Phys Vivas · gastrointestinal
Colorectal Cancer — Viva Defence
DCE viva defence for Colorectal Cancer.
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Colorectal Cancer Viva
Long Case Viva Defence
Opening statement
"This patient presents with a problem best framed as Colorectal Cancer. My priorities are to identify red flags, confirm the mechanism with purposeful investigations, start a sequenced management plan, and integrate multimorbidity and follow-up." [1] [2]
Examiner questions
Q1: "What makes this urgent?" [1]
"I look for threats to airway, perfusion, neurology, metabolism, infection or bleeding, and I escalate those before elective work-up." [1] [2]
Q2: "What is your first investigation package?" [2]
"I order tests that change management now, not a scattergun panel." [1] [2]
Q3: "Walk me through treatment." [1]
"Stabilise, treat the mechanism, prevent complications, and plan monitoring." [1] [2] [3]
Q4: "What is the classic trap?" [2]
"Treating a label without confirming the discriminating mechanism, or delaying escalation." [1] [2]
References6ShowHide
- [1]Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA Cancer J Clin, 2024.PMID 38572751
- [2]Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study N Engl J Med, 1993.PMID 8474513
- [3]Bretthauer M, Løberg M, Wieszczy P, et al. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death N Engl J Med, 2022.PMID 36214590
- [4]André T, Boni C, Mounedji-Boudiaf L, et al. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer N Engl J Med, 2004.PMID 15175436
- [5]Sauer R, Becker H, Hohenberger W, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer N Engl J Med, 2004.PMID 15496622
- [6]André T, Shiu KK, Kim TW, et al. Pembrolizumab in Microsatellite-Instability-High Advanced Colorectal Cancer N Engl J Med, 2020.PMID 33264544