Review of colorectal cancer quality performance indicators: consultation

Active treatment

Treatment which is intended to improve the cancer and/or alleviate symptoms, as opposed to supportive care.

Adenoma

A benign (non malignant) tumour that develops from epithelial tissue.

Adjuvant therapy / treatment

Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.

Anastomosis

An artificial connection, created by surgery, between two tubular organs or parts, especially between two parts of the intestine. For example, a junction created by a surgeon between two pieces of bowel which have been cut to remove the intervening section.

Anastomotic dehiscence/ leak

Bursting open or splitting of the surgical connection between two sections of intestine

Anterior resection

The procedure to remove a diseased section of rectum, and re-joining of the healthy tissue at either end of the diseased area.

Anti-cancer therapy

Any treatment which is designed to kill cancer cells.

Asymptomatic

Having no symptoms. You are considered asymptomatic if you:

• Have recovered from an illness or condition and no longer have symptoms
• Have an illness or condition (such as early stage high blood pressure or glaucoma) but do not have symptoms

Biopsy

Removal of a sample of tissue from the body to assist in diagnosis of a disease.

Bowel

The long, tube-shaped organ in the abdomen that completes the process of digestion. The bowel has two parts, the small bowel and the large bowel.

Cause-specific survival

A method of estimating net survival. Only deaths attributable to the cancer of diagnosis are counted as deaths, giving the probability of survival in the absence of other causes of death.

Chemoradiotherapy

Treatment that combines chemotherapy with radiotherapy.

Chemotherapy

The use of drugs that kill cancer cells, or prevent or slow their growth.

Circumferential margins ( CRM)

Margins of tissue surrounding a rectal cancer after it has been removed.

Clinical effectiveness

Measure of the extent to which a particular intervention works.

Clinical Nurse Specialist ( CNS)

A nurse with specialist training in a particular type of cancer.

Clinical trials

A type of research study that tests how well new medical approaches or medicines work. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease.

Colon

Part of the bowel. Also called the large intestine or large bowel. This structure has five major divisions: caecum, ascending colon, transverse colon, descending colon and sigmoid colon. The colon is responsible for forming, storing and expelling waste matter into the rectum.

Colonoscopy

Examination of the interior of the large bowel using a long, flexible, instrument (a colonoscope) inserted through the anus. A colonoscope is capable of reaching to the upper end of the large bowel (colon) and can be used to diagnose diseases of the large bowel.

Colorectal Cancer

Cancer that develops in the colon (the longest part of the large intestine) and/or the rectum (the last several inches of the large intestine before the anus).

Co-morbidity

The condition of having two or more diseases at the same time.

Computed Tomography ( CT)

An X-ray imaging technique used in diagnosis that can reveal many soft tissue structures not shown by conventional radiography. A computer is used to assimilate multiple X-ray images into a two-dimensional and/or three-dimensional cross-sectional image.

CT Colonography

Computed tomography of the abdomen and pelvis that focuses on the colon. Computed tomography is an x-ray

Contraindicated

A symptom or medical condition that makes a particular treatment or procedure inadvisable because a person is likely to have a bad reaction.

Curative

Having properties which cure. Something which overcomes disease and promotes recovery.

Elective

Subject to the choice or decision of the patient or physician, applied to procedures that are advantageous to the patient, but not urgent.

Emergency Surgery

Unscheduled surgery performed promptly and often for lifesaving purposes.

Extramural vascular invasion

Involvement of a vascular structure which has a smooth muscle in the wall.

Fatal

Results in death.

High risk

High risk colorectal cancer is defined as patients with pT4 (see TNM) disease and extramural vascular invasion.

Independent risk factor

A substance or condition that increases an individual's chances of getting a particular type of cancer.

Index procedure

Initial or first surgical procedure performed.

Interventional radiology

A minimally invasive procedure where images are used to guide instruments through the body to the specific area where treatment should be targeted.

Intravenous iodinated contrast

A substance administered intra venously (directly into bloodstream) to enhance the visibility of structures on imaging.

KRAS

A gene which is found in the human body. If this gene mutates cancer can form.

KRAS testing

A test to establish the type of KRAS gene mutation present in a colorectal cancer.

Large bowel

Another name for the large intestine.

Long course radiotherapy

A course of radiotherapy lasting up to 6 weeks.

Lymph nodes

Small bean shaped organs located along the lymphatic system. Nodes filter bacteria or cancer cells that might travel through the lymphatic system.

Metastatic disease

Spread of cancer away from the primary site to somewhere else via the bloodstream or the lymphatic system. Metastatic disease can be local (close to the area where the cancer is) or distant (in another area of the body).

Morbidity

How much ill health a particular condition causes.

Mortality

Either (1) the condition of being subject to death; or (2) the death rate, which reflects the number of deaths per unit of population in any specific region, age group, disease or other classification, usually expressed as deaths per 1000, 10,000 or 100,000.

Magnetic Resonance Imaging ( MRI)

A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue.

Multi Disciplinary Team Meeting ( MDT)

A meeting which is held on a regular basis, which is made up of participants from various disciplines appropriate to the disease area, where diagnosis, management, and appropriate treatment of patients is discussed and decided.

Neo-adjuvant chemotherapy

Chemotherapy treatment which is given before the treatment of a primary tumour with the aim of improving the results of surgery and preventing the development of metastases.

Palliative

Anything which serves to alleviate symptoms due to the underlying cancer but is not expected to cure it.

Pathological

The study of disease processes with the aim of understanding their nature and causes. This is achieved by observing samples of fluid and tissues obtained from the living patient by various methods, or at post mortem.

Performance status

A measure of how well a patient is able to perform ordinary tasks and carry out daily activities. ( PS WHO score of 0=asymptomatic, 4=bedridden).

Post operative complication

A complication or problem experienced following a surgical procedure.

Prognosis

An assessment of the expected future course and outcome of a person's disease.

Radical treatment

Treatment that aims to get to completely get rid of a cancer.

Radiotherapy

The use of radiation, usually X-rays or gamma rays, to kill tumour cells.

Rectal anastomosis

A surgical procedure where part of the rectum is removed and the remaining ends joined together.

Rectal Cancer

Cancer that forms in the tissues of the rectum (the last several inches of the large intestine closest to the anus).

Rectum

The distal or lowest portion of the large intestine.

Recurrence

When new cancer cells are detected, at the site of original tumour or elsewhere in the body, following treatment.

Short course radiotherapy

5 courses of radiotherapy given over 1 week prior to surgery being performed.

Staging

Process of describing to what degree cancer has spread from its original site to another part of the body. Staging involves clinical, radiological, surgical and pathological assessments.

Stoma

An artificial opening of the bowel that has been brought to the abdominal surface.

Surgery/Surgical Resection

Surgical removal of the tumour/lesion.

Synchronous tumours

Two or more different tumours presenting at the same time.

Total mesorectal excision ( TME)

A procedure in which any tissue surrounding the rectum which may contain tumour cells is removed at the same time as the rectum.

Transanal endoscopic microsurgery ( TEM)

A minimally invasive surgical approach for local excision of rectal lesions that cannot be directly visualized, and is also an alternative to open or laparoscopic excision.

Transanal resection of tumour ( TART)

Surgical procedure performed to remove a tumour in the rectum through the anus.