COLO RECTAL CARCINOMA
| A | Age of the patient | |
| B |
Distance from anal verge |
|
| C |
Fixity of the tumour |
|
| D |
Extent of tumour |
Abdominoperineal resection is done in colorectal carcinoma on the basis of:
| A |
Age of the patient |
|
| B |
Distance from anal verge |
|
| C |
Fixity of the tumour |
|
| D |
Extent of tumour |
In the treatment of rectal cancer, distance of the tumor from the Dentate line is taken into consideration.
LAR is done when tumor is situated 2cms from the dentate line so that 2cms of normal tissue can be resected below the dentate line.
If 2cms of normal tissue cannot be resected below the tumor (but above the dentate line), APR procedure is done.
| A |
CEA titres |
|
| B |
Degree of atypia |
|
| C |
Size of tumor |
|
| D |
Extent of tumour |
Ans. is ‘d’ i.e., Extent of tumor
The single most important prognostic indicator of colorectal carcinoma is the extent of the tumor at the time of diagnosis, the so-called stage.
Most important prognostic factor for colorectal carcinoma is
| A | Site of lesion | |
| B |
Tumour size & characteristics |
|
| C |
Age of patient |
|
| D |
Lymph node status |
Ans is d i.e. Lymph node status
“The number of positive nodes appeared to be the single most important prognostic factor.”-DeVita
The best investigation for colorectal carcinoma –
| A |
Exfoliative cytology |
|
| B |
Air contrast barium enema |
|
| C |
Ultrasound |
|
| D |
Colonoscopy and biopsy |
Ans. is ‘d’ i.e., Colonoscopy and biopsy
- Colonoscopy has been shown to be superior to double-contrast barium enema and also to have a higher sensitivity for detecting villous or dysplastic adenomas or cancers than the strategy employing occult fecal blood testing and flexible sigmoidoscopy.
- A double-contrast barium enema is done when colonoscopy is contraindicated
- Colonoscopy has for many years been regarded as the reference standard for diagnosing colonic pathology.
- Colonoscopy is known to have high sensitivity and specificity for the detection of cancer, pre-malignant adenomas, and other symptomatic colonic diseases.
- If a lesion suspicious of cancer is detected on CT colonography, offer a colonoscopy with biopsy to confirm the diagnosis.
| A |
Site of lesion |
|
| B |
Stage of lesion |
|
| C |
Age of patient |
|
| D |
Lymph node status |
Answer is B (Stage of lesion)
The most important prognostic factor of colorectal carcinoma is the ‘stage of disease’..
The ‘stage of disease’ gives information related to depth of penetration into bowel wall and extent of regional lymph node spread, both of which are the two most important independent prognostic. factors.
Most important prognostic factors
‘Extent of Regional Lymph node spread’ and ‘Depth of tumor invasion’ are the most important determinants of prognosis
Single most important prognostic
Stage of diseaseQ
Stage of disease gives information on both the depth of tumor penetration into the bowel wall and the extent of regional lymph node involvement
`Stage’ of disease is a superior prognostic factor in comparison to Lymph node status alone
Single most important independent prognostic factor is the Lymph nodal status or the number of positive nodes
Single most important independent prognostic factor
Lymph node status°
Pathologic. Molecular and Clinical Features that May Affect Prognosis in Patients with Colorectal Cancer:
|
Feature of Marker |
Effect of prognosis |
|
Pathologic |
|
|
• Surgical-pathologic stage |
|
|
Depth of bowel wall penetration |
Increased penetration diminishes prognosis |
|
Number of regional nodes involved by tumor |
1-4 nodes is better than > 4 nodes |
|
• Tumor morphology histology |
|
|
Degree of differentiation |
Well-differentiated is better than poorly differentiated |
|
Mucinous (colloid) or signet ring cell histology |
Diminishes prognosis |
|
Scirrhous histology |
Diminishes prognosis |
|
• Venous invasion |
Diminishes prognosis |
|
• Lymphatic invasion |
Diminishes prognosis |
|
.. • Perineural invasio |
Diminishes prognosis |
|
• Local inflammation and immunologic reaction |
Improved prognosis |
|
• Tumor morphology |
Polypoid/exophytic is better than ulcerating/infiltrating |
|
• Tumor DNA content |
Increased DNA content (aneuploidy) diminishes prognosis |
|
• Tumor size |
No effect in most studies |
|
Molecular |
|
|
• Loss of heterozygosity at chromosome 18q (DCC, DPC4) |
Diminishes prognosis |
|
• Loss of heterozygosity at chromosome 17q (p53) |
Diminishes prognosis |
|
• Loss of heterozygosity at chromosome 8p . |
Diminishes prognosis |
|
• Increased labeling index for p21WAFICIPI protein |
Improved prognosis |
|
• Microsatellite instability |
Improved prognosis |
|
• Mutation in BAX gene |
Diminishes prognosis |
|
Clinical |
|
|
• Diagnosis in asymptomatic patients |
Possibly improved prognosis |
|
• Duration of symptoms |
No demonstrated effect |
|
• Rectal bleeding as a presenting symptom |
Improved prognosis |
|
• Bowel obstruction |
Diminishes prognosis |
|
• Bowel perforation |
Diminishes prognosis |
|
• Tumor location |
May be better for colon than for rectum |
|
|
May be better for left colon than for right colon tumors |
|
• Age < 30 yr |
Diminished prognosis |
|
• Preoperative CEA |
Diminished prognosis with a high CEA level |
|
• Distant metastases |
Markedly diminished prognosis |
