CANCER INSTITUTE

MBBS Year 4 Cancer Patient Pathway

Tutorial 2 Colorectal Cancer Student Case Notes

Tutorial Preparation

You are expected to review the case notes and any presentation available on Moodle in advance of your
tutorial. You will be expected to be able to discuss the cases with your tutor and peers during the tutorial.

Student Case Notes

Contents
Colorectal Cancer Case 1.............................................................................................................................2
Colorectal Cancer Case 2.............................................................................................................................3
Colorectal Cancer Case 3.............................................................................................................................4
Colorectal Cancer Case 1
Patient Information: 55 year old male referred with ‘change in bowel habit over several weeks and PR
bleeding.

1) What questions do you ask him to obtain a full history?

2) What examination do you perform?

3) What investigations do you organise?

Patient Information: Outcome - ulcerated mass in caecum, histology confirms a moderately differentiated
adenocarcinoma.

4) Which further investigations do you organise?

Patient Information: Outcome - no evidence of metastatic disease

5) What is the next step after completion of staging investigations?

Patient Information: Histopathology shows a T3N1 (1/10) moderately differentiated adenocarcinoma

6) What determines the risk of recurrence? What is the risk of recurrence for this patient?

7) Would you consider any further treatment? If so, what are the options and why is it given?

Patient Information: Patient opts for chemotherapy with 5-FU/oxaliplatin

8) During the first cycle of chemotherapy the patient is brought to the A & E department complaining of
shortness of breath and chest pain. What would you be concerned about?

9) What is the follow up for this patient?

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Colorectal Cancer Case 2
Patient Information: 68 year old female referred with fatigue, iron deficiency anaemia and abnormal LFTs.

1) What questions do you ask her to obtain the full history?

2) What examination do you perform?

3) What investigations do you organise?

Patient Information: Outcome - mass in sigmoid, histology confirms a moderately differentiated

adenocarcinoma.

4) Which further investigations do you organise?

Patient Information: Outcome – extensive liver metastases in both lobes

5) What is the next step after completion of staging investigations?

6) What are the treatment options?

7) What is the prognosis? With treatment? Without treatment?

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Colorectal Cancer Case 3
Patient Information: 73 year old male referred with PR bleeding and tenesmus

1) What questions do you ask her to obtain the full history?

2) What examination do you perform?

3) What investigations do you organise?

Patient Information: Outcome - mass in middle 1/3 of rectum, histology confirms a moderately
differentiated adenocarcinoma;

4) Which further investigations do you organise?

Patient Information: Outcome – MRI shows that circumferential resection margin may be compromised,
no evidence of distant metastases

5) What is the next step after completion of staging investigations? What are the treatment options?
What are the potential late complications of treatment for this group of patients?

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