PK
;\ _rels/PK
;\ docProps/PK
;\ ppt/PK
;\
ppt/_rels/PK
;\ ppt/charts/PK
;\ ppt/charts/_rels/PK
;\ ppt/embeddings/PK
;\
ppt/media/PK
;\ ppt/slideLayouts/PK
;\ ppt/slideLayouts/_rels/PK
;\ ppt/slideMasters/PK
;\ ppt/slideMasters/_rels/PK
;\ ppt/slides/PK
;\ ppt/slides/_rels/PK
;\
ppt/theme/PK
;\ ppt/notesMasters/PK
;\ ppt/notesMasters/_rels/PK
;\ ppt/notesSlides/PK
;\ ppt/notesSlides/_rels/PK
;\
(* * [Content_Types].xml
PK
;\] ] _rels/.rels
PK
;\1ku docProps/app.xml
0
0
Microsoft Office PowerPoint
On-screen Show (16:9)
0
21
21
0
0
false
Fonts Used
2
Theme
1
Slide Titles
21
Arial
Calibri
Office Theme
Slide 1Slide 2Slide 3Slide 4Slide 5Slide 6Slide 7Slide 8Slide 9Slide 10Slide 11Slide 12Slide 13Slide 14Slide 15Slide 16Slide 17Slide 18Slide 19Slide 20Slide 21
PptxGenJS
false
false
false
16.0000
PK
;\V docProps/core.xml
Colorectal Carcinoma - Surgical Lecture
PptxGenJS Presentation
Prof. Zahid Mahmood
Prof. Zahid Mahmood
1
2026-04-09T07:30:41Z
2026-04-09T07:30:41Z
PK
;\m! ppt/_rels/presentation.xml.rels
PK
;\Oݨ ppt/theme/theme1.xmlPK
;\D9 9 ppt/presentation.xml
PK
;\X ppt/presProps.xml
PK
;\ ppt/tableStyles.xml
PK
;\D
>0 0 ppt/viewProps.xml
PK
;\H7t ! ppt/slideLayouts/slideLayout1.xml
PK
;\ђ7 7 , ppt/slideLayouts/_rels/slideLayout1.xml.rels
PK
;\k ! ! ppt/slides/slide1.xml
Colorectal CarcinomaMalignant Tumours of the Large IntestineBailey & Love — Latest EditionProf. Zahid MahmoodDepartment of SurgeryFinal Year MBBS | UHS / CPSP Aligned CurriculumBailey & Love Style · Exam-Oriented · Viva Ready · Case-Based LearningPK
;\3 ppt/slides/_rels/slide1.xml.rels
PK
;\. ppt/notesSlides/notesSlide1.xml
1PK
;\:A * ppt/notesSlides/_rels/notesSlide1.xml.rels
PK
;\kf ppt/slides/slide2.xml
02Learning Outcomes▶ Define CRC; state UK epidemiology + sex ratio▶ Enumerate aetiology; explain adenoma–Ca sequence▶ Stage using Dukes'/TNM; recognise clinical features▶ Plan surgery, adjuvant therapy and follow-upProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\2- ppt/slides/_rels/slide2.xml.rels
PK
;\ ppt/notesSlides/notesSlide2.xml
2PK
;\xշ * ppt/notesSlides/_rels/notesSlide2.xml.rels
PK
;\ s% ppt/slides/slide3.xml
03Epidemiology (Bailey & Love)▶ 2nd commonest cause of cancer death in the UK▶ 42,000 new cases/year; 56% male, 44% female▶ 1/3 rectal, 2/3 colonic; peaks in 8th decade▶ Less common in resource-poor countries (diet)Prof. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\W/ ppt/slides/_rels/slide3.xml.rels
PK
;\K |Ő ppt/notesSlides/notesSlide3.xml
3PK
;\9 Y * ppt/notesSlides/_rels/notesSlide3.xml.rels
PK
;\UN ppt/slides/slide4.xml
