COLON CANCERHamad Emad H. Dhuhayr

CONTENTS

• SOEPEL

• COLON CANCER

SOEPEL

• S A 60-year-old female patient was admitted to hospital for dyspnea, chest pain, fatigue and recurrent plural effusion from 1 year.

• O taking history and physical examination.

• E chronic heart failure, renal failure and cirrhosis

• P Echo and ecg

• E medication.

• L colon cancer

COLORECTAL CANCER

DEFINITION

• Third most common type of cancer and second most frequent cause of cancer-related death

• A disease in which normal cells in the lining of the colon or rectum begin to change, grow without control, and no longer die

• Usually begins as a noncancerous polyp that can, over time, become a cancerous tumor

TYPICAL SITES OF INCIDENCE AND SYMPOMS OF COLON CANCER

RISK FACTOR

• Polyps (a noncancerous or precancerous growth associated with aging)

• Age

• Inflammatory bowel disease (IBD)

• Diet high in saturated fats, such as red meat

• Personal or family history of cancer

• Obesity

• Smoking

• alcohol

Result of interplay between environmental and Genetic factors

Central environmental factors:

Diet and lifestyle

35% of all cancers are attributable to diet

50%-75% of crc in the us may be preventable Through dietary modifications

Development of CRC

consumption of red meat

animal and saturated fat

refined carbohydrates

alcohol

increased risk

Dietary factors implicated in colorectal carcinogenesis

dietary fiber

vegetables

fruits

antioxidant vitamins

calcium

folate (B Vitamin)

decreased risk

Dietary factors implicated in colorectal carcinogenesis

HEREDITARY COLORECTAL CANCER SYNDROMES:

• Familial syndromes such as familial adenomatous polyposis.

• (FAP)—an autosomal dominant disorder caused by mutations in the adenomatous polyposis Coli (APC) gene on chromosome 5—may lead to an increased risk of colon cancer.

• In FAP, Cancers commonly develop in adolescence and young adulthood, and the incidence of colorectal Neoplasms is nearly 100% by age 50 years.

CONT….

• Hereditary nonpolyposis colon cancer.

• (HNPCC or lynch syndrome) is associated with a lower but significant risk of cancer of the Colon and rectum.

• Mutations in tumor suppressor genes such as MCC, DCC, BRCA1, and p53

• Also confer higher risks for colorectal neoplasms.

SCREENING

• A. Adults with signs or symptoms consistent with colorectal neoplasm should undergo testing To exclude the presence of a mass.

• B. All average-risk adults aged 50 years or older should undergo one or more of the following: annual Fecal occult blood test (FOBT) or fecal immunochemical test (FIT), flexible sigmoidoscopy every 5 years, double-contrast barium enema (DCBE) every 5 years, CT colonography every 5 years, or Colonoscopy every 10 years. All positive tests should be followed up with a colonoscopy.

• C. High-risk patients, including those with a personal or family history of colorectal cancer or Adenomatous polyps, a history of FAP or HNPCC, or a history of inflammatory bowel disease, Should be screened earlier and more frequently.

PATHOLOGY

• A. The large majority of colorectal neoplasms are adenocarcinomas, and most are well or moderately differentiated. Poorly differentiated neoplasms are associated with poor prognosis.

• B. Squamous cell carcinomas can arise in the anus. Such neoplasms differ from adenocarcinomas in terms of biology and therapy.

DIAGNOSIS

• Colonoscopy is the preferred diagnostic test for colorectal cancer

• Barium enema and fl exible sigmoidoscopy.

• Biopsy of suspicious lesions is required to establish a diagnosis.

• Tumor markers such as carcinoembryonic antigen (cea) or carbohydrate antigen (ca).

• Radiologic studies are used to evaluate the extent of local disease and to screen for metastatic disease.

STAGE 0 COLORECTAL CANCER

• Known as “cancer in situ,” meaning the cancer is located in the mucosa (moist tissue lining the colon or rectum)

• Removal of the polyp (polypectomy) is the usual treatment

STAGE I COLORECTAL CANCER

• The cancer has grown through the mucosa and invaded the muscularis (muscular coat)

• Treatment is surgery to remove the tumor and some surrounding lymph nodes

STAGE II COLORECTAL CANCER• The cancer has grown

beyond the muscularis of the colon or rectum but has not spread to the lymph nodes

• Stage ii colon cancer is treated with surgery and, in some cases, chemotherapy after surgery

• Stage ii rectal cancer is treated with surgery, radiation therapy, and chemotherapy

STAGE III COLORECTAL CANCER• The cancer has spread to

the regional lymph nodes (lymph nodes near the colon and rectum)

• Stage iii colon cancer is treated with surgery and chemotherapy

• Stage iii rectal cancer is treated with surgery, radiation therapy, and chemotherapy

STAGE IV COLORECTAL CANCER• The cancer has spread

outside of the colon or rectum to other areas of the body

• Stage IV cancer is treated with chemotherapy. Surgery to remove the colon or rectal tumor may or may not be done

• Additional surgery to remove metastases may also be done in carefully selected patients

A Mucosa 80%B Into or through M. propria 50%C1 Into M. propria, + LN ! 40%C2 Through M. propria, + LN! 12%D distant metastatic spread <5%

Dukes staging system

Goals of treatment

Goals of treatment for early disease

• Remove cancer cells

• Kill cancer cells

• Keep the cancer cells from returning

Treatment is defined by stage and type of cancer present

Goals of treatment for advanced disease

• Slow or stop the growth of cancer cells

• Manage quality of life concerns

REFERENCES

• DAVIDSON’S

• KUMAR

• WEBSITE