Coloractal Cancer is the most common malignancy of the gastrointestinal system. In this presentation brief information about this cancer is supplied.
may useful for medical students
2. Most common malignancy of GI
Aging
Dominant
after age 50
Hereditary Risk Factors
20% with a family history
FAP, HNPCC
Environmental and Dietary Factors
Saturated or polyunsaturated fats
Inflammatory Bowel Disease
long-standing colitis
Other Risk Factors
Cigarette smoking, Ureterosigmoidostomy, Acromegaly,
Pelvic irradiation
Epidemiology and Risk Factors
4. Definition:
An autosomal dominant condition with numerous
polyps and increased risk of colorectal cancer
A known family history of FAP with even one
adenomatous polyp …or
Developing hundreds to thousands of adenomatous
polyps shortly after puberty (without a family history)
Familial Adenomatous Polyposis
5. 1% of all colorectal adenocarcinomas
mutation in the APC gene (5q)
75% of cases
25% without a family history
Lifetime risk of colorectal cancer 100% by age 50 years
Treatment is surgical
Most patients elect to have an ileal pouch–anal
anastomosis
FAP
6. fewer polyps (usually 10 to 100)
The right colon
Cancer risk 50%
APC mutation testing + in 60%
Screening by colonoscopy
Unknown family mutation
at age 13–15y, then every 4y to age 28y.
Treatment is surgical
Total abdominal colectomy with ileorectal anastomosis
Attenuated FAP
7. Definition:
An AD genetic condition
High risk of colorectal carcinoma at an early age
(average age: 40–45 years) & other cancers
More common than FAP
70% develop cancer
HNPCC (Lynch Syndrome)
8. Is based on family history
The Amsterdam criteria:
3 affected relatives (one must be a first-degree relative
of one of the others)
in 2 successive generations of a family
one patient diagnosed before age 50 years.
HNPCC
Diagnosis
9. Screening
Colonoscopy
annually
At age 20–25y / 10y younger than the youngest age at
diagnosis in the family.
Transvaginal ultrasound / Endometrial aspiration biopsy
Annually
age 25–35y
HNPCC
Cntd...
10. Total colectomy with ileorectal anastomosis
once adenomas or a colon carcinoma is diagnosed
prophylactic colectomy
prophylactic hysterectomy
bilateral salpingo-oophorectomy
women who have completed childbearing
HNPCC
Treatment
11. 10–15% of colorectal cancer
Risk of cancer increases with a family history.
Double with one first degree relative (12%)
35% with 2 first degree relatives
Screening Colonoscopy
every 5 y
at age 40y / 10y before the age of the earliest
Familial Colorectal Cancer
12. Nonspecific
a change in bowel habits
rectal bleeding
Abdominal pain
Bloating
Obstruction is more likely in Left-sided tumors
unexplained anemia
weight loss
Clinical Presentation
13. Tumor stage (T) Definition
T0 No evidence of cancer
Tis Carcinoma in situ
T1 Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades through muscularis
propria into subserosa or into
nonperitonealized pericolic or perirectal
tissues
T4 Tumor directly invades other organs or
tissues or perforates the visceral
peritoneum of specimen
Staging
14. Nodal stage (N) Definition
NX Regional lymph nodes cannot be
assessed
N0 No lymph node metastasis
N1 Metastasis to one to three pericolic or
perirectal lymph nodes
N2 Metastasis to four or more pericolic or
perirectal lymph nodes
N3 Metastasis to any lymph node along a
major named vascular trunk
Staging
Distant metastasis (M)
MX Presence of distant metastasis cannot
be assessed
M0 No distant metastasis
M1 Distant metastasis present
15. Staging & 5-year suvival
Stage TNM 5-Year Survival
I T1–2, N0, M0 70–95%
II T3–4, N0, M0 54–65%
III Tany, N1-3, M0 39–60%
IV Tany, Nany, M1 0–16%
16. Colonoscopy
Synchronous disease up to 5%
Chest and Abdominal/pelvic CT scan
distant metastases
Routine Blood tests and CEA
Endorectal ultrasound / Pelvic MRI
The ultrasound T and N stage of rectal cancer
Preoperative Evaluation
17. The objective is
remove the primary tumor with clean borders
And its lymphovascular supply
Chemotherapy
Stages III and IV
Stage II if
Young patient
Bad histology
Radiotherapy
Greatly used for rectal cancers
Treatment
18. Stage 0 (Tis, N0, M0)
Polipectomy with clean margins
Stage I: The malignant polyp (T1, N0, M0)
Polipectomy by endoscope (low risk of LN metastasis)
Segmental colectomy
Stages I and II: Localized colon carcinoma (T1–3, N0, M0)
The majority cured with surgical resection
Adjuvant chemotherapy
young patients
“high-risk” histologic
THERAPY FOR COLONIC CARCINOMA
19. Stage III: Lymph Node Metastasis (T any, N1, M0)
Surgery
adjuvant chemotherapy
Stage IV: Distant metastasis (T any, N any, M1)
metastases limited to the liver
Resection
adjuvant chemotherapy
The remainder
Palliative therapy
22. A full colonoscopy
within 12 months
If normal, every 3-5y
CEA
every 2–3 months for 2 years
If + CT scan
Transrectal sonography
Rectal Cancer
Every 4 months for 4 y
Follow-Up and Surveillance