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