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Tumours of Large Intestine
Dr.C.P.Ganesh babu, M.S.,
Anatomic Location of CRC
• Cecum 14 %
• Ascending colon
10 %
• Transverse colon
12 %
• Descending colon 7
%
• Sigmoid colon 25 %
• Rectosigmoid junct.9 %
• Rectum 23 %
Symptoms associated with CRC
Colon cancers result from a series of pathologic changes that
transform normal epithelium into invasive carcinoma. Specific genetic
events, shown by vertical arrows, accompany this multistep process.
WHO Classification of CRC
• Adenocarcinoma in situ / severe dysplasia
• Adenocarcinoma
• Mucinous (colloid) adenocarcinoma (>50%
mucinous)
• Signet ring cell carcinoma (>50% signet ring
cells)
• Squamous cell (epidermoid) carcinoma
• Adenosquamous carcinoma
• Small-cell (oat cell) carcinoma
• Medullary carcinoma
• Undifferentiated Carcinoma
Risk factors for CRC
• Age
• Adenomas, Polyps
• Sedentary lifestyle, Diet, Obesity
• Family History of CRC
• Inflammatory Bowel Disease (IBD)
• Hereditary Syndromes (familial adenomatous
polyposis (FAP))
Dietary factors implicated in
colorectal carcinogenesis
Increased risk
• consumption of red
meat
• animal and saturated
fat
• refined carbohydrates
• alcohol
Dietary factors implicated in
colorectal carcinogenesis
Decreased risk
• dietary fiber
• vegetables
• fruits
• antioxidant vitamins
• calcium
• folate (B Vitamin)
Specimen containing an invasive colorectal carcinoma and two
adenomatous polyps.
Multiple adenomatous polyps of the cecum are seen here in a case of
familial polyposis.
Familial polyposis in which mucosal surface of the colon is a carpet of
small adenomatous polyps. Even though they are small , there is a 100%
risk over time for development of adenocarcinoma, for which total
colectomy is recommended
Adenocarcinoma of the cecum demonstrates an exophytic growth
pattern.
Staging of CRC
• TNM system
• Primary tumor (T)
• Regional lymph nodes (N)
• Distant metastasis (M)
*Note: Tis includes cancer cells confined within the glandular basement
membrane (intraepithelial) or lamina propria (intramucosal) with no
extension through the muscularis mucosae into the submucosa.
**Note: Direct invasion in T4 includes invasion of other segments of the
colorectum by way of the serosa; for example, invasion of the sigmoid colon
by a carcinoma of the cecum.
Dukes staging system
A Mucosa 80%
B Into or through M. propria 50%
C1 Into M. propria, + LN ! 40%
C2 Through M. propria, + LN! 12%
D distant metastatic spread <5%
Sites of metastasis
Liver
Lung
Brain
Bone
Via blood
Lymph nodes
Abdominal wall
Nerves
Vessels
Via lymphatics Per continuitatem
Diagnosis
• Colonoscopy is the preferred diagnostic test for
colorectal cancer
• Barium enema and fl exible sigmoidoscopy.
• Biopsy of suspicious lesions is required to establish
a diagnosis.
• Tumor markers such as carcinoembryonic antigen
(cea) or carbohydrate antigen (ca).
• Radiologic studies are used to evaluate the extent of
local disease and to screen for metastatic disease.
Therapy
• Surgical resection the only curative treatment
• Likelihood of cure is greater when disease is
detected at an early stage
• Early detection and screening is of pivotal
importance
Tumours of large intestine

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Tumours of large intestine

  • 1. Tumours of Large Intestine Dr.C.P.Ganesh babu, M.S.,
  • 2. Anatomic Location of CRC • Cecum 14 % • Ascending colon 10 % • Transverse colon 12 % • Descending colon 7 % • Sigmoid colon 25 % • Rectosigmoid junct.9 % • Rectum 23 %
  • 4. Colon cancers result from a series of pathologic changes that transform normal epithelium into invasive carcinoma. Specific genetic events, shown by vertical arrows, accompany this multistep process.
  • 5. WHO Classification of CRC • Adenocarcinoma in situ / severe dysplasia • Adenocarcinoma • Mucinous (colloid) adenocarcinoma (>50% mucinous) • Signet ring cell carcinoma (>50% signet ring cells) • Squamous cell (epidermoid) carcinoma • Adenosquamous carcinoma • Small-cell (oat cell) carcinoma • Medullary carcinoma • Undifferentiated Carcinoma
  • 6. Risk factors for CRC • Age • Adenomas, Polyps • Sedentary lifestyle, Diet, Obesity • Family History of CRC • Inflammatory Bowel Disease (IBD) • Hereditary Syndromes (familial adenomatous polyposis (FAP))
  • 7. Dietary factors implicated in colorectal carcinogenesis Increased risk • consumption of red meat • animal and saturated fat • refined carbohydrates • alcohol
  • 8. Dietary factors implicated in colorectal carcinogenesis Decreased risk • dietary fiber • vegetables • fruits • antioxidant vitamins • calcium • folate (B Vitamin)
  • 9. Specimen containing an invasive colorectal carcinoma and two adenomatous polyps.
  • 10. Multiple adenomatous polyps of the cecum are seen here in a case of familial polyposis.
  • 11. Familial polyposis in which mucosal surface of the colon is a carpet of small adenomatous polyps. Even though they are small , there is a 100% risk over time for development of adenocarcinoma, for which total colectomy is recommended
  • 12. Adenocarcinoma of the cecum demonstrates an exophytic growth pattern.
  • 13. Staging of CRC • TNM system • Primary tumor (T) • Regional lymph nodes (N) • Distant metastasis (M) *Note: Tis includes cancer cells confined within the glandular basement membrane (intraepithelial) or lamina propria (intramucosal) with no extension through the muscularis mucosae into the submucosa. **Note: Direct invasion in T4 includes invasion of other segments of the colorectum by way of the serosa; for example, invasion of the sigmoid colon by a carcinoma of the cecum.
  • 14. Dukes staging system A Mucosa 80% B Into or through M. propria 50% C1 Into M. propria, + LN ! 40% C2 Through M. propria, + LN! 12% D distant metastatic spread <5%
  • 15. Sites of metastasis Liver Lung Brain Bone Via blood Lymph nodes Abdominal wall Nerves Vessels Via lymphatics Per continuitatem
  • 16. Diagnosis • Colonoscopy is the preferred diagnostic test for colorectal cancer • Barium enema and fl exible sigmoidoscopy. • Biopsy of suspicious lesions is required to establish a diagnosis. • Tumor markers such as carcinoembryonic antigen (cea) or carbohydrate antigen (ca). • Radiologic studies are used to evaluate the extent of local disease and to screen for metastatic disease.
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  • 21. Therapy • Surgical resection the only curative treatment • Likelihood of cure is greater when disease is detected at an early stage • Early detection and screening is of pivotal importance