04Aetiology — Adenoma–Carcinoma Sequence▶ Most CRC arise from adenomatous polyps (B&L)▶ APC mutation: early; 2/3 of colonic adenomas▶ K-ras: later event; activates signalling pathways▶ p53: invasion marker; absent in adenomasProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\` ppt/slides/_rels/slide4.xml.rels
PK
;\vs ppt/notesSlides/notesSlide4.xml
4PK
;\J * ppt/notesSlides/_rels/notesSlide4.xml.rels
PK
;\J
ppt/slides/slide5.xml
05Aetiology — Risk Factors (B&L)▶ Diet: red/processed meat (haem, N-nitroso)▶ IBD, smoking, alcohol ↑ risk; fibre + Mg protective▶ Aspirin: substantial CRC protective evidence▶ Cholecystectomy: marginal ↑ right colon Ca riskProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\5 ppt/slides/_rels/slide5.xml.rels
PK
;\W8 ppt/notesSlides/notesSlide5.xml
5PK
;\Q e * ppt/notesSlides/_rels/notesSlide5.xml.rels
PK
;\B ppt/slides/slide6.xml
06Hereditary Syndromes — Lynch & FAP▶ Lynch: MLH1/MSH2/MSH6/PMS2 mutations; MSI▶ Amsterdam II: ≥3 relatives; 2 gen; one <50 yrs▶ Lynch: 2-yearly colonoscopy from age 25 (MLH1)▶ FAP: hundreds of polyps; prophylactic colectomyProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\ج+ ppt/slides/_rels/slide6.xml.rels
PK
;\z ppt/notesSlides/notesSlide6.xml
6PK
;\=| * ppt/notesSlides/_rels/notesSlide6.xml.rels
PK
;\* ppt/slides/slide7.xml
07Molecular Subtypes (CMS) — B&L▶ CMS1: MSI; right-sided; Lynch/sporadic tumours▶ CMS2: WNT + MYC activation; canonical pathway▶ CMS3: metabolic dysregulation; KRAS mutant▶ CMS4: TGF-β activation; mesenchymal; worst prog.Prof. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\F ppt/slides/_rels/slide7.xml.rels
PK
;\)l ppt/notesSlides/notesSlide7.xml
7PK
;\|g * ppt/notesSlides/_rels/notesSlide7.xml.rels
PK
;\ ppt/slides/slide8.xml
08Pathology — Macroscopic & Site Distribution▶ Annular = obstruction; Ulcerating = bleeding▶ Rectum 38%; Sigmoid 21%; Caecum 12%; Asc. 5%▶ Left colon predominant; flexures/transverse rare▶ Microscopically: columnar cell adenocarcinomaProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\6 ppt/slides/_rels/slide8.xml.rels
PK
;\iސ ppt/notesSlides/notesSlide8.xml
8PK
;\pO * ppt/notesSlides/_rels/notesSlide8.xml.rels
PK
;\[AC ppt/slides/slide9.xml
09Spread of Colorectal Cancer▶ Local: longitudinal + radial; invades adjacent▶ Lymphatic: paracolic → mesenteric → central▶ Haematogenous: liver (portal vein); 1/3 at Dx▶ Transcoelomic: peritoneum, ovary, omentumProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\>$ ppt/slides/_rels/slide9.xml.rels
PK
;\q ppt/notesSlides/notesSlide9.xml
9PK
;\1 * ppt/notesSlides/_rels/notesSlide9.xml.rels
PK
;\ ppt/slides/slide10.xml
