International incidence of colorectal cancer is high, making it the 3rd most common cancer in men and 2nd in women. Risk factors include age over 60, diet high in red/processed meats, family history, smoking, obesity, and certain medical conditions. Colorectal cancer develops from polyps that may bleed, cause bowel changes, or spread. Screening allows early detection and reduces mortality. Treatment involves surgery, chemotherapy, and radiotherapy depending on stage. Prevention focuses on screening, lifestyle changes like diet and exercise, and avoiding risk factors when possible.

2. Epidemology:
International > Colorectal Cancer (CRC) is the 3rd most common cancer in
men (663,000 cases, 10.0% of the total cancers) and the second in women
(570,000 cases, 9.4% of the total cases) worldwide.
India >
Males = 4.3/1,00,000
Females = 3.4/ 1,00,000
Race > Higher Incidence in African Americans
Sex > almost equal (ratio of 1.2:1)
Age > 55-65 years
Geographic > Countries which are more industrialized like U.S., Canada, UK,
Western Europe, Australia have a much higher incidence than less
industrialized parts of the world like Asia, Africa, and South America.

3. 3
Etiology / Risks
• Age > 60 Yrs
• Diet high in red or processed meats
• Ulcerative colitis or Crohn’s Disease
• Have a family history of colon cancer
• Other Cancers Breast, uterine, or ovarian cancer
• Familial Adenomatous Polyposis (FAP).
• Hereditary non-polyposis colorectal cancer (HNPCC) syndromes
• Smoking & Alcohol
• Obesity
• Drug effects: Recent studies have suggested that estrogen replacement
therapy and NSAID’s such as aspirin may reduce colorectal cancer risk.

4. How Does Colorectal Cancer Develop?

5. • Abdominal pain and tenderness in the lower abdomen
• Blood in the stool / Rectal bleeding
• Diarrhea, constipation, or other change in bowel habits
• Narrow stools / ribbon-like stools
• Weight loss with no known reason
• Unexplained, persistent nausea or vomiting
• Few present with – Intestinal Obstruction / Peritonitis in Emergency
• Iron-deficiency anemia,
• Change in bowel habits
• Right-sided lesions are more likely to bleed and cause diarrhea, while left-sided
tumors are usually detected later and could present with bowel obstruction.

6. Sites of Colon Cancer:

7. Tumors on Left Side of Colon
• Intestinal Obstruction
• Lower Abdominal Pain ( Colicky )
• Abdominal Distention
• Alternating Diarrhoea & Constipation
Sigmoid Tumors
Transverse Colon Tumors
• Tenesmus + Passage of Mucus & Blood
• Mistaken for Ca Stomach – Position , Anemia + Lassitude
Caecum & Ascending Colon Tumors
• Sever Anemia
• Mass in Rt. Iliac Fossa

10. Examination & Investigations
• Digital rectal exam
• Fecal occult blood test (FOBT)
• Sigmoidoscopy ( Flexible )
• Colonoscopy
• Radiology
– Double Contrast Barium Enema
– USG ( Liver Metastases )
– Spiral CT ( Elderly )
• Future Techniques
– Stool DNA Testing
– Capsule Endoscopy
– Virtual Colonoscopy
( CT Colonography )

12. Double-contrast Barium Enema

13. Differential Diagnoses
• Arteriovenous malformation (AVM)
• Carcinoid/Neuroendocrine Tumors and Rare Tumors of GI Tract
• Crohn’s Disease
• Diverticulosis, Small Intestinal
• Gastrointestinal Lymphoma
• Ileus
• Ischemic bowel
• Small Intestinal Carcinomas
• Ulcerative Colitis

14. Staging :
Dukes
TNM
Jass

15. Treatment :
1) Surgical

16. Ca Ceacum > Rt. Hemicolectomy Hepatic Flexure
Pelvic Colon

17. 2) Palliative Chemo ( In Advanced Stages )
• TS-inhibitors
– Raltitrexed
– Multitargeted Antifolat
• Oral 5-FU prodrugs
– Capecitabine
– UFT (Ftorafur + Uracil)
– S-1
– Emitefur
• New 5-FU modulators
– 5-Ethyniluracil
– Trimetrexate
• Other new compounds
– Irinotecan
– Oxaliplatin
Others :
• Bevacizumab (Avastin) anti-angiogenesis
drug ( humanized monoclonal antibody
to (VEGF)
• EGFR - Targeted monoclonal antibodies.
• Cetuximab (Erbitux)
• Panitumumab (Vectibix)

18. 3) Radiotherapy
• ( Stage III ) - Used in combination with chemotherapy
• ( Stage IV + Liver Spread ) –
• Ablation
• Delivering chemotherapy or radiation directly into the liver
• Cryotherapy
• Combined with Surgery

19. Prevention :
A ) Screening : ( Reduces Mortality Risk Upto 15% )
Testing options for the early detection of colorectal cancer and adenomatous polyps
for asymptomatic adults aged 50 > years
• Tests that detect adenomatous polyps and cancer
• Flexible sigmoidoscopy every 5 years, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every 5 years, or
• computed tomographic colonography every 5 years
• Colonoscopy in every 10 Years ( High Risk Individuals )
• Tests that primarily detect cancer
• Annual guaiac-based fecal occult blood test with high test sensitivity for cancer, or
• Annual fecal immunochemical test with high test sensitivity for cancer, or
• Stool DNA test with high sensitivity for cancer, interval uncertain

20. B ) Lifestyle Modification & Others
• Low-fat and high-fiber diets
• Avoid diet high in red or processed meats, or meats cooked at high
temperatures
• Eat a variety of fruits and vegetables every day.
• Engage in physical activity every day.
• NSAIDs
• Quit Smoking & Alcohol