COLORECTAL CANCER COLORECTAL CANCER n Incidence n n

COLORECTAL CANCER

COLORECTAL CANCER n Incidence n n n 2 nd after bronhopulmonary C in males and breast in females >65 ani M: F=1 -1, 5: 1

n n RISK FACTORS n Precancerous status Food habits Ulcerative colitis Excess of animal fat and colesterol Lack of fibers in food Excess of salt, spicy, smoked mea, alcohol, food additives n n n Heredity n n Some diseases with heredia=tary component – increased risk of cancer: n n Ulcerative colitis; Poliposis colli Adenomatous polips. There are families with increased incidence of colorectal cancer NPCC 15 times higher risk then rest of population Higher risk if: : n n Onset in childhood Longer then 19 years evolution Malignant degeneration ~3040 y much earlier then sporadic cancer Often multiple cancer – synchronous Adenomatous polypes – specially >2 cm FAP – certain cancer after 1520 y Crohn’s 10 y of evolution in patients with onset below 21 y

Pathology More often sigmoid colon – logic of sigmoidoscopy n Most often single tumors, but multiple synchronous or metachronous tumors are not unusual n

n MACROSCOPY n n a) exofitic –cauliflower like b) schirous n n c) coloide (mucinous): n n Major hyperplasie of fibroconjunctiv tissue Circular development – stenosis Fmore often left side Proiferation of mucinous cells; Soft, friable, bleeding Often right side, young patients d) ulceration

Pathology n Microscopy: n n adenocarcinoama: cylindric epithemlium Carcinoid tumors – very unusual; Epidermoid carcinoma– exceptional; Sarcoama

n a) direct: n n Spread pathways In the wall – serosa – ajacent organ In the surface: n n Along submucosal layer n b) lymphatic: n transperitoneal: Most often Intraperietal – local – regional lymph nodes n Colic veins – portal system – lver MTS Lombar and vertebral veins – pulmonary MTS Neoplastic cells get detached and reseaded (anastomotic recurrences). n e) n T 4 a – exposure to the serosa n n c) Vascular: n d) intraluminal: n circumferential; longitudinal: n n n Douglas pouch Omentum Peritoneal carcinomkatosis f) perineural: .

n n Stadiul 0 Stadiul III n Stadiul IV Tis T 1 T 2 T 3 T 4 any T Staging N 0 N 0 N 0 N 1 N 2, N 3 any N M 0 M 0 M 1 Dukes A B C

SYMPTOMS n Changes in bowel habit n n n Constipation Diarrhea !alternation of constipation with diarrhea) Dependent on location of the colon n n n From discomfort to colicky Aggressive peristalsis above the tumor n n n Borborism Meteorism Can suggest the location Location of pain: n n n RLQ – distension of cecum; Epigastric – often in transverse colon cancer; RUIQ lombar – may creat confusion n occult melenar; Hematochezia Other synptoms: n Pain n Bleeding ~ gastric problems ~ billiary symptoms ~ urinary syptoms General signs : n anorexia, weight loss, low fever

Clinical examination n Often negative n GENERAL; n general: n Palor, apathy, diminshed turgor n Cachexia – advanced stages n LOCAL n Nothing n Tumor n Ascitis n Hepatomegaly n Rectal/vaginal : n Sigmoid tumors falling in the pouch of n Carcinomatosis. Douglas;

n Non specific LAB Anaemia (microcytis, hypochromic) ; n Increased ESR n leucocitosis n Abnormal liver tests n n CEA Not for diagnostic purpose; n Only high values are significant for C colon, stomach, pancreas. Normal value do not have significance n More valuable for post therapy follow up n Occult blood test: screening ? ? ? n Colic cytology n

X-Ray n Corect dg in 90% n Plain X-Ray in complications n Barium enema n Wall rigidity n Filling defects. n Stenosis – golf trousers n Ulcerations

n Colonoscopy n n Biopsy Treatment

Echoendoscopy CT MRI US scan

Virtual CT colonoscopy

Evolution and complications 1. Obstruction: n Left colon and rectum n Incomplete obstruction to acut obstruction n Typical presentation 2. Perforation: a) extension through the wall; n b) diastatic: n c) juxtatumoral. n

3. Septical: n n Abscess formation; Peritonitis 4. Fistula: n n exterior – piostercoral fistula Other organ; 5. Volvulus 6. Invagination 7. Compression 8. Invazia organelor învecinate: 9. Anemia: 10. Metastasis

TREATMENT n Surgical: - tumor, lymph nodes, regiomal lymphnodes +/invadet organs n Radical – oncologic colectomy with regional

n Paliative: n 1. by pass: 2. diverting stoma 3. stents n n

n Tratament endoscopic