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Colorectal Cancer Colorectal cancer - statistics Leading causes of cancer death in the US Male Female Lung – 31% Lung – 25% Prostate – 11% Breast – 11% Colorectal –10% Colorectal –11% Colorectal cancer - statistics Affects 150,000 new patients per year Accounts 60,000 deaths annually Peak incidence at 70-80 years Large Intestine - Colon Layers of the large intestine 1. 2. 3. 4. Mucosa Submucosa Muscularis externa Serosa Changes associated with aging a) Decreased secretory mechanisms; b) Decreased motility; c) Loss of strength and tone of the muscular tissue; d) Diminished response to pain and internal sensations Colon cancer Risk factors 1. Diet 2. Alcohol consumption 3. Smoking 4. Hypovitaminosis 5. Genetics 6. Obesity Colon Cancer Premalignant conditions and diagnoses: 1. Crohn’s disease 2. Non-specific ulcerative colitis 3. Polyps 4. Polyposis 5. Villous adenomas Classification of colon cancer I External grow II Infiltrative grow III Mixed grow Classification of colon cancer 1) 2) 3) 4) 5) adenocarcinoma mucous adenocarcinoma mucocellular carcinoma non-differentiated cancer non-classified cancer Classification of rectal cancer 1) 2) 3) 4) 5) 6) 7) adenocarcinoma mucous adenocarcinoma mucocellular carcinoma squamous cell carcinoma glandular-squamous cell carcinoma non-differentiated cancer non-classified cancer Classification of colorectal cancer TNM – system T1 - up to mucosa and submucosa T2 - up to muscular or serous layer T3 - outside of the bowel T4 – other organs are involved Classification of colorectal cancer TNM-system N1 – lesions in regional nodules N4 – lesions in other nodules M0, M1, MX G1, G2, G3, GX Classification of colon cancer Dukes system: Dukes A – tumor within the muscularis propria Dukes B – tumor invading the muscularis Dukes C – tumor with positive lymph nodes Dukes D - metastases Clinical features of colon cancer 1. 2. 3. 4. Vague abdominal pain Rectal bleeding Change in bowel habits Systemic syndromes a) weakness b) malaise c) fatigue Colorectal cancer I. Iron-deficiency anemia in an elderly male patient is colon cancer until proven otherwise II. Large bowel obstruction in all patients is colon cancer until proven otherwise Clinical forms of colon cancer 1. 2. 3. 4. 5. 6. Asymptomatic Toxic Enterocolitis -like Dyspepsia -like Pseudo inflammatory Obstructive Diagnostics of colon cancer 1. 2. 3. 4. 5. 6. 7. X-ray Colonoscopy Rectoscopy Sygmoscopy CEA –carcinoembryonic antigen CT MRI Treatment of colon cancer Left-sided hemicolectomy Right-sided hemicolectomy Excision of the colon Excision of the sigmoid colon Colostomy Treatment of rectal cancer Depends on the proximity to the anal verge Abdominoperineal resection (extirpation) Low anterior resection Wide local excision Sygmostomy Treatment of colorectal cancer 1. Management of colon cancer depends on lymph node status 2. Colon cancers are resected even if metastatic Screening Digital rectum examination Stool guaiac test Flexible sigmoidoscopy Colonoscopy