All Australians aged between 50 and 74 years.
What family history is relevant in assessing bowel cancer risk?
Family history of bowel cancer or polyps in first- and second-degree relatives.
What does a negative faecal occult blood test result indicate in the context of bowel cancer screening?
It might be reassuring but does not completely exclude the diagnosis of colorectal cancer.
What genetic screening result did Ben receive?
No significant variant found in the colorectal cancer gene testing panel.
How does smoking affect colon cancer risk?
Smoking increases the risk of getting and dying from colon cancer, and raises the risk of recurrence.
What dietary changes can help reduce the risk of colon cancer?
Diets rich in complex carbohydrates and lower in animal proteins, with minimal consumption of preserved meats.
What is Justin Yeung's role at the University of Melbourne?
Professor of Surgery.
What are the learning outcomes of the CPD activity on bowel cancer?
Participants will be able to identify at-risk individuals, list red flag symptoms, implement screening strategies, manage post-treatment care, and assess palliative care needs.
Is genetic testing recommended for Tom, who has a Category 2 risk for colorectal cancer?
No, genetic testing is not currently recommended for him.
What role do general practitioners play in colorectal cancer?
They are important in early diagnosis, management, and timely referral.
What differential diagnoses should be considered for Carrick's symptoms?
Haemorrhoids, anal fissure, diverticular disease, gastrointestinal ulcers, inflammatory bowel disease, and angiodysplasia.
What were the results of Ben's ancillary tests?
Preserved mismatch repair enzymes and wild-type BRAF.
Why is a previous colonoscopy not definitive in excluding colon cancer?
Because the right colon may not have been reached during the procedure.
What position does Kate Mahon hold at Chris O’Brien Lifehouse?
Director of Medical Oncology.
What is a recommended test for identifying potential cases of Lynch syndrome?
Immunohistochemical testing of colorectal cancer tissue for DNA mismatch repair protein expression.
How can general practice teams support patients with palliative care needs?
By providing care, support, and access to specialist palliative care services.
What next steps should be taken if there is evidence of iron deficiency anaemia?
Refer for gastroscopy and colonoscopy, consider an abdominal CT scan, and consider iron infusion or blood transfusion.
What dietary history should be inquired about for bowel cancer risk assessment?
The patient’s red meat intake or if they are vegetarian.
Why is it important to provide multilingual resources for bowel cancer screening?
To accommodate diverse patient populations.
What resource provides information on bowel cancer for patients?
Cancer Council's website.
What is the significance of the pT2N0M0 staging for Carrick?
It indicates a tumor that is invasive but has not spread to lymph nodes or distant sites.
What was the previous recommendation for people at moderately increased risk according to the 2017 guidelines?
A two-yearly immunochemical faecal occult blood test from age 40–49, then five-yearly colonoscopy from age 50–74.
What is the significance of population-level screening for bowel cancer?
It leads to an increasing number of Australians living with bowel cancer and improves survivorship care.
What tests are essential for assessing Ben's unexplained anemia?
Iron studies, vitamin B12 and folate levels, screening for coeliac disease, and stool culture.
What further management steps are involved after a cancer diagnosis in the right colon?
Discuss CT scans for staging, urgent referral for right hemicolectomy, and multidisciplinary discussion regarding radiotherapy and chemotherapy.
What is a Mini-Audit in the context of CPD?
A review of the last five relevant patients managed, summarizing management and outcomes to identify areas for improvement.
What is one effective strategy to improve bowel cancer screening participation?
Personalised reminders, such as text messages from the patient's general practice.
What are the three risk categories for colorectal cancer screening?
Category 1: Near-average risk, Category 2: Moderately increased risk, Category 3: Potentially high risk.
