5. CASE DISCUSSION
• 22YRS OLD / F presented to the ER with
diffuse abdominal pain – 15 days. Features
suggestive of Intestinal Obstruction .
• CT Scan – large mixed density mass lesion in
RT adnexa infiltrating into adjacent portion of
sigmoid colon & rectum .
6. CASE DISCUSSION
• Laparotomy / segmental colostomy /
peritoneal biopsy was done .
Operative findings –
• large cystic lesion in pelvis with dense
adhesions .
• Hugely dilated large bowel obstructions .
• Entire peritoneal cavity is studded with
secondaries including the serosal aspect of
tranverse colon & sigmoid .
9. EPIDEMIOLOGY
- Incidence of colorectal cancer in India is 3.6 – 4.1 per
100,000
- Left sided tumors are more common
-Around 2/3
- ~ 25% of patients are < 40 years of age
- More proximal tumors
11. EPIDEMIOLOGY
- Incidence of CRC in India expected to rise by 80% by
2035
- 114,000 new cases with mortality ~ 87,000
- 25% of patients present with metastases
- 35% develop metastases after primary therapy
- k-ras mutation is around 40 %
-Similar to world-wide data
12. CRC > 55
INCIDENCE AND MORTALITY TRENDS
~1990s
2011
CRC 50 - 55
EAO CRC
Per
100,000
years
13.
14.
15.
16.
17. MAY BE ATTRIBUTED TO
BEHAVIOURAL FACTORS
Obesity
Western diet
Lack of physical activity
No screening
19. 1. Patients with resectable metastatic disease at presentation
2. Patients with unresectable disease at presentation that becomes
potentially resectable after downstaging (conversion) with systemic
therapy
3. Patients who have potentially resectable metastatic disease but
who are not candidates for resective surgery
4. Patients with unresectable metastatic disease
PATIENTS WITH METASTATIC DISEASE CAN BE
CLASSIFIED INTO 4 GROUPS:
20. Resection
Maximising OS, while maintaining QoL
Treatment
strategy
Treatment
goal
Curative
surgery
10%
Classification
Upfront
resectable
MOST PATIENTS WITH mCRC HAVE INITIALLY
UNRESECTABLE DISEASE AT FIRST PRESENTATION:
INCREASING OS IS THE PRIMARY TREATMENT GOAL
20–30% 60–70%
Potentially
resectable
Permanently
unresectable
CT +
biologic
CT +
biologic
Relapse
Initially unresectable
21. Current
patients
A
B
All patients receive
standard treatment (A)
Clinical trials survival benefit from A
Future
patients Molecular analysis
of tumor
A
B
C
D
Choice of treatment
dependent upon
molecular
profile of tumor and
patient genotype
A New Paradigm for Colorectal Cancer Clinical
Trials
22. COLON CANCER: MORE THAN 1 DISEASE
MSI vs MSS RAS WT vs
mutant
Right vs left vs
rectal
Young vs old
Stool flora typesBRAF WT vs
mutant
HER2
Molecular Anatomic
27. BIOFILM: A NEW CONCEPT OF TUMORIGENESIS
Biofilm may cause an increased
epithelial proliferation by
upregulation of the proinflammatory
IL-6 and
its downstream effector STAT3
Invasive polymicrobial bacterial
biofilms (bacterial aggregates
encased in a likely complex
matrix) predominantly (89%)
on right-sided tumors
Biofims associated with chronic
inflammation (e.g. CID)
Colon mucosal biofilm detection
may predict increased risk for
development of sporadic CRC
E-cadherin P-STAT3IL-6