10Staging — Dukes' Classification (B&L)▶ Stage A: invasion; muscularis propria intact▶ Stage B: breaches muscularis propria; N0▶ Stage C: nodes involved; adjuvant chemo▶ Stage D (unofficial): metastatic; 10% 5-yr surv.Prof. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\Ѳ ! ppt/slides/_rels/slide10.xml.rels
PK
;\O ppt/notesSlides/notesSlide10.xml
10PK
;\T + ppt/notesSlides/_rels/notesSlide10.xml.rels
PK
;\\ ppt/slides/slide11.xml
11Staging — TNM (UICC 8th Edition)▶ T1: submucosa; T2: muscularis; T3: pericolorectal▶ T4a: breaches peritoneum; T4b: invades organ▶ N1: 1–3 nodes; N2: ≥4; N1c: satellite deposits▶ M1a: 1 organ; M1b: >1 organ; M1c: peritoneumProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\; ! ppt/slides/_rels/slide11.xml.rels
PK
;\s6ӑ ppt/notesSlides/notesSlide11.xml
11PK
;\O + ppt/notesSlides/_rels/notesSlide11.xml.rels
PK
;\O ppt/slides/slide12.xml
12Clinical Features & Investigations▶ Left CRC: change in bowel habit + PR bleed▶ Right CRC: IDA, palpable mass; 20% emergency▶ Colonoscopy: gold standard; biopsy + synchronous▶ CT TAP: standard staging; MRI for rectumProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\ c ! ppt/slides/_rels/slide12.xml.rels
PK
;\*)@ ppt/notesSlides/notesSlide12.xml
12PK
;\Fb + ppt/notesSlides/_rels/notesSlide12.xml.rels
PK
;\
2 ppt/slides/slide13.xml
13Screening (B&L — UK Programme)▶ FIT: age 60–74; 2-yearly; replaces guaiac test▶ FIT: more accurate than guaiac; 15–20% ↓ mortality▶ Flexible sigmoidoscopy at 55 — replaced by FIT▶ Positive FIT → colonoscopy for definitive diagnosisProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\x ! ppt/slides/_rels/slide13.xml.rels
PK
;\Ї ppt/notesSlides/notesSlide13.xml
13PK
;\yv + ppt/notesSlides/_rels/notesSlide13.xml.rels
PK
;\db* ppt/slides/slide14.xml
14Surgical Operations — Right & Left Sides▶ Right hemicolectomy: caecal/ascending Ca (CME)▶ Extended right: transverse + splenic flexure Ca▶ Left hemicolectomy: sigmoid/descending; IMA tie▶ Laparoscopic colectomy: NICE-recommendedProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\O ! ppt/slides/_rels/slide14.xml.rels
PK
;\0 ppt/notesSlides/notesSlide14.xml
14PK
;\?ݤ + ppt/notesSlides/_rels/notesSlide14.xml.rels
PK
;\;eZ ppt/slides/slide15.xml
15Emergency Surgery & Stenting (B&L)▶ 20% emergency: obstruction/perforation/bleed▶ Right-sided: hemicolectomy + anastomosis safe▶ Left: Hartmann's or resect + anastomosis; wash▶ Colonic stent: converts emergency to electiveProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\*R ! ppt/slides/_rels/slide15.xml.rels
PK
;\Qz ppt/notesSlides/notesSlide15.xml
15PK
;\$Q + ppt/notesSlides/_rels/notesSlide15.xml.rels
PK
;\
ppt/slides/slide16.xml
