Colo Rectal Carcinoma

COLO RECTAL CARCINOMA


COLO RECTAL CARCINOMA

  • Colo rectal carcinoma is the carcinoma affecting caecum, colon & rectum.
  • It is the most common internal carcinoma in western world.
  • 1/3rd of tumour are in rectum & 2/3rd in colon.

Etiology-

  • Environmental factors
  • Diet rich in fat, meat & low in fibre.
  • Adenomatous polyps
  • Genetic factors
  • Inflammatory bowel disease
  • Surgical procedures- Ureterosigmoidostomy
  • Choleccystectomy

Pathology

  • Colo rectal carcinoma occurs- rectum (38%), sigmoid (21%), descending colon (4%), cancer of caecum (12%), ascending colon (5%)

Staging-

  • The most important prognostic factor of colorectal carcinoma is the ‘stage of disease’.

– The two most important prognostic factors-

  • Depth of invasion
  • Lymph node status

Clinical features-

Right colon tumors

  • Growth: fungative, ulcerative, polypoid or cauliflower like
  • Infiltration absent
  • Iron deficiency anemia due to chronic blood loss
  • Palpable mass in the RIF, which is not moving with respiration
  • Spurious (early morning) diarrhea

Left sided colon tumours

  • Growth: obstructive, annular lesions producing napkin ring constriction
  • Infiltration present
  • Rectal bleeding, Colicky pain
  • Altered bowel habits (alternating diarrhea and constipation)
  • Abdominal distension due to subacute/chronic obstruction
  • Tenesmus

Investigations

  • Barium enema: apple core lesion in left sided carcinoma
  • Colonoscopy and biopsy: is the investigation of choice
  • CEA: normal level <2.5ng/ml; >5ng/m1 significant
  • Low sensitivity(also ↑ in pancreatitis, hepatitis, obstructive jaundice, BPH)
  • Pre-op levels >7.5ng/ml indicates poor prognosis

Increase in CEA during follow up

  • Slow rise – loco regional disease
  • Rapid rise – metastasis

Treatment-

  • Bowel preparation is not safe for right sided colonic surgery. The method used is dietary restriction to fluids only for 48 hrs before surgery
  • Carcinoma of the caecum or ascending colon: right hemicolectomy
  • Carcinomas of the transverse colon and splenic flexure: extended right hemicolectomy
  • Carcinomas of descending and sigmoid colon: left hemicolectomy
  • Right sided tumors presenting as obstruction: right hemicolectomy
  • Left sided tumors presenting as obstruction
  • Hartmann’s procedure or resection and anastomosis

If facilities available an expanding metal stent followed by resection and anastamosis

  • The criteria for resection is < 3 lesions in one lobe of liver
  • Chemotherapy
  • 5-FU + (folinic acid)Leucovorin + Irinotecan(topoisomerase-1 inhibitor) improves survival in patients with metastatic disease(FOLFIRI regimen)
  • 5-FU + (folinic acid)Leucovorin + Oxiplatin(FOLFOX regimen) is equally effective

Exam Important

  • Colo rectal carcinoma is the carcinoma affecting caecum, colon & rectum.
  • Colo rectal carcinoma is the carcinoma affecting caecum, colon & rectum.
  • It is the most common internal carcinoma in western world.
  • 1/3rd of tumour are in rectum & 2/3rd in colon.

Etiology-

  • Environmental factors
  • Diet rich in fat, meat & low in fibre.
  • Adenomatous polyps
  • Genetic factors
  • Inflammatory bowel disease
  • Surgical procedures- Ureterosigmoidostomy
  • Choleccystectomy

Pathology

Staging-  

  • The most important prognostic factor of colorectal carcinoma is the ‘stage of disease’.

– The two most important prognostic factors-

  • Depth of invasion
  • Lymph node status

Investigations

  • Barium enema: apple core lesion in left sided carcinoma
  • Colonoscopy and biopsy: is the investigation of choice
Don’t Forget to Solve all the previous Year Question asked on COLO RECTAL CARCINOMA

Module Below Start Quiz

This site uses Akismet to reduce spam. Learn how your comment data is processed.

%d bloggers like this:
Malcare WordPress Security