Rectal Carcinoma
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- Colorectal carcinoma is more common in males than females and usually occurs after age 60. Risk factors include low fiber/high fat diets and hereditary conditions. - Tumors develop through a sequence of benign adenoma growth and progression to carcinoma. Genetic mutations in genes like APC and KRAS drive this progression. - Tumors most commonly occur in the rectum, sigmoid colon, and descending colon. They may cause bleeding, bowel habit changes, weight loss, and anemia. Staging uses Dukes' system from A to D depending on tumor depth and spread.
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Rectal Carcinoma
- 1. RECTUM
- 3. More than 60 yrs. Male : Female 2:1
- 4. Etiology Geographical variation North America North Europe A disease of developed countries
- 5. Diet Low vegetable intake Fatty diet Refined carbohydrates
- 6. Adenoma – carcinoma sequence Adenoma – hyperplasia – dysplasia Carcinoma in situ – invasive carcinoma
- 7. Familial polyposis coli – Number size type – Hereditary non polyposis coli
- 9. Genetic basis APC mutation – Beta catenin pathway Loss of APC (T supp. Gene) Loss of K-RAS gene Loss of P53 gene
- 10. Microsatellite instability pathway Multiple mutations
- 11. Morphology 60% - Rectum 25% - Sigmoid colon and descending colon 10% - Caecum and ileocaecal valve 5% - Ascending colon
- 12. Gross – Right side growth and Left side growth
- 13. Right side growth – Large cauliflower like soft friable Projecting in to the lumen
- 15. Left side growth – Encircle the bowel wall Napkin ring configuration
- 17. Microscopy Same for right and left side 95% - Adenocarcinoma Others – Undifferentiated , Adeno-squamous
- 19. Histological grades Well differentiated Moderately differentiated Poorly differentiated
- 20. Spread Direct spread – Circumferential and depth Lymphatic spread Hematogenous spread
- 21. Clinical features Bleeding Change in bowel habits (Lt) Weight loss Loss of appetite Anemia, weakness
- 22. Complications Obstruction And hemorrhage Perforation Sec. infection CEA – raised levels
- 23. Staging and Prognosis Dukes’ staging Stage A – T1N0M0 – Only mucosa Stage B1 – T2N0M0 – Submucosa Stage B2 – T3N0M0 – Muscularis and serosa Stage C1 – TxN1M0 – Muscularis and LN Stage C2 - same – Serosa and LN Stage D – TxNxM1 – Distant mets
- 25. Anal canal tumors Sqamous cell carcinoma Basaloid carcinoma Mucoepidermoid carcinoma Adenocarcinoma Undifferentiated Melanoma
- 26. THANKS