16Adjuvant Therapy & Prognosis (B&L)▶ Stage III (Dukes' C): FOLFOX → 67–70% 5-yr▶ Stage II (Dukes' B): chemo for high-risk only▶ Metastatic: FOLFIRI ± bevacizumab/cetuximab▶ Overall 5-yr: 58%; Stage A ~95%; Stage D ~10%Prof. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\
! ppt/slides/_rels/slide16.xml.rels
PK
;\ ppt/notesSlides/notesSlide16.xml
16PK
;\ y + ppt/notesSlides/_rels/notesSlide16.xml.rels
PK
;\7M;
ppt/slides/slide17.xml
17Follow-up, ERAS & Complications▶ CT + CEA 3-yearly: detect metachronous + liver mets▶ ERAS: LOS 10–14 days → 3–5 days (B&L)▶ Anastomotic leak: 4–8%; CT early; back to theatre▶ Hepatic resection for isolated liver metsProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\檋 ! ppt/slides/_rels/slide17.xml.rels
PK
;\r . ppt/notesSlides/notesSlide17.xml
17PK
;\BI + ppt/notesSlides/_rels/notesSlide17.xml.rels
PK
;\t\2 ppt/slides/slide18.xml
18Mnemonics & High-Yield Exam Points▶ APC→K-ras→p53: mutation sequence (early→late)▶ VIVA: p53 = invasion marker; absent in adenomas▶ Dukes' C: FOLFOX adjuvant; ↑ survival by ~20%▶ Krukenberg: ovarian mets via transcoelomic spreadProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\Yh ! ppt/slides/_rels/slide18.xml.rels
PK
;\ ppt/notesSlides/notesSlide18.xml
18PK
;\N + ppt/notesSlides/_rels/notesSlide18.xml.rels
PK
;\Ԥ[# [# ppt/slides/slide19.xml
Clinical Scenario — Case-Based LearningCASE: 65-yr male; 3-month history of rectal bleeding and change in bowel habit. His father was diagnosed with colon cancer aged 48. Hb 9.8 g/dL (microcytic). Colonoscopy: annular tumour at sigmoid colon with biopsy showing adenocarcinoma. CT staging: no distant metastases. N2 disease on CT.Q1: Stage and operative plan?✔ TNM Stage III (N2); Dukes' C — laparoscopic left hemicolectomy + high-tie IMAQ2: Post-op adjuvant plan and family counselling?✔ FOLFOX adjuvant chemo; family referral for Lynch syndrome screening (father <50)Prof. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\~ ! ppt/slides/_rels/slide19.xml.rels
PK
;\0[ ppt/notesSlides/notesSlide19.xml
19PK
;\i + ppt/notesSlides/_rels/notesSlide19.xml.rels
PK
;\v5 5 ppt/slides/slide20.xml
MCQs — SBA Style (CPSP / UHS Pattern)1Q1. Commonest site of colorectal cancer (B&L)?A) Caecum B) Sigmoid C) Rectum ✔ (38%) D) Descending colon2Q2. Which mutation is a marker of invasion in CRC?A) APC B) K-ras C) p53 ✔ D) MLH13Q3. Anastomotic leak rate after colonic surgery?A) 1–2% B) 4–8% ✔ C) 10–15% D) 20–25%4Q4. Dukes' C — adjuvant chemotherapy regimen?A) FOLFIRI B) FOLFOX ✔ C) Capecitabine alone D) Bevacizumab aloneProf. Zahid Mahmood | Colorectal Carcinoma | Final Year MBBS | UHS / CPSPPK
;\g_ ! ppt/slides/_rels/slide20.xml.rels
PK
;\7 ppt/notesSlides/notesSlide20.xml
20PK
;\SB + ppt/notesSlides/_rels/notesSlide20.xml.rels
PK
