LOGO

Colorectal cancer:
Dr. Mohamed Shekhani

2012
Contents

3
1

CRC location distribution.

2

CRC clinical presentations

3

Sporadic CRC

4

Familial CRC
Contents

3
1

CRC Epidemiology

2

CRC Precursors

3

Hereditary CRC syndromes

4

CRC screening
CRC: Epidemiology/risk factors
CRC
Epidemiology

Sporadic average risk
Most common GIT cancer
3rd most common cancer
2nd m...
Stratification of Colorectal Cancer Risk

CRC Risk
High risk

Average risk
-ve family
history
Most
LTR 5-6%
>50 years.

FA...
Risk/protective factors for CRC
protective factors

Risk factors

Hereditary CRC

IBD
WESTERN

No family H/O CRC

CRC

Asi...
Adenoma-carcinoma sequence develop over
10 years: rationale for screening
CRC: Adenoma-carcinoma sequence
Rationale for screening by colonoscopy
CRC
LAP with dysplasia
Screening for
early detection

Large adenomatous polyps

Sma...
Hereditary CRC Syndromes: FAP

Mutation in APC genes

100% will develop 100s of
adenomatous colonic polyps & cancer
By 40 ...
Hereditary CRC Syndromes: FAP

Need screening colonoscopy earlier than
The usual age of 50 years

Extra GIT Features:
Bone...
Hereditary CRC Syndromes: AFAP

Mutations at the terminal end of
the APC gene

20 or more adenoma

SAME RISK OF CRC.

AFAP
Hereditary CRC Syndromes: HNPCC

Mutations at DNA MMR gene

Polyps larger
more in proximal colon
Progress more rapidly to ...
Hereditary CRC Syndromes: familial

Do not meet criteria for FAP or HNPCC

1ST degree or 2nd degree relative with
CRC befo...
Hereditary CRC Syndromes: others

Familial juvenile polyposis

the Peutz-Jeghers syndrome
(hamartomatous polyps)

Both at ...
IBD CRC risk

Duration > 8 years of active colitis
Early age of onset

Extent

Presence of PSC.

IBD CRC Risk
Algorithm for screening for CRC
Management
 Surgery is the only hope for cure.
 Carcinomas within 2 cm of the anal verge may require abdominoperineal re...
LOGO

2012
Git crc 4th 2012 abstract.
Git crc 4th 2012 abstract.
Git crc 4th 2012 abstract.
Git crc 4th 2012 abstract.
Git crc 4th 2012 abstract.
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Git crc 4th 2012 abstract.

  1. 1. LOGO Colorectal cancer: Dr. Mohamed Shekhani 2012
  2. 2. Contents 3 1 CRC location distribution. 2 CRC clinical presentations 3 Sporadic CRC 4 Familial CRC
  3. 3. Contents 3 1 CRC Epidemiology 2 CRC Precursors 3 Hereditary CRC syndromes 4 CRC screening
  4. 4. CRC: Epidemiology/risk factors CRC Epidemiology Sporadic average risk Most common GIT cancer 3rd most common cancer 2nd most common cancer death 2% die from this cancer. Men>women Blacks>white Increase sharply after 50 Hereditary CRC syndromes: Higher than average CRC risk &include: FAP AFAP HNPCC IBD Familial CRC.
  5. 5. Stratification of Colorectal Cancer Risk CRC Risk High risk Average risk -ve family history Most LTR 5-6% >50 years. FAP 100% •HNPCC 10% •IBD 10-20% •Familial FDR 10% Occur earlier <50 years. • minority Text ALL
  6. 6. Risk/protective factors for CRC protective factors Risk factors Hereditary CRC IBD WESTERN No family H/O CRC CRC Asia/Africa High veg;fruits/ calcium/folate Physical inactivity High red meat, sucrose,fat Low calcium/folate. Obesity,smoking, Alcohol, cholecystectomy Physical activity
  7. 7. Adenoma-carcinoma sequence develop over 10 years: rationale for screening
  8. 8. CRC: Adenoma-carcinoma sequence
  9. 9. Rationale for screening by colonoscopy CRC LAP with dysplasia Screening for early detection Large adenomatous polyps Small adenomatous polyps Normal 30-50% of adults develop adenomatous polyps during their lifetime, but only 1 / 20 will progress to cancer. 15-25% >50 ys have adenomatous polyps, males>females.
  10. 10. Hereditary CRC Syndromes: FAP Mutation in APC genes 100% will develop 100s of adenomatous colonic polyps & cancer By 40 years age. GIT Extra colonic tumors: 2nd most common after colonic; adenoma/adenocan of ampulla of vater, Fundal gland polyps. FAP
  11. 11. Hereditary CRC Syndromes: FAP Need screening colonoscopy earlier than The usual age of 50 years Extra GIT Features: Bone/soft tissue tumors Retinal pigment epith hypertrophy Treatment: Total colectomy with ileostomy to prevent cancer. FAP
  12. 12. Hereditary CRC Syndromes: AFAP Mutations at the terminal end of the APC gene 20 or more adenoma SAME RISK OF CRC. AFAP
  13. 13. Hereditary CRC Syndromes: HNPCC Mutations at DNA MMR gene Polyps larger more in proximal colon Progress more rapidly to CRC. 8O% develop cancer >50 Vs 5% > 50 in average risk persons. Extra-colonic tumors:FRS,Kid,pancbil,SI HNPCC
  14. 14. Hereditary CRC Syndromes: familial Do not meet criteria for FAP or HNPCC 1ST degree or 2nd degree relative with CRC before or after 50 Risk increase with increasing numbers of Affected relatives. Familal CRC
  15. 15. Hereditary CRC Syndromes: others Familial juvenile polyposis the Peutz-Jeghers syndrome (hamartomatous polyps) Both at increased risk for developing CRC. others
  16. 16. IBD CRC risk Duration > 8 years of active colitis Early age of onset Extent Presence of PSC. IBD CRC Risk
  17. 17. Algorithm for screening for CRC
  18. 18. Management  Surgery is the only hope for cure.  Carcinomas within 2 cm of the anal verge may require abdominoperineal resection & colostomy.  Postoperative colonoscopy after 6–12 months &periodically thereafter for local recurrence or new ‘metachronous’ lesions, occuring in 6% of cases.  Adjuvant radio-chemotherapy for rectal cancer.  Paliative chemo-radiotherapy or stenting for inoperable cases.
  19. 19. LOGO 2012
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