Tag: Colo Rectal Carcinoma

Colo Rectal Carcinoma

COLO RECTAL CARCINOMA

Q. 1

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

Q. 1

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

Ans. B

Explanation:

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.

Distance from the dentate line is not given among the option so distance from the anal verge is answer of choice here as dentate line is just 2cms from the anal verge.
 
Ref: Devita’s Oncology 8/e, Chapter 39, section 13; CSDT 13/e, Page 664; Schwartz 9/e, Page 1028; Sabiston 18/e, Page 1413.

Q. 2

Single most important prognostic indicator of colorectal carcinoma is –

 A

CEA titres

 B

Degree of atypia

 C

Size of tumor

 D

Extent of tumour

Q. 2

Single most important prognostic indicator of colorectal carcinoma is –

 A

CEA titres

 B

Degree of atypia

 C

Size of tumor

 D

Extent of tumour

Ans. D

Explanation:

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.


Q. 3

Most important prognostic factor for colorectal carcinoma is

 A

Site of lesion

 B

Tumour size & characteristics

 C

Age of patient

 D

Lymph node status

Q. 3

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. D

Explanation:

Ans is d i.e. Lymph node status 

“The number of positive nodes appeared to be the single most important prognostic factor.”-DeVita

Quiz In Between


Q. 4

The best investigation for colorectal carcinoma –

 A

Exfoliative cytology

 B

Air contrast barium enema

 C

Ultrasound

 D

Colonoscopy and biopsy

Q. 4

The best investigation for colorectal carcinoma –

 A

Exfoliative cytology

 B

Air contrast barium enema

 C

Ultrasound

 D

Colonoscopy and biopsy

Ans. D

Explanation:

Ans. is ‘d’ i.e., Colonscopy and biopsy 


Q. 5

Most important prognostic factor for colorectal carcinoma is :

 A

Site of lesion

 B

Stage of lesion

 C

Age of patient

 D

Lymph node status

Q. 5

Most important prognostic factor for colorectal carcinoma is :

 A

Site of lesion

 B

Stage of lesion

 C

Age of patient

 D

Lymph node status

Ans. B

Explanation:

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


Quiz In Between



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
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