;\;4 4 ppt/slides/slide21.xml
High-Yield Summary 1CRC: APC→K-ras→p53 sequence; rectum commonest site (38%) 2Stage III (Dukes' C): FOLFOX ↑ 5-yr survival to 67–70% 3Laparoscopic colectomy: NICE-recommended; equivalent survival 420% emergency presentation; stent converts emergency to electiveProf. Zahid Mahmood | Colorectal Carcinoma | End of LecturePK
;\z ! ppt/slides/_rels/slide21.xml.rels
PK
;\89| ppt/notesSlides/notesSlide21.xml
21PK
;\HΩ + ppt/notesSlides/_rels/notesSlide21.xml.rels
PK
;\K ! ppt/slideMasters/slideMaster1.xml
PK
;\N) , ppt/slideMasters/_rels/slideMaster1.xml.rels
PK
;\6T T ! ppt/notesMasters/notesMaster1.xml
7/23/19Click to edit Master text stylesSecond levelThird levelFourth levelFifth level‹#›PK
;\s * * , ppt/notesMasters/_rels/notesMaster1.xml.rels
PK
;\ _rels/PK
;\ $ docProps/PK
;\ K ppt/PK
;\
m ppt/_rels/PK
;\ ppt/charts/PK
;\ ppt/charts/_rels/PK
;\ ppt/embeddings/PK
;\
ppt/media/PK
;\ B ppt/slideLayouts/PK
;\ q ppt/slideLayouts/_rels/PK
;\ ppt/slideMasters/PK
;\ ppt/slideMasters/_rels/PK
;\
ppt/slides/PK
;\ 3 ppt/slides/_rels/PK
;\
b ppt/theme/PK
;\ ppt/notesMasters/PK
;\ ppt/notesMasters/_rels/PK
;\ ppt/notesSlides/PK
;\ ppt/notesSlides/_rels/PK
;\
(* * P [Content_Types].xmlPK
;\] ] P. _rels/.relsPK
;\1ku 0 docProps/app.xmlPK
;\V 8 docProps/core.xmlPK
;\m! ; ppt/_rels/presentation.xml.relsPK
;\Oݨ J ppt/theme/theme1.xmlPK
;\D9 9 k ppt/presentation.xmlPK
;\X i{ ppt/presProps.xmlPK
;\ | ppt/tableStyles.xmlPK
;\D
>0 0 } ppt/viewProps.xmlPK
;\H7t ! ppt/slideLayouts/slideLayout1.xmlPK
;\ђ7 7 , ppt/slideLayouts/_rels/slideLayout1.xml.relsPK
;\k ! ! l ppt/slides/slide1.xmlPK
;\3 " ppt/slides/_rels/slide1.xml.relsPK
;\. . ppt/notesSlides/notesSlide1.xmlPK
;\:A * ppt/notesSlides/_rels/notesSlide1.xml.relsPK
;\kf ppt/slides/slide2.xmlPK
;\2- = ppt/slides/_rels/slide2.xml.relsPK
;\ I ppt/notesSlides/notesSlide2.xmlPK
;\xշ * ppt/notesSlides/_rels/notesSlide2.xml.relsPK
;\ s% ) ppt/slides/slide3.xmlPK
;\W/ U ppt/slides/_rels/slide3.xml.relsPK
;\K |Ő a ppt/notesSlides/notesSlide3.xmlPK
;\9 Y * . ppt/notesSlides/_rels/notesSlide3.xml.relsPK
;\UN A ppt/slides/slide4.xmlPK
;\` {( ppt/slides/_rels/slide4.xml.relsPK
;\vs * ppt/notesSlides/notesSlide4.xmlPK
;\J * T1 ppt/notesSlides/_rels/notesSlide4.xml.relsPK
;\J
g3 ppt/slides/slide5.xmlPK
;\5 S ppt/slides/_rels/slide5.xml.relsPK
;\W8 U ppt/notesSlides/notesSlide5.xmlPK
;\Q e * {\ ppt/notesSlides/_rels/notesSlide5.xml.relsPK
;\B ^ ppt/slides/slide6.xmlPK
;\ج+ ~ ppt/slides/_rels/slide6.xml.relsPK
;\z ր ppt/notesSlides/notesSlide6.xmlPK
;\=| * ppt/notesSlides/_rels/notesSlide6.xml.relsPK
;\* ppt/slides/slide7.xmlPK
;\F ppt/slides/_rels/slide7.xml.relsPK
;\)l ppt/notesSlides/notesSlide7.xmlPK
;\|g * IJ ppt/notesSlides/_rels/notesSlide7.xml.relsPK
;\ ״ ppt/slides/slide8.xmlPK
;\6 ppt/slides/_rels/slide8.xml.relsPK
;\iސ $ ppt/notesSlides/notesSlide8.xmlPK
;\pO * ppt/notesSlides/_rels/notesSlide8.xml.relsPK
;\[AC ppt/slides/slide9.xmlPK
;\>$ - ppt/slides/_rels/slide9.xml.relsPK
;\q 9 ppt/notesSlides/notesSlide9.xmlPK
;\1 * ppt/notesSlides/_rels/notesSlide9.xml.relsPK
;\ ppt/slides/slide10.xmlPK
;\Ѳ ! Q+ ppt/slides/_rels/slide10.xml.relsPK
;\O _- ppt/notesSlides/notesSlide10.xmlPK
;\T + .4 ppt/notesSlides/_rels/notesSlide10.xml.relsPK
;\\ C6 ppt/slides/slide11.xmlPK
;\; ! V ppt/slides/_rels/slide11.xml.relsPK
;\s6ӑ X ppt/notesSlides/notesSlide11.xmlPK
;\O + ]_ ppt/notesSlides/_rels/notesSlide11.xml.relsPK
;\O ra ppt/slides/slide12.xmlPK
;\ c ! ppt/slides/_rels/slide12.xml.relsPK
;\*)@ ppt/notesSlides/notesSlide12.xmlPK
;\Fb + ppt/notesSlides/_rels/notesSlide12.xml.relsPK
;\
2 ppt/slides/slide13.xmlPK
;\x ! ppt/slides/_rels/slide13.xml.relsPK
;\Ї ppt/notesSlides/notesSlide13.xmlPK
;\yv + ppt/notesSlides/_rels/notesSlide13.xml.relsPK
;\db* ӷ ppt/slides/slide14.xmlPK
;\O ! ppt/slides/_rels/slide14.xml.relsPK
;\0 ppt/notesSlides/notesSlide14.xmlPK
;\?ݤ + ppt/notesSlides/_rels/notesSlide14.xml.relsPK
;\;eZ ppt/slides/slide15.xmlPK
;\*R ! D ppt/slides/_rels/slide15.xml.relsPK
;\Qz R ppt/notesSlides/notesSlide15.xmlPK
;\$Q + ! ppt/notesSlides/_rels/notesSlide15.xml.relsPK
;\
6 ppt/slides/slide16.xmlPK
;\
! {. ppt/slides/_rels/slide16.xml.relsPK
;\ 0 ppt/notesSlides/notesSlide16.xmlPK
;\ y + X7 ppt/notesSlides/_rels/notesSlide16.xml.relsPK
;\7M;
m9 ppt/slides/slide17.xmlPK
;\檋 ! Y ppt/slides/_rels/slide17.xml.relsPK
;\r . [ ppt/notesSlides/notesSlide17.xmlPK
;\BI + b ppt/notesSlides/_rels/notesSlide17.xml.relsPK
;\t\2 d ppt/slides/slide18.xmlPK
;\Yh ! ppt/slides/_rels/slide18.xml.relsPK
;\ ppt/notesSlides/notesSlide18.xmlPK
;\N + č ppt/notesSlides/_rels/notesSlide18.xml.relsPK
;\Ԥ[# [# ُ ppt/slides/slide19.xmlPK
;\~ ! h ppt/slides/_rels/slide19.xml.relsPK
;\0[ v ppt/notesSlides/notesSlide19.xmlPK
;\i + E ppt/notesSlides/_rels/notesSlide19.xml.relsPK
;\v5 5 Z ppt/slides/slide20.xmlPK
;\g_ ! - ppt/slides/_rels/slide20.xml.relsPK
;\7 ; ppt/notesSlides/notesSlide20.xmlPK
;\SB +
ppt/notesSlides/_rels/notesSlide20.xml.relsPK
;\;4 4 ppt/slides/slide21.xmlPK
;\z ! 4 ppt/slides/_rels/slide21.xml.relsPK
;\89| -6 ppt/notesSlides/notesSlide21.xmlPK
;\HΩ + < ppt/notesSlides/_rels/notesSlide21.xml.relsPK
;\K ! ? ppt/slideMasters/slideMaster1.xmlPK
;\N) , ] ppt/slideMasters/_rels/slideMaster1.xml.relsPK
;\6T T ! _ ppt/notesMasters/notesMaster1.xmlPK
;\s * * , } ppt/notesMasters/_rels/notesMaster1.xml.relsPK w w " ~