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Colon cancer final


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Colon cancer final

  2. 2. Learning Objectives  Overview Anatomy of colon Epidemiology Etiology Pathology Clinical features Investigation
  3. 3. Overview Colon cancer begins when abnormal cells within the colon start growing uncontrollably.  Symptoms may not occur initially, but as the disease progresses, a person may notice a change in their bowel habits or dark / bright red blood in their stools. There are several factors that increase a person's chance of developing colon cancer, some within a person's control (for example, being overweight and leading a sedentary lifestyle) and some not (for example, having an inflammatory bowel disease).
  4. 4. EPIDEMIOLOGY • Colon cancer is the third most common cancer in the United States, with around 100,000 new cases being diagnosed each year • The incidence of colon cancer varies between and within the countries suggesting environmental factors The ratio between male & female is almost equal It is common in western countries but rare in Asia & Africa The difference is among racial groups within different areas of the country suggesting genetic or cultural factors are important
  5. 5. ETIOLOGY • The exact cause/s of the colon cancer is unknown
  6. 6. Who's at Risk? Age Diet Polyps Personal Medical History Family Medical History Genetic factors Inflammatory bowel disease Irradiation
  7. 7. RISK FACTORS for Colon Cancer • Age – Colon cancer is more likely to occur as people get older. This disease is more common in people over the age of 50. – However, colon cancer can occur at younger ages, even, in rare cases, in the teens.
  8. 8. • Diet  Colon cancer seems to be associated with diet that is high in fat(animal fat), calories, and low in fiber. Increased fecal bile salt- Postcholecystectomy High anaerobic bacterial count in feces
  9. 9. Polyps • A polyp is a growth of tissue in the lining of an organ. • There are 2 main types of colon polyps:  Hyperplastic : Very small chance they’ll grow into cancer  Adenomatous : Most colon cancers start as adenomatous polyps (“adenomas”)
  10. 10. • Personal Medical History. Research shows that women with a history of cancer of ovary, uterus, or breast may have an increased chance of developing colon cancer. Also, a person who had colon cancer may develop this disease again. • Family Medical History. First-degree relatives (parents, siblings, children) of a person who had colon cancer are likely to develop this type of cancer themselves, especially if the relative had the cancer at a young age.  If many family members have had colon cancer, the chances increase even more.
  11. 11. Genetic factors: • Play very important role in Colonic cancer • The familial syndromes with increased risk of colon carcinoma includes: – Familial adenomatous polyposis – HNPCC » Lynch syndrome » Turcots syndrome » Peutz-jeghers syndrome
  12. 12. Hereditary Colon Cancer Syndromes: Familial adenomatous polyposis APC gene • Individuals develop thousands of adenomatous polyps in the colon Both copies of the APC gene must be lost for development of adenomas • Invariably, one or more of these polyps undergoes malignant transformation, giving rise to colon cancer
  13. 13. Non familial colon carcinomas and sporadic adenomas • Has homozygous loss of APC gene
  14. 14. Hereditary Colon Cancer Syndromes: HNPCC Hereditary non-polyposis colon cancer (HNPCC), sometimes called Lynch syndrome, Accounts for approximately 5% to 10% of all colon cancer cases The risk of colon cancer in families with HNPCC is 70% to 90%, which is several times the risk of the general population  Gene encoding the type II TGF-β receptor is inactivated in colon cancers that develop in patients with HNPCC
  15. 15. • Inflammatory bowel disease:  Ulcerative colitis: Patient with extensive colitis and for long duration are at high risk of developing colon cancer  Crohn’s disease : Is also associated with increased risk of cancer • Irradiation & immunosuppresion: Irradiation is well known carcinogenic, patient on immunosuppression drugs or disease are at increased risk of developing colon cancer
  16. 16. PATHOLOGY • Adenoma-carcinoma sequence – Between 70-90 % of colon cancer arise from adenomatous polyp. – the adenoma- carcinoma sequence is multi- step process involving sequential mutations or deletions of genes • The larger the polyp (more than 2cm in diameter) the greater the risk of cancer
  17. 17. Adenoma-carcinoma sequence
  18. 18. • Macroscopically: colon cancers may appear to the naked eye as:  Exophytic cauliflower-type of growth  Ulcerating lesion penetrating through the bowel wall  Annular constricting growth  or as the rare colloid mucus- secreting tumors
  19. 19. SYMPTOMS
  20. 20. SYMPTOMS Fatigue Persistent diarrhea or constipation & weight loss Abdominal cramps Dark & bright red blood in your stool Loss of appetite Anemia
  21. 21. These type of cancers have two general varieties BASED ON WHERE IN THE AFFECT YOUR WHOLE BODY COLON THE TUMOR IS LOCATED  Change in bowl habits (1) Unexpected weight loss a) Change in stool frequency/shape/color (2) Loss appetite b) Constipation and diarrhea (3) Unexplained fatigue LOCAL SYMPTOMS SYSTEMIC SYMPTOMS
  22. 22. RARE SYMPTOMS If colon cancer is not diagnosed until its advanced stages, it may cause one or more of these symptoms: Fever Air bubbles in urine Problem in breathing Headache and neurological problems Bone pain
  24. 24. MRI
  26. 26. Other medical conditions with the same symptoms  one or more of the symptoms like rectal bleeding or abdominal pain may also be reason for another medical problem  Examples of these conditions that may mimic that of colon cancer include: 1. Hemorrhoids 2. Appendicitis 3. Diverticulitis 4. Infectious Colitis
  27. 27. TREATMENT Surgery 1.Ploypectomy 2.Colectomy  Chemotherapy
  28. 28. REVIEW QUESTIONS 1. What biomarker mutation do 40% of colon cancer possess? 2. If a patient is diagnosed with colon cancer which part of the body would be effected first because of metastasis? 3. What genetic disorder are associated with colon cancer?
  29. 29. R.Q • A patient underwent colectomy and chemotherapy after 3 months of this cycle, she is now in remission, and when she met her doctor for the follow up she complained of fatigue and difficulty with concentration at weekly bridge games which of the following explanation could account of her symptoms?
  30. 30. A. Symptoms may be the result of anemia caused by chemotherapy B. The pt. may be dehydrated C. The pt. may be immunosuppressed A. The pt. may be